Port-a-cath, an implantable port or an implantable venous access system, is one of the various types of central venous catheters that is used by patients in long-term treatments or for administering fluids and medicines. Common locations are either on the chest or on arm. The Port-a-cath is advised by a doctor for many reasons;
- Frequent administration of fluids or medications for long-term
- For chemotherapy in cancer patients
- Obtaining blood samples
- Delivering TPN
- Delivering coagulation factors in patients with hemophilia
- For administering contrast agents
- For administering analgesics to patient with chronic pain
A port-a-cath is made up of three parts, portal, catheter and a catheter connector. Let us discuss one by one the role of each of these parts.
Portal- is the reservoir compartment or a small chamber that is sealed at the top with a septum. Portal is made of silicone. The septum can be punctured many times with a needle before it becomes weak. Every time fluid needs to be administered or blood drawn, this port is located.
Catheter– is a flexible tube that runs from the portal and is inserted into the vein surgically. Catheter is made of silicone and . Catheter terminates in superior vena cava.
Connector– is basically a catheter connector that connects catheter to the portal. This could be made of titanium, titanium and plastic or entirely plastic.
Placement And Removal Of Port-a-cath
The placement of port-a-cath involves a small surgical procedure, which lets us place the catheter completely inside the body. This is performed under the effect of a local anesthetic using imaging guidance (X-ray or ultrasound). A skin incision as long as 3cm is given on the chest wall for the port and another is given on the neck. The neck incision is of 5mm and does not require to be sutured, instead it is closed with a surgical tape.
Likewise, removal of this implantable venous catheter requires a small incision so that it can be removed gently from neck and chest. This might require local anesthesia.
This type of implantable venous access catheter requires minimal care as compared to other catheters, since it is completely under the skin. However, there are still a few guidelines that patient has to follow when it comes to port-a-cath.
Cleaning the site- A dressing covers the needle (if placed) and the portal site so that both the things are secured in their place. It is very important to keep the dressing dry and clean. You will have to check regularly for any redness, swelling, bruising or tenderness. If any of these signs are present, then contact your clinician immediately.
Flushing- This is another very important instruction that you have to abide by, in order to prevent clot formation in the catheter. Implanted port has to be flushed with heparin solution after an infusion, injection or every four weeks. This is called heparin lock. In case of double ports, both the lumens need to be flushed.
Restricting Activities- While it’s understood that vigorous activities need to be avoided, it is best to consult your doctor before resuming the normal routine. Activities like swimming increase the chance if catheter damage.
Now that you have read the specific guidelines, make sure you are familiar with the basic care techniques of port-a-cath. These guidelines include;
- Once inserted, don’t tilt the needle
- Needle or any other tubing attached should not be left open to air
- If the fluid does not flow freely after being injected, stop immediately and call your doctor.
- Most importantly, any change in the appearance of the site around injection should be reported immediately.
Pretty much like other devices that are implanted, port-a-cath has potential complications as well. The complications that are associated with such devices include fragmentation and catheter disconnection that might result in embolization as well. Other complications include;
- A bacterial infection whether due to an immunocompromised state or poor hygiene could play havoc with a patient who is already very weak.
- Thrombosis is the complication that is being avoided by flushing the catheter regularly
- Pneumothorax could be a result while gaining access to subclavian vein or jugular vein.
- Arterial injury- subclavain artery can also be punctured leading to a hematoma.