Port-a-caths are surgically inserted under the skin of the chest or upper arm to allows easy IV access.
They consist of a catheter and a portal, and because they are completely enclosed within the skin, they are accessed using a non-coring needle. They come with single or multiple-lumens, each of with has its own port.
Port-a-caths are positioned by a surgeon or radiologist using either conscious sedation or anaesthesia. Clinical nurse specialists can insert and remove CVCs, or access a port-a-cath after completion of a relevant theory and practice course.
It is important check if patients are taking anticoagulants such as warfarin and rivaroxaban, or antiplatelets such as aspirin and clopidogrel because these may need adjusting or stopping temporarily before the procedure.
A port-a-cath is not visible, but it can be felt as a slight bump where the port is inserted. Patients prefer port-a-caths because:
- They are more discreet than tunnelled CVCs
- Patients can shower, bathe or swim with a port-a-cath in place
Port-a-caths have fewer complications than other types of CVCs and increase patients’ quality of life.
Port-a-caths require minimal maintenance once the skin has healed, apart from being flushed out every 4 weeks. This is normally performed by the healthcare team in patients who are treated more frequently than every 4 weeks. For patients with less frequent appointments, an attending nurse or doctor can flush out the port-a-cath.
Patients can return home with their port-a-caths in place. It is therefore important for them to be able to recognise complications and when to contact the primary health care team.
Port-a-caths require less maintenance and have a lower risk of infection. They are recommended for patients who require long-term, frequent and intermittent venous access, but are not suitable for:
- Obese patients
- Patients with extreme weight loss and muscle wasting
- At mastectomy sites
- Before or after chest irradiation.
Complications with port-a-caths include clots, blockages and infections. Symptoms associated with these complications may be:
- Red, warm, swollen, painful or bruised area around the port-a-cath site
- Presence of considerable bleeding
- Fever, shortness of breath or dizziness
- Leakage of fluid
- Blockage
Port-a-caths are widely used in cancer patients requiring long-term or irritant chemotherapy, patients with chronic illnesses, and patients having a haematopoietic stem cell transplant (HSCT) who require long-term chemotherapy as part of a conditioning regimen.
