Dr Ronwyn van Eeden explains when a port for chemotherapy is needed.
What is a port?
It’s a device or drum, usually made from plastic or metal, that is placed under the skin of the chest. The drum is covered by a thin silicone membrane, through which a specialised needle is inserted.
The port is completely under your skin and you can usually only feel a small bump. From that a thin tube, called a catheter, runs directly into a large vein. Your chemotherapy runs through this catheter into the vein. There are different brands of ports.
A topical anaesthetic cream can be applied to the area of the port a little while before a needle is inserted, to numb the area.
Why would you need a port?
The decision to have a port is an important discussion to have with your oncologist before you start chemo. It depends on the type or frequency of treatment you’ll be receiving and what impact it will have on your daily activities and quality of life. Ports do allow you to still do normal activities, such as showering, swimming, jogging or playing with your children.
Usually, a port is not a good idea for patients who have a history of blood clots, or a patient with current infections.
It’s not mandatory to have a port when receiving chemo. You can also receive chemo intravenously. This is when a jelco or a cannula is inserted, through a peripheral vein on your hand or arm, and connected to the treatment.
A port is sometimes suggested for the following reasons:
• To prevent the discomfort of being pricked by a needle for peripheral venous access often, if you do a daily or weekly chemo regimen.
• If you have difficult veins, or veins that nurses struggle to find and often prick several times before finding access.
• Also, if you have lymphoedema (swelling of the arm) after breast cancer surgery.
• If the type of chemo given is very damaging to veins, meaning that it can cause burning or irritation.
• If the chemo given has a high-risk to damage the surrounding tissues or muscles if it leaks around the vein.
• If you have bleeding problems, such as low platelet counts.
• If you’re having a treatment that runs over a day or two, or a treatment that runs in as a continuous infusion with a pump that goes home with you.
• If you require many blood transfusions.
How is a port inserted?
It’s inserted by a general or vascular surgeon and is done in a sterile environment in theatre. It is an outpatient procedure and you need not stay overnight.
Most times, it’s done under general anaesthetic. It can also be done under local anaesthesia or conscious sedation. The surgery itself can carry a risk of bleeding, nerve damage or a build-up of fluid around the area. Rarely, it can result in a punctured lung, or an accidental injury to the blood vessel itself.
Sometimes, the surgeon can leave the needle in place after he/she has inserted the port, and it can be connected to your treatment directly the following day. The cost is generally covered by medical aids.
How long is a port needed?
Ports can remain in place for weeks, months, or years. If you’re likely to need treatment again in the future, it is a good idea to leave it in place. Otherwise, after discussion with your oncologist, you can decide when it is a good time to remove it.
Caring for a port
It is important to take good care of your port:
- Always wash your hands, or ensure your healthcare providers wash their hands before the port is used, to prevent infection.
- Always make sure the area is cleaned before use.
- Have your port flushed every three to six months at the hospital.
Risks of a port
The most important of these are infections or clots. Other less common problems can be the catheter or port moving underneath your skin, or a kink or blockage in the catheter.
Warning signs that there is something wrong include:
- The area becomes red, swollen, painful, bruised, or warm.
- If you have increased pain at the site of the port.
- Swelling develops in your arm on the same side as the port.
- There is a lot of bleeding.
- You get a fever, not explained by another cause.
- Any fluid leaks out.
- The catheter tube outside your body gets longer.
- The nurse cannot flush the catheter or port with liquid.
You should contact your doctor or oncology nurse immediately if any of these are experienced.
Benefits of a port
It reduces the amount of needle pricks you receive, especially if you have a weekly treatment. The risk of extravasation (chemo leaking into surrounding tissues) is decreased.
It also decreases hospital admissions for chemo that need to run overnight. And, blood can also be drawn from your port.
Ports are easily inserted with minimal risk, and if taken care of, they can make receiving chemo or other treatments a lot easier than normal intravenous drips. This is providing it’s the right choice regarding your treatment and you’re the right patient without any contra-indications for the procedure.
MEET OUR EXPERT – DR RONWYN VAN EEDEN
Dr Ronwyn van Eeden ia a medical oncologists at The Medical Oncology Centre of Rosebank, which has an accredited clinical trial unit. She has a focus in cancer immunotherapy.