Tuesday, April 3, 2012

Port-a-caths Part II

Port-a-cath is Not a Cruise Ship Destination...Part II
For full information about Port-a-caths, see the links below.  There is plenty of information already out there about ports, so I won't reinvent the wheel.   I will write about what I think are some of the major points of having a Port-a-cath (aka "port").

What is the #1 question cancer patients want to know about Port-a-caths?   They want to know what it looks like when it has been inserted into a real human being (see photos below).
What is it?  It is a "venous access device" or an implantable device attached to a catheter that sits under your skin.  The catheter part is threaded through one of your major veins and it kind of "hangs" in the top part of your superior vena cava.  We give chemo through it  (or IV fluid, or blood, or TPN).   Instead of giving a boatload of stuff through one small vein in your arm at a lower rate that will take forever, we can give it in a port that flows into a bigger "vein or vessel".  A lame analogy?  If you have a little tiny pipe that drains your sink, then it will take longer to empty out your sink.  If you have a large, open pipe, the water in the sink will drain quickly. 
Some types of chemotherapy are especially toxic.  That's good for attacking cancer cells, but hard on your healthy tissue.  Chemo can damage the healthy skin and arm tissue if it is running through an IV that becomes dislodged out of a vein (can happen with movement of your arm).  This causes it to leak out of a "normal" arm IV site or vein into the healthy adjacent skin.  With a port, we don't have to worry about this.  The port is sutured in place and "buried" under a little  pocket of skin to hold it securely.  The catheter part goes into a large vein.     
Why do I need it?  We can draw blood out of it, and infuse chemo, blood products, IV fluid into it with just one needle stick.  Even if you have great veins or "pipes" (as we say in the business), if you need chemo for 6 months or 1 year, we are going to "use up" some of your veins.  Each time you visit us, we might have to hunt for decent IV sites, apply heat and "stick" your arm 2 or 3 times before we can find a vein.  As you can imagine, none of this is fun.  It is actually painful and upsetting.  Multiply those numbers by many clinic visits throughout the year, and now you know why it might be beneficial to have a port placed.
A port can become your best friend.  Nobody is excited about getting one, but once you have one,  you will be grateful that you had it inserted. 
Here's what a port looks like by itself.  Out of the box.  Not in a human.  The two on the left are single lumens and the two on the right are double lumens (single barrel or double barrel!!).  On the double lumen, even though it looks like they have 2 "heads" and only one "tail", there are actually 2 tails inside the long catheter. 

They might put a double lumen in if you are going to get a "big guns " chemo regimen or bone marrow/stem cell transplant.  These are regimens that typically have several different types of chemo to give.  There are treatments that require you to get 2 infusions at one time (one type of chemo in one side and one in the other side).  Or you might get chemo in one side and IV fluid in the other side. Or you might need one side to infuse blood products or IV antibiotics, and one to infuse TPN (Total Parenteral Nutrition aka "IV Food in a Bag").  There are even triple lumens.   

Basically the port is a surgical steel "metal" device with a rubber stopper covering it, with plastic or silicone surrounding it.   Here's another angle of the device without the catheter or "tail" attached to it.

1)  To "access' the port, the nurse first looks for "your bump". She then cleans the site with antiseptic solution (The port lies flat under the skin, is attached to the catheter that goes into your large blood vessel).

2)  The nurse will feel around your skin until she locates the port. She will then hold it steady between her fingers with one hand, and with the other hand she will take a hook shaped needle and will stick the needle into the rubber "stopper" area on the top of the port. She will do this quickly in one motion as if she is playing darts. The quicker she does it the less it hurts. She can "feel" the needle go through the rubber stopper and she can "feel" it if the needle hits the metal base below.
The orange stuff you see is antiseptic/betadine not blood, so don't get skeeved out by it!

Actual port "bump" of "Dee-Hee" a fabulous, gorgeous ovarian cancer patient who agreed to let me take this photo!!!  Thank you Dee-Hee!!!
Here's the antiseptic that has been rubbed on the port site.   The nurse steadies the port between 2 fingers of one hand.  With her other hand she uses the hook shaped needle to access the port.
She will attach a syringe, will pull back on it and make sure she can get a good blood flow.  Once she has, she will tether the needle down with plastic occlusive film and tape to hold it in place.

Huber needle with foam pad, attached to IV catheter tube.

Dee Hee's port with plastic wrap over the "Emla" numbing cream.

Here's another view of the components

One stick. Blood comes out and goes to lab to be tested  (where they check your blood counts). IV fluid and chemo go in. At the end of the session, the needle is removed and you go on your way.

Things to remember:  

Once the insertion incision is healed (7 to 10 days after it is inserted), you can swim, bathe with it, leave it uncovered and open to air. 

It needs to be flushed once a month with a heparin (aka blood thinner) solution to keep it patent.
If you are going  3 months until your next MD visit, remember that you will need appointments booked monthly for your nurse to do a quick "flush".

You can get "Emla Cream", which is an anesthetic cream that you put on your skin (with a piece of saran wrap or plastic covering that your nurse will give you) over it.  Put this on when you leave your house and then 1 hour later when  you are sitting in the clinic it will have numbed up your skin a bit and will ease the discomfort of putting a large needle through it.

Tell the radiology folks that you have it if you are going for an MRI or scan.   If you are going through security at the airport, you had best tell the security folks too.  You will get a card to carry in your wallet with basic info about your port. 
Here are some good websites that give an overview and explain how ports are inserted.  If you are a patient or family member, I beg you not to watch any of the "port insertion" videos on YouTube that show you the actual insertion.  These are meant for instruction for placement and are disturbing to look at unless you are into Operating Room surgeries and dig that kind of thing.
2 Fabulous Nurses who have "accessed" Dee-hee's port

Remember....the port is very useful during chemo.  But as with all of chemo side effects, your port is only taking up rental space on your chest temporarily.  It will be removed after chemo is finished (when you and your doctor decide when you want it removed).


  1. Thank you so much for this resource. It's really helped ease some of the fear and anxiety I have going into this pretty scary journey.