Placing the Port is a small surgical procedure and takes less than an hour. It is performed by an interventional radiologist under local anesthesia with IV sedation.The procedure involves a 3cm skin incision on the chest wall for the port pocket and 5mm incision in lower neck to enter the vein. The port is placed completely inside the body. One end of the catheter is inserted into the vein while the other end is connected to the portal, under the skin. The tip of the catheter lies in a vein just above the heart.
There are two ways of Port placement:
Chest-placed system: This is the most common approach to Port placement. The Port is placed in the chest and the catheter is inserted into a vein in the chest. The tip of the catheter lies in a vein just above the heart.
Arm-placed system: The port and the catheter are inserted into a vein in the upper/lower arm. The tip of the catheter lies in a vein just above the heart.
Generally, the patients can go home two hours after the procedure or after the effect of sedation has worn off. However, patients are advised to not drive or operate any machinery for 24 hours. When the incisions are healed, one can notice a small bump under the skin.
Keeping the port-site clean at all times is very crucial. If an access needle is in place, it is covered with a dressing to keep the site clean and prevents the needle from dislocating. If there is no needle in place, one can bathe/shower regularly.
After surgery, it is normal to have some redness and tenderness at the area of incision which should resolve in 24-48hrs. However if you continue to have redness, tenderness, swelling or drainage from the site for more than 2-3 days or notice any other unusual skin changes, contact your doctor immediately.
Avoid any strenuous activities involving the chest/arms for at least ten days. If the port is not used in 7 days after placement, follow-up with your doctor for a wound check and dressing change.
If your portacath is no longer being used, you need to follow-up with your doctor every 4 weeks and get it flushed with saline water and locked with heparinized saline to prevent formation of blood clots.
Minimize physical activities that involve excessive, repetitive upper extremity motion: such as swimming, golfing, weight-lifting as there is risk of catheter damage/ fragmentation (breaking). Check with your doctor to make sure you take proper precautions while engaging in such activities.
Risk of infection: although the risk of infection with the port is minimal, catheter-related bloodstream infection is a concern in cancer patients. This can be prevented by keeping the port site clean, using antimicrobial catheters and antibacterial solutions to flush the catheter. If infected, the port is removed and one is treated with appropriate antibiotic medications.
Risk of forming clots: After months of insertion, clots can form in the catheter. This is prevented by flushing the catheter regularly after blood draws and not giving any contrast through the port. Patients do not need to be on any treatment to prevent clot formation in the Port-A-Cath.
Air outside the lungs: at the time of port placement air can leak out of the lungs but usually resolves with time.
Irritation or blistering of skin where chemotherapy is being given
Catheter dislocation if not properly secured with sterile tapes or surgical strips
With the use of modern imaging technology, there is very little risk of bruising, bleeding or damage to the blood vessels.