Ports are central venous catheters that are an important part of making cancer or other chronic treatment easier. By providing reliable access to the body’s venous system, “missed IVs” and “rolling viens” are generally eliminated. Most children undergoing chemotherapy will have a port placed to facilitate their care.
Ports are completely implanted under the skin and have a pierceable reservoir under the skin. The strong piercable silastic top of the port allows the needle to be placed securely into the device. A long Silastic tube then travels under the skin from the reservoir to a major vein. The device can be used for withdrawing blood from the vein or giving medications.
Common brands include : Bard Port, Port-a-cath, Medi-Ports to name a few.
These devices are completely implanted in the patient. The port resides in the soft tissue under the skin. The soft silastic tube stays within the vein. The Silastic tip usually ends in the superior vena cava just above the heart.
Insertion is done under general anesthesia in children. The common risks to port placement and typical frequency of those risks is listed below.
- Pneumothorax (1 to 2%)
- Bleeding (1 to 2%)
- Infection (1 to 2%)
- Port malfunction (rare)
- Thrombosis (clotting) of the vein (unknown)
- Anesthesia (very small, if otherwise healthy)
X-ray showing an implanted port:
With a Port-a-Cath, there is completely implanted device under the skin. The port is made of metal or plastic with a softer, but thick silastic diaphragm over the top. In the middle is a chamber. When your doctor or nurse needs to use the catheter, a special type of non-coring needle (“Huber” needle) will be placed through the skin. The first “access” of the port is often done at the time of initial placement while your child is under anesthesia. Future access of the port is done with your child awake. A special cream (EMLA cream) can be applied prior to placing the needle to numb the site. A clear, occlusive bandage holds this needle in place and helps prevent infection. When the infusion or blood draw is complete, the needle is removed and the implanted port is considered “de-accessed.” The de-accessed port can be felt under the skin, but is completely covered by natural skin.
Ports need to be flushed with sterile saline and heparin once a month if not being used.