When intravenous (IV) therapy is needed for a long time, your doctor may use an implanted port. The implanted port is a device that is placed under the skin. It lessens the need to start an IV for every treatment. After the implanted port is in place, IV medicines and treatments can be given directly into the blood stream through the port.
The implanted port (sometimes called an Implantofix® or Port-A-Cath® ) has 2 main parts: the catheter and the port (Picture 1). The catheter is a soft, narrow plastic tube that is put into a vein inside the body. The port is a small chamber disk with a silicone rubber top called a “ septum.” The septum covers the top of the port and reseals itself after it is punctured by a special needle. The septum can be punctured about 2000 times with this special needle before it needs to be replaced. The port is surgically placed under the skin, usually on the chest (Picture 2).
Once the catheter is in the vein, a port can be used to:
- Give medicines.
- Give blood and blood products.
- Give parenteral (IV) nutrition.
- Draw blood for some lab tests. Certain blood tests cannot use blood from the implanted port.
Benefits of the implanted port
From a child's point of view, the best part about having the implanted port is that it reduces the number of needle sticks. (It is important to realize, however, finger sticks or other needle sticks may still be needed for blood tests.) Other benefits are:
- It can remain in the vein for a long time.
- There is less discomfort, since the IV therapy can be given more easily.
- No dressings or bandages are needed after the skin has healed when a needle is not in place.
- It prevents the "burning" feeling sometimes felt with medicine given by other IV methods.
- Activity is not restricted with the implanted port. If there is no needle in place, bathing, exercise, swimming and playing are all possible once the incision has healed (Picture 3).
Inserting the implanted port
The implanted port is inserted in the operating room while the patient is asleep (under general anesthesia). Two small cuts are made: one to locate the vein and a second to make a "pocket" under the skin for the port. After the catheter is placed into the vein, the port is inserted under the skin into the pocket. The port is stitched into place and both incisions are closed. After the incision is healed, you will see only the shape of the septum under the skin (Picture 2).
After the implanted port is inserted
After the implanted port is placed in the vein:
- The implanted port may be used as soon as the surgeon gives permission.
- For a day or two after the implanted port is inserted, the skin may be tender around the 2 incisions. The soreness will disappear within a few days.
- The body tissue will heal around the port in about 3 weeks to hold the implanted port in place. How the implanted port works
- When IV therapy is needed, a special non-coring needle is inserted through the skin into the port. Because the needle goes through the skin, a slight pricking sensation is felt. EMLA® cream may be applied to numb the skin before the needle is inserted.
- A small dressing or bandage is used to cover and protect the needle while it is in.
- The IV fluid or medicine flows through the needle, into the port, through the catheter and into the blood stream.
- When the treatment is over, or at least every 7 days, the needle is removed and replaced if needed.
- If the dressing begins to leak or becomes loose, the needle and dressing need to be changed.
Several complications are possible when using the Implanted Port. These are rare but can occur. They include:
- Infection at the port injection site or in the blood.
- Blood clots in the catheter or in the vein.
- Movement of the implanted port and irritation to the vein.
- Infiltration - swelling and tenderness caused by the needle slipping out of the port. This can cause IV fluid to flow under the skin instead of into the vein.
- Trouble finding the port to insert the needle. While in the hospital with an implanted port While receiving an IV solution through the implanted port:
- The end of the needle will be attached to plastic tubing. The tubing runs through a small machine that pumps the solution into the vein.
- It is possible to be up, out of bed or, for small children, held (Picture 4).
- The part of the IV tubing outside the body will be taped securely to the chest to prevent any pulling or strain on the needle.
- Both you and your child must be very careful the IV tubing does not get pulled. Let the nurse know right away if any part of the needle comes out or if the tubing becomes disconnected.
Care of the implanted port
Because the implanted port is completely under the skin, it requires very little care.
- Wait 24 hours before showering or swimming after the needle is removed to allow the needle hole to heal. This lessens the risk of infection around the port body.
- Wash the skin at the injection site between injections or infusions.
- A bandage is not needed when a needle is not in place.
- Check the site daily for any redness, swelling, warmth or other signs of infection.
Flushing the Catheter
- A medicine called heparin is used to prevent blood from clotting inside the catheter. After an injection into the port and before the needle is removed, the catheter is "flushed" with a small amount of heparin.
- The implanted port must be flushed after each treatment and flushed at least once every month by a registered nurse or other trained person. Removal of the implanted port The implanted port will be removed when the IV therapy is completed. This is done in the operating room under general anesthesia.
When to call the doctor
Call your doctor if any of the following occurs:
- If you notice any redness, tenderness, bruising, swelling, warmth or drainage at or near the port injection site.
- For a fever (100.4 or higher), aches or "flu-like" symptoms.
- If there is swelling, tingling or pain at or near the port injection site or in the arm closest to the port.
If you have any questions, be sure to ask your doctor or nurse.