Implanted port

Overview

Implanted ports are used by healthcare providers to administer IV treatments and blood transfusions directly into a vein, while assisting blood draws to have an easy access. Patients with conditions such as cancer, severe infections, kidney failure, or inflammatory bowel disease (IBD) may require these devices. With an implanted port, the number of needle sticks needed for treatments like chemotherapy is significantly reduced.

These ports simplify vein access for those frequently undergoing IV treatments or blood draws. Typically, the port is a disc-shaped device, about the size of a quarter, and is placed beneath the skin in areas such as the chest, arm, or abdomen, often remaining barely visible. When it is no longer necessary, a healthcare provider can easily remove it.

An implanted port consists of two main components:

• Septum: This soft silicone top serves as the access point for veins, allowing specialized needles to be inserted for treatments or blood draws.
• Catheter: A thin, flexible tube that connects the port directly to a vein, linking it to the circulatory system.

Types

There are several types of implanted ports, including:

• Single lumen: This port features a single access point (septum) and is the most common variety.
• Double lumen: Shaped like a triangle, this port has two access points, which is beneficial for patients needing multiple medications simultaneously.
• Power-injectable: Many single- and double-lumen ports are designed to be power-injectable, allowing healthcare providers to inject contrast dyes for imaging scans such as CT scans and MRIs.

Reasons for undergoing the procedure

Implanted ports can be beneficial for both adults and children, serving anyone in need of frequent or long-term IV treatments, blood transfusions, or blood draws. A healthcare provider may suggest a port for individuals who have:

• Cancer requiring chemotherapy, IV fluids, or frequent blood draws.
• Infections necessitating long-term IV antibiotics.
• Parenteral (IV) nutrition for inflammatory bowel disease (IBD). 
• Kidney failure needing dialysis.

Risk

Approximately one in three individuals may experience complications with implanted ports, with infections being the most common issue. Any infection can increase the risk of a serious, potentially life-threatening condition known as sepsis.

Other possible risks include:

• Blood clots that developed in the catheter or vein
• Catheter tip dislodged
• Collapsed lung (pneumothorax)
• Cracked port
• Embolism (air bubble in a blood vessel)
• Hemothorax (blood accumulation in the pleural cavity between the chest wall and lungs)
• Port or catheter blockage

Before the procedure

Before receiving an implanted port, you may need to:

• Undergo blood tests to assess kidney function and blood clotting.
• Provide your healthcare provider with a list of all medications and supplements you are taking.
• Discontinue blood-thinning medications, such as aspirin.
• Fast (avoid eating or drinking) for a specified period prior to the procedure.

During the procedure

Implanting a port is an outpatient procedure that usually takes around an hour, enabling you to go home the same day. However, you will need someone to drive you. Typically, ports are implanted under the skin on the right side of the chest, but they can also be positioned on the inner side of the upper arm or in the abdominal area below the ribcage.

You will receive anesthesia to induce a light sleep, making you conscious but unable to remember the procedure. Local anesthesia will numb the surgical site, while children may be given general anesthesia for deeper sedation.

The procedure to place a port involves several key steps:

• Utilizing continuous X-ray imaging (fluoroscopy) for guidance throughout the procedure.
• Making a small incision in the neck to access a vein, usually the superior vena cava, jugular vein, or subclavian vein.
• Establishing an access point in the vein.
• Creating another small incision in the chest, arm, or abdomen for port insertion.
• Forming a pouch beneath the subcutaneous layer of skin to hold the port.
• Positioning the port within this pouch.
• Threading the catheter from the port to the vein.
• Connecting the catheter to the vein through the incision in the neck.
• Conducting a chest X-ray to confirm the proper placement of the device.
• Closing the incisions with stitches that will dissolve over time.

You may visit your healthcare provider’s office for treatments, while they can instruct you on how to administer certain treatments at home using the port for your child. Blood draws and transfusions, however, will take place in a healthcare facility.

To administer IV treatments, you or a healthcare provider will:

• If necessary, applying an anesthetic cream to numb the skin over the port, as the skin can thicken over time, making it less sensitive to needle insertion.
• Clean the area with an antiseptic to ensure sterility.
• Cover the skin over the port with a sterile dressing to reduce the risk of infection.
• Insert a thin needle into the septum (the silicone top of the port).
• Administer the medication or draw blood, then gently withdraw the needle.
• Use a different needle to flush the device with a solution to help prevent blood clots.
• Carefully remove the needle and cover the site with a transparent bandage, allowing you to observe for any signs of infection, such as redness or streaks.

After the procedure

Implanted ports may cause a slight bulge under the skin where they are placed. To alleviate any discomfort after the procedure, nonsteroidal anti-inflammatory drugs (NSAIDs) can be effective. Once the incision has healed, the port and its rubber cap will not be visible.

It’s important to keep a bandage over the incision site. After the area heals, you shouldn’t experience any discomfort, but it’s advisable to avoid lifting heavy objects or engaging in strenuous activities until your healthcare provider gives you the green light.

Designed for longevity, implanted ports can withstand up to 2,000 needle insertions before they need replacement. Depending on your treatment plan, the port may only be necessary for a few weeks or months.

Outcome

An implanted port provides numerous advantages, including:

• The ability to receive at-home treatments such as chemotherapy or dialysis.
• Fewer needle sticks overall.
• The option to administer multiple medications simultaneously (with a double-lumen port).
• The convenience of undergoing multiple blood tests and treatments in a single day with just one needle insertion.
• The capability for prolonged treatments, such as administering strong antibiotics over several days.

Additionally, the port minimizes the risk of:

• Pain, bruising, bleeding, and infections.
• IV fluid leaks from a vein into surrounding tissues.
• Damage to veins, such as from powerful chemotherapy, or ruptures.

Once the incision site has healed, you can return to most activities. However, it’s advisable to consult your healthcare provider before engaging in contact sports like football or any high-impact activities.

Removing the port is generally quicker than the initial placement and usually does not require anesthesia. If you experience any pain afterward, you may want to take NSAIDs for relief.

During the removal process, your healthcare provider will:

• Apply a numbing cream to the skin.
• Make a small incision at the port site.
• Gently pull on the catheter to detach it from the vein.
• Remove both the port and catheter through the incision.
• Your healthcare provider will use dissolvable stitches to close the incision.

The skin over the port requires no special care. If you’re not undergoing regular treatments, you or your healthcare provider should flush the port and catheter once a month. This flushing helps reduce the risk of clots and blockages, ensuring the line remains open for future use.

You should contact your healthcare provider if you notice any of the following symptoms:

• Fluid or bleeding near the port site
• Lightheadedness or fainting
• Shortness of breath
• Infection indication at the port site, such as fever, redness, edema, or warmth
• An increase in size in the arm on the port side