Your doctor may have recommended a chemotherapy port before you begin chemotherapy. Some important questions to consider: What is a port exactly, when is it used, and what are the benefits and downsides of having a port?
What Is a Port for Chemotherapy?A chemotherapy port (also known as a port-a-cath) is a small devise that is implanted under your skin to allow easy access to your bloodstream. A port can be used to draw blood and infuse chemotherapy drugs. It can also be used if you need transfusions of red blood cells or platelets.
When Are Ports Used for Chemotherapy?Whether or not your doctor recommends a port may depend on several things. Some medications can only be given through a port. If you will be having several infusions of chemotherapy (some oncologists recommend port if you will more than four treatments), a port is often easier than inserting an IV each time. And some people have veins that are difficult to access, making a port a better option than placing an IV.
How Is a Port Inserted?A port is most often inserted during a same-day surgical procedure that can be performed with a local anesthetic. Most physicians prefer that you have your port placed at least one week before beginning chemotherapy (if possible.) If you are having a surgical procedure for your cancer, such as a lobectomy for lung cancer or a mastectomy for breast cancer, your surgeon may insert a port at the same time your other surgery is performed.
During insertion, a small round metal or plastic disc is placed under your skin through an inch-or-two-long incision. This may be located on your upper chest or occasionally your upper arm. This port is then attached to a catheter tube that is threaded into one of the large veins near your neck, such as the subclavian vein or jugular vein, and ends near the top of your heart.
After your port is placed, you will notice a slight protrusion in your skin, over the port. During blood draws or chemotherapy infusions, a nurse will insert a needle into your port in an area called the "septum," a resealing rubber center on your port. Since the port is completely under your skin, you will be able to bathe and swim without being concerned about getting an infection in your port.
BenefitsThe benefits of having a chemotherapy port over using a traditional IV include:
- Greater comfort – A single needle stick through your skin is usually all that is needed to access your port. With IV therapy and traditional blood draws, sometimes many needle sticks are needed to find a good vein, especially if your veins have been damaged from repeated blood draws and infusions.
- Avoiding delays – Not only do you avoid the delay of having your nurse attempt to find a good vein to draw blood or infuse chemotherapy, but having a port can reduce the time needed to prepare your hand or arm for the procedure.
- Lowering the risk of "extravasation" – When an IV is used, medications are more likely to leak (extravasate) into the tissues surrounding your hand or arm. Since many chemotherapy medications are caustic to tissue, a port can reduce the risk of inflammation related to leakage of these medications.
- Easier bathing and swimming – Since a port is completely under the skin, you can usually bathe and even swim without being concerned about the risk of infection.
Possible DrawbacksPossible risks include:
- The risk of the surgical procedure to install the port. Any surgical procedure can carry the risk of infection. Rare (less than 1%) complications of insertion can include bleeding (such as if the subclavian vein is punctured) and a pneumothorax (collapse of the lung), if your lung is accidentally punctured during the procedure.
- Infection – The risk of infection varies in studies but isn’t uncommon. If a port becomes infected, it will often need to be removed and replaced.
- Thrombosis – A clot may form in the port or catheter, causing it to stop working. Between 12 and 64% of people who have a port placed for chemotherapy will develop a thrombosis (clot) in the catheter (often causing a need for the port to be replaced.)
- Mechanical problems that cause the port to stop working – In some cases mechanical problems, such as movement of the catheter or separation of the port from the skin, can cause a port to stop working.
- Limitations in activity – Though activities such as bathing and swimming are usually okay, your oncologist may recommend holding off on exercises to strengthen your upper body or arms until your port is removed.
- Scaring – Given the gravity of cancer treatment, a scar from the port is a relatively minor drawback. But some people may find a scar on their upper chest disturbing for cosmetic reasons or because it is a symbol that they once went through chemotherapy.
How Does a Port Differ from a PICC Line?PICC stands for "peripherally inserted central catheter." A PICC line is usually placed in a vein for shorter-term treatment (for example, for access that will be needed for one to six weeks only.) PICC lines are placed in your arm closer to your skin (subcutaneous) and does not reach as close to your heart as a port catheter.
How Is a Port Removed?When you and your physician are confident that your port is no longer needed, it may be removed through a simple surgical procedure.
What Will You Need to Know If You Have a Port?It will be important to ask your doctor if your port needs any special care, such as flushing with a medication to help prevent clots from forming.
When to Call Your DoctorSince infection is the most common complication of having a port, contact your doctor if you develop a fever or note any redness, swelling, pain or drainage around your port.
Heibl, C. et al. Complications associated with the use of Port-a-Caths in patients with malignant or haematological disease: a single-centre prospective analysis. European Journal of Cancer Care. 2010. 19(5):676-81.
Narducci, F. et al. Totally implantable venous access port systems and risk factors for complications: a one-year prospective study in a cancer centre. European Journal of Surgical Oncology. 2011. 37(10):913-8.
National Cancer Institute. Chemotherapy and You: Support for People With Cancer. Questions and Answers About Chemotherapy. Updated 06/29/07. http://www.cancer.gov/cancertopics/coping/chemotherapy-and-you/page2
Vescia, S. et al. Management of venous port systems in oncology: a review of current evidence. Annals of Oncology. 2008. 19(1):9-15.