What is a port?
Ports are a long-term form of Central Venous Access Devises (CVADs).
Normally, these are small devices that can be implanted under the skin
to allow easy access to a person's circulatory system. Having a port
can prevent undue wear and tare on a person's peripheral veins as well
as making venous access much easier if those veins are not large and
easily visible.
The Port/CVAD essentially provides a larger and easily distinguishable
target that will not move when an IV needs to be started or blood needs
to be drawn. Ports can make life much easier for many people with chronic
conditions requiring frequent vein accesses for blood draws and/or medications.
This convenience comes at a price through. People who have ports must
stay vigil as ports have an increased risk of infection and require
more routine maintenance than starting a new IV whenever access is needed.
Anatomy of a Port
(The above image is enlarged for easy viewing. The size of a port or
CVAD is normally larger than the size of a quarter and smaller than
a 50-cent piece.)
The Septum,
often called the Diaphragm, is the point of entry for the needle. Being
made of a self-sealing silicone, the septum can be pierced repeatedly
by needles without causing permanent damage. By sealing against the
needle when penetrated, and resealing itself when the needle is removed,
the septum acts as a barrier that helps prevent cross contamination
from the surrounding tissue.
The Anchor Plate and
Suture Holes are basically
self-explanatory. When the port is being implanted, the surgeon will
use the holes in the anchor plate to suture the port in a specific place,
preventing it from moving within the person's body over time.
The Reservoir is simply
the area were fluid exchange actually takes place. It is inside the
reservoir that medications actually leave the needle and enter the body.
The Catheter is a tube
that connects to the port's reservoir and is surgically inserted into
a vein or artery. Medications flow from the port, through the catheter
and directly into the blood stream. In some cases ports can also be
used for blood draws, at which point the process is simply reversed,
blood is pulled through the catheter, into the reservoir and out through
a needle.
Implantation
The implantation of a port is a surgical procedure and thus should
be preformed in an operating room. The procedure begins with the surgeon
thoroughly cleaning the area when the catheter and port will eventually
be inserted. The vast majority of ports used in the bleeding disorders
community are now placed in the chest and accesses the subclavian vein.
Older patients are normally only given local anesthetics but anesthesia
is often used in children to prevent complications that can be caused
by movement during the procedure.
Once the area has been prepared (cleaned and numbed) a small incision
is made and a needle is inserted into the subclavial vein followed by
a guide wire and the catheter. The catheter is then slid inside the
vein until it reaches the heart's right atrium. With the catheter in
place, the surgeon removes the guide wire and feeds the now free end
through the various layers of muscle between the vein and the new port
location and connects it to the port reservoir.
Next the surgeon creates a pocket in subcutaneous tissue on the chest
wall that will hold and cushion the device and places the port in its
new home. With everything in place, the surgeon attaches the port to
the fascia (connective tissues that enclose the muscles) using permanent
sutures to prevent the port from moving and flipping over.
The original incision is stitched closed and the procedure itself is
complete.
After Implantation
After the port surgery is complete, it is suggested that the site be
kept covered for 48 hours with sterile dressings to prevent infection.
After the skin has healed the dressings can be removed, as the layer
of skin will prevent infection due to environmental conditions.
Directly after the surgery and for the next week or so it is very important
to pay attention to your port and signs of infection. Port infections
are very serious matters. Since the catheter leads directly to the heart
port infections can spread throughout the entire body very quickly.
Some signs of infection to watch for include:
- The area around the port becomes red.
- The area around the port becomes hot to the touch.
- The area around the port becomes increasingly tender.
- You begin running a fever.
- You notice swelling around the port.
- You begin seeing fluid draining from the site.
Port Maintenance
It is very important to maintain your port through regular heparin
flushes and alerting your provider(s) if you see anything out of the
ordinary. As a rule of thumb, ports should be flushed with heparin after
each use regardless of the port location. On top of the flushing each
use, it is a good idea to flush a port with heparin at least once a
month if the catheter is placed in a vein, and at least once a week
if it has been placed in an artery.
Depending on the type and location of the port the care recommendations
can vary. You should consult your physician for the optimal care guidelines
for your exact situations.
Port Flushing Procedure
Supplies:
1) Sterile Field
2) Alcohol Wipes
3) Povidone-iodine swabs
4) Sterile Gloves
5) Prefilled Saline Flush Syringe
6) Syringe of Heparin Flush
7) Huber (Gripper) Needle
8) Adhesive Bandage
Procedure:
1) Wash hands thoroughly and place a sterile field on the surface
you will be using to lay out supplies. (The sterile filed helps prevent
contamination of material for the surroundings.)
2) If the needle hurts or bothers the individual being accessed a
topical anesthetic can be applied to give some comfort.
3) Clean the port site and surrounding area with alcohol wipes, followed
by Povidone-iodine and allow to dry.
4) After putting on your rubber gloves, attach the gripper needle
to your saline flush syringe.
5) Slowly push the plunger until a drop of saline can be seen forming
on the tip of the needle.
6) Feel for the port under the skin and push the needle through the
skin and septum at a 90-degree angle with the septum. Insertion of
the needle should not stop until it has come into contact with the
metal plate that forms the back of the port. (Illustrated Below)
7) Pull back on the plunger until you see blood starting to be drawn
from the port. This ensures that needle is positioned correctly in
the port, and the catheter is free of clots. (This step may not be
possible if the port accesses an artery instead of a vein.)
8) Steadily push the plunger forcing the saline out of the syringe
and flushing the port.
9) Once the saline flush has been completed, unhook the saline syringe
from the needle and attach the syringe of heparin.
10) Press the plunger on the heparin syringe to flush the device
with heparin.
11) While holding the port into the chest wall with one hand, grip
the needle with the other hand pull it out.
12) Paint the area again with povidone-iodine and cover with an adhesive
bandage.
Accessing a Port
To administer medication through a port, a very similar procedure is
used as was discussed in the Port Flushing Procedure. The only difference
is additional steps that need to be added between steps 8 & 9.
Those steps are:
8.1) Once the saline flush has been completed, unhook the saline
syringe from the needle and attach the syringe or bag of medication
that needs to be administered.
8.2) After the medication has been fully infused, unhook the medication
from the needle and attach another saline flush.
This means that the port should be flushed with saline both before
and after medication is given through it.
Port FAQs
Q: Can I go swimming
if I get a port?
A: Yes, since the port is placed
under the skin it is well protected from environmentally caused infections.
Having a port should not make any difference as to what a person can
or cannot do. Swimming should be avoided for the first two weeks after
the surgery though in order to allow the wound to heal.
Q: Can I shower after
having port surgery?
A: Yes, showering should not
be a problem as long as you cover the site with an appropriate dressing.
Typically, after three days the wound has healed enough for showers
to be taken without the dressing. Baths, however, where the wound can
become submerged should be avoided for at least two weeks.
Q: What happens if my port becomes infected?
A: That depends on the nature
of the infection. If the infection is caught early enough and is inside
the port, most infections can successfully be treated with antibiotics
given directly through the port. If the pocket on the chest wall becomes
infected the port must be removed.
Q: Can a port be removed once it has
been implanted?
A: Yes, ports
are frequently removed for various reasons. Removing a port does mean
going back into the operating room where a surgeon will remove the port
& catheter, using sutures to mend the vein, pocket and skin.
Q: Will my port interfere
with me getting an MRI?
A: Possibly. There are many variables
that need to be taken into account in this answer. Since the port has
metal in it and MRIs use strong magnetic fields to create the images
it depends on the part of the body that is getting scanned (and its
proximity to your port) as well as the strength of the magnetic field
being used. You definitely should check with your doctor and make the
facility and technician performing the MRI aware of the port.
Q: Will my port set
off the metal detectors at airport security?
A: Most metal detectors used
in the airports are not set sensitive enough to detect ports however,
if the detector is set to be sensitive it definitely can get set off
by a port. It is a good idea to have a travel letter from your doctor
that explains the port, just in case.
Q: How long do ports
last before having to be replaced?
A: There is no set expiration
date or time limit on a port. Ports implanted in children may need replacement
if the child outgrows the catheter.
Sources:
National Institutes of Health
Smith's Medical
University Hospital and Clinics, Madison, WI
Total Parenteral Nutrition Team at Medline Plus
University of Pittsburg, Medical College
