Portacath insertion and removal

A portacath (Port) is an implanted device giving access to veins for patients who need regular long-term administration of antibiotics or chemotherapy drugs. Chemotherapy drugs can be toxic and often need to be delivered into a large central vein where the drugs are instantly diluted by the blood stream and distributed efficiently to the entire body.

For patients with difficult veins, ports can also be used for withdrawing blood for blood tests.

What is a portacath?

PORT 1A portacath system consists of two parts, the port (reservoir) and the catheter (tube).

The port which is a small rounded device made of titanium metal is implanted under the skin in the upper chest area. It has one chamber covered by a plastic membrane through which a needle can be inserted to deliver medication or take out blood.

The tube which is connected to the port runs in the tunnel under the skin going over collar bone then enters the large vein in the neck with its end lying in right side of the heart.

The plastic membrane is made up of self sealing plastic rubber; hence it can be punctured numerous times.

The portacath can be left in place for several years. If this is the case, your oncology practice will arrange for monthly flushes of heparinised saline into the port, so that the port doesn’t become blocked.

The port has no electrical components and therefore can be used in any environment. It only has a small amount of metal and does not usually set off alarms at airports, but you may wish to carry a card with you explaining that you have this device in place.

When the time comes for removal of the portacath, this is usually a simpler procedure than its insertion. It is removed under local anaesthetic as a day case/outpatient procedure.

Why do I need a portacath?

Your treatment may require frequent access of the venous system. Toxic drugs, for example chemotherapy drugs, can damage small veins and frequent access can be painful. Having access to large veins makes your therapy safe and more comfortable.

How is a portacath inserted?

The portacath insertion is carried out in an angiography suite at Intra Epsom or North Harbour. Your Interventional Radiologist will be assisted by nurses and other highly trained staff.

  • You will be given sedation to make you feel relaxed and sleepy but you will be still aware during the procedure. The procedure is done using local anaesthesia at the insertion site.
  • The skin over the front of the chest and the side of the neck are cleaned well with disinfectant swabs.
  • Local anaesthetic is administered to the skin over the chest site.
  • Ports are usually placed on the chest wall. An incision of approximately 3cm is made in skin on the front of the chest and a “pocket” is created under the skin for the port.
  • Local anaesthetic is administered to the side of the neck and using ultrasound guidance, access is gained to the vein in the neck, via a small (5mm) incision.
  • The tube (catheter) is then fed through the vein until the tip of the catheter is sitting in one of the large veins in your chest.
  • A small tunnel is made in the skin for the tube to pass through and the other end is connected to the port.
  • Correct positioning of the catheter is confirmed by fluoroscopy (using x-ray).
  • The incisions under the collar bone and the side of the neck closed with dissolvable sutures (stitches) and a small sterile dressing is put in place.

Following the procedure in the angiosuite, you will spend 1 - 2 hours in recovery in a recliner chair at Intra, following which you will discharged if everything is normal.

At Intra all ports are compatible with having an injection for CT scans (‘Powerport’). The port must be accessed with a powerloc® needle for administration of CT contrast (dye). You will be given a wallet card describing the port to carry with you to all medical appointments.

What will I experience during the procedure?

  • An intravenous catheter (IV line) for the administration of fluids and medication will be inserted into a vein on the back of your hand or in your arm.
  • You will feel a slight pin prick when the needle is inserted into your vein for the intravenous line (IV) and when the local anaesthetic is administered to the chest wall and neck.
  • Devices to monitor your heart rate and blood pressure will be attached to your body.
  • You will be given sedation and pain relief through your IV to make you feel relaxed.
  • You may feel slight pressure when the device and catheter are inserted, but no significant discomfort.
  • As the contrast material passes through your body, you may get a warm feeling.

While you are at Intra your pain will be well-controlled with medication infused through your IV line.

How should I prepare for the procedure?

  • Fasting: You will likely be instructed not to eat anything  30-60 minutes before your procedure. You are encouraged to continue to drink clear fluids up to your admission time.Your doctor will tell you which medications you may take in the morning.
  • Allergies or previous reactions to contrast (x-ray dye): Please inform Intra staff at the time of booking your procedure if you have any known history of allergies, particularly allergies to x-ray contrast and seafood.
  • Diabetes: If you are a diabetic you should inform your doctor at the time of booking. You may need to discuss your insulin dose with your Interventional Radiologist.
  • Medications: Please inform your doctor about all the medication you are taking. You doctor may advise you to stop taking some medications temporarily few days prior to your procedure e.g. blood thinners such as Warfarin and Clexane.

 Please bring with you any medication and any recent blood test results or chest x-rays.

You may bring your favourite music on iPod or smart phone as this can be played during the procedure. You are also encouraged to bring a friend or family member.

On the day of your procedure, please make your way to the Intra reception at our Epsom or North Harbour faciliities.

What happens after the procedure?

  • The area around the port may be swollen and tender following insertion. If the port is to be used the same day it is inserted the interventional radiologist will leave a needle in the port.
  • When the anaesthetic wears off, you may feel some discomfort at the site of the incision and therefore you may require some simple pain relief such as paracetamol.
  • The portacath system requires no daily care from you.
  • You will be given some extra waterproof dressing and instructions on when and how to change you dressing if required. This can also be done by your oncology nurse after your chemotherapy treatment until your incission site has healed.
  • If left unused the port needs to be flushed with heparinised saline once a month to prevent it from getting blocked. Your oncology nurse will organise this.
  • You may shower 24 hours after the portacath has been inserted with the waterproof dressing in place, but if the dressing gets damp it will need to be changed for a dry one. You may have a bath after 2 weeks.
  • Once the wound is healed (usually within 10-14 days) no dressing will be required.
  • It is recommended that you do not perform any strenuous exercises or do any heavy lifting for 10 -14 days following the procedure. However, regular walking is encouraged.
  • Once the port is no longer required, your oncologist will refer you back to us for removal. The removal process will be similar to insertion, performed under local anaesthetic and sedation.

What are the risks?

  • Given the use of modern guidance technology (x-ray and ultrasound), the risks are minimal.
  • There is a slight risk of wound infection, bleeding and / or vessel injury
  • There is also the remote chance of allergy to medications used during the procedure.

You should contact your doctor or oncology nurse immediately if you have any of the following:

  • Chest pain
  • Pain, swelling, redness or drainage of pus around the port site or incisions
  • Swelling of the neck, face or arm on the side where the port is inserted
  • Shortness of breath or dizziness