Help save lives this holiday season
A subcutaneous port has a small round metal chamber (portal) with a rubber top (septum) and a flexible tube (catheter). It is placed completely under the skin on the right side of the chest. A catheter threads under the skin from the metal chamber into a large vein near the collarbone, then into or near the right atrium of the heart. It is also called implantable venous port or Port-a-Cath.
Intravenous (IV) medicines and treatments can be given directly into the bloodstream through the port. The nurse inserts a special type of needle through the skin and into the rubber top of the portal to draw blood or to give an infusion of drugs or fluid.
When a subcutaneous port is used
A subcutaneous port is used when:
- a person needs intravenous (IV) access to receive fluids or drugs over a long period of time
- the small veins in the body can no longer be used for giving fluids or drugs
Benefits of a subcutaneous port
There are many benefits to having a subcutaneous port rather than a regular IV. The most important benefit is that it reduces the number of needle sticks. However, it is important not to tell children that having a subcutaneous port means they will never have to be “poked” again, since they may still need needle sticks for some blood tests.
A subcutaneous port:
- can stay in the vein for a long period of time
- reduces discomfort because IV therapy can be given more easily
- Local anesthetic creams can be used to numb the skin before puncturing the port with the special needle.
- does not require a dressing once the skin has healed and a needle is no longer in place
- prevents the “burning” sensation sometimes felt when getting drugs by other IV methods
- does not restrict activity
- People can bathe, exercise, swim and play once the incision heals and the needle is not in place.
- requires no care at home
How a subcutaneous port is placed
The doctor places a subcutaneous port in the operating room while the person is under general anesthesia. Sometimes local anesthesia is used for adults and older children.
- The doctor makes 2 small cuts (incisions) in the skin. One cut is made in the chest to place the portal. The other cut is made near the collarbone where the catheter will enter a vein in the lower part of the neck.
- The catheter is placed in a large vein in the neck and threaded into or near the right atrium of the heart.
- The other end of the catheter is tunnelled under the skin and attached to the portal.
- Fluid is injected into the portal to ensure it is working correctly.
- The portal is then placed under the skin in the chest and stitched to the underlying muscle.
- The doctor stitches both incisions closed.
- After the incisions heal, the shape of the portal can be seen under the skin.
- An x-ray is done to confirm the catheter tip is in the correct position.
After a subcutaneous port is placed
A subcutaneous port may be used as soon as the surgeon gives permission, often the same day or the next morning. The skin may be tender around the incisions for 1–2 days after the port is placed. Body tissue will heal into the port in about 3 weeks. These tissues hold the port in place.
How a subcutaneous port works
Because the port is under the skin, it must be accessed using a special needle (Huber needle). When IV therapy is needed:
- The skin is thoroughly cleaned with antiseptic. The needle is inserted through the skin and the rubber top of the portal.
- Because the needle goes through the skin, the person feels a slight prick.
- Local anesthetic creams can be applied an hour before to numb the site, or ethyl chloride can be sprayed on the skin right before the poke.
- The needle is attached to a short length of tubing that hangs down the front of the chest.
- A small dressing is used to cover and protect the needle.
- The fluid or medicine flows through the needle into the port, then through the catheter and into the blood.
- After the treatment is over, the needle is removed.
Possible complications of a subcutaneous port include:
- infection in the skin at the exit site or in the blood
- Some infections can be treated with antibiotics without removing the subcutaneous port. Sometimes it must be removed.
- blood clots in the catheter or the vein
- The catheter may be flushed with a drug to try and dissolve the clot.
- Sometimes the subcutaneous port may be removed.
- the subcutaneous port moves and irritates the vein
- The subcutaneous port may be removed.
- slipping of the needle from the back of the port chamber
- The IV fluid flows under the skin instead of into the vein.
- The subcutaneous port cannot be used until the swelling goes down.
While a port is in use
While the person receives an IV solution through the subcutaneous port:
- The end of the needle will be attached to plastic tubing that runs through a small machine (IV pump), which will pump the solution into the vein.
- Adults do not need to stay in bed. A child may be held or can get out of bed.
- The part of the needle outside the body will be taped securely to the chest to prevent any pulling or strain on the needle.
- Be careful that the IV tubing does not get pulled.
- Let the nurse know immediately if any part of the needle comes out or if the tubing gets disconnected.
- The subcutaneous port will be flushed after treatment is over.
- A drug called heparin is used to prevent blood from clotting inside the catheter.
- After an injection into the port and before the needle is removed, a registered nurse will flush the subcutaneous port with a small amount of heparin.
- The subcutaneous port must be flushed after each treatment and at least once every 4 weeks.
Caring for a subcutaneous port
Because a subcutaneous port is completely under the skin, it needs very little care.
- The skin at the injection site needs to be washed as normal.
- A bandage is not needed when a needle is not in place.
- Check the site daily for any redness, swelling or other signs of infection.
Removing a subcutaneous port
A subcutaneous port will be removed when IV therapy is no longer needed. This is done in the operating room under general anesthesia, usually on an outpatient basis.
When to call the doctor
Call the doctor if:
- there is any redness, tenderness, bruising or drainage at or near the port injection site
- the person has a fever, aches or flu-like symptoms
- the port moves
- there is swelling, tingling or pain at or near the port injection site
Establishing a national caregivers strategy
The Canadian Cancer Society is actively lobbying the federal government to establish a national caregivers strategy to ensure there is more financial support for this important group of people.