Port Catheter Placement

Port catheter placement is a minimally invasive surgical procedure commonly performed for patients who require long-term intravenous (IV) access.

A port-a-cath is a small, disc-shaped device that is typically placed underneath the skin on the right side of the chest. It is attached to a thin, flexible tube called a catheter that is threaded into a large vein above the right side of the heart called the superior vena cava. It is commonly used to inject liquids directly into this vein as part of intravenous (IV) therapy.

A port catheter may remain in place for weeks or months, and prevents the need for repeated needle sticks and trauma to small vessels.

Parts of a Port

A port consists of:

• Septum: This soft silicone top functions as an access point into the vein. Special needles are placed into the septum for blood collection or to administer treatment.
• Catheter: This flexible, thin tube links the port to the vein, connecting it to your circulatory system.

Indications

Port catheter placement is most often indicated to provide long-term or frequent intravenous therapy. IV therapy is a method of administering fluids, medicine, nutrition, or blood directly into the blood stream.

In general, your physician may recommend a port for the following conditions:

• Infections requiring IV antibiotics
• Gastrointestinal conditions requiring IV total parenteral nutrition (TPN)
• Kidney failure that requires dialysis
• Cancer that requires IV fluids, frequent blood draws, or chemotherapy

Preparation

Preparation for a port catheter placement may involve the following steps:

• A thorough history and physical examination
• Blood tests to ensure you have healthy blood-clotting cells (platelets), and to assess kidney function
• Providing your physician with a list of medications and supplements you are taking
• Informing your doctor of any recent illnesses or medical conditions you have, such as a history of kidney disease
• Refraining from medications such as aspirin that thin the blood
• Refraining from liquids or solids for a defined amount of time prior to the procedure
• Signing an informed consent form

Surgical procedure

Port catheter placement is a simple outpatient procedure that takes about an hour. It is usually performed under sedation or general anesthesia, depending on the patient’s preference and health factors.

In general, the procedure involves the following steps:

• You will be asked to lie down on the procedure table in a supine (face-up) position.
• Your surgeon will inject a numbing medication at the incision sites.
• A small incision is made typically on the right side of the chest, below the collarbone, to make a pocket underneath the skin for port placement.
• Another small incision is made in the neck area to access a large vein, typically the superior vena cava, and create an access point.
• Next, a catheter is threaded or guided under fluoroscopy (live X-ray imaging) from the port to a large vein in the chest, and tunneled under the skin.
• Once the catheter and port are in position, they are connected.
• Finally, your surgeon closes the incisions with dissolvable sutures or surgical glue.
• A chest X-ray is performed to ensure the catheter and port have been placed in the correct location.

Postoperative care

After the port catheter placement procedure, you will be transferred to an observation room to be monitored for any adverse reactions. Since it is an outpatient procedure, you will be discharged home the day of the procedure. However, you should arrange for someone to drive you home.

You may experience mild discomfort, pain, or swelling from the incision sites. Medications are provided as needed to address these. Instructions on incision site care and bathing will be provided to keep the wound clean and dry. Avoid strenuous activities or heavy lifting until you receive your physician’s consent.

Risks and Complications

Risks and complications associated with port catheter placement may include the following:

• Hematoma (swelling of blood under the skin)
• Infection
• Bleeding
• Sepsis
• Catheter occlusion
• Port migration
• Pneumothorax (collapsed lung)
• Blood clots or deep vein thrombosis (DVT)

Summary

A port-a-cath is a type of central venous catheter device that is placed under the skin of the chest for regular administration of nutrients and medicine into your body over a prolonged period of time. The port protects your veins from damage caused by frequent blood draws, transfusions, or long-term IV therapy. Doctors typically remove the port once patients have completed their full course of IV treatments through a quick, simple outpatient procedure.