Cancer, chemotherapy and Port (Port a cath)

Chemotherapy is one of the common treatments for cancer, along with surgery, radiation therapy, immunotherapy, hormone therapy and targeted therapies.

After the diagnosis of cancer and the choice of the protocol of care, in most IV chemotherapy, the placement of a Port catheter, also called a Port or Port a cath is often indicated.

In oncology, this subcutaneous device has been used since the 1980s.

In this article, I will detail all the information that I think is essential about the Port a cath with its definition, the reasons for its installation, its placement, the precautions to be respected and of course, how its withdrawal is, with, at each times, tips that help to better live through cancer treatments.

Chemo : What is a Port ?

The main reason for placing a Port for chemotherapy is the preservation of peripheral (superficial) veins.

Indeed, chemotherapy contains toxic products that will destroy the cancer cells, but also damage fragile veins that are on the surface of the skin and allow conventional blood tests.

This toxicity of chemotherapy of superficial veins is mitigated thanks to the Port. Indeed, this device contains a box (the perfusion chamber) connected to a catheter (silicone or polyethylene), itself connected to a large vessel, such as the vena cava. It’s in the silicone infusion chamber that the needle is introduced which will inject the chemotherapy. The arms are thus free, unlike a conventional infusion.

 

So, thanks to the Port, the chemotherapy drugs are directly injected into a large vessel where they are diluted rapidly and the venous walls are preserved.

In addition, the fact of not injecting the veins of the arm (which are already used for the blood draw), allows to save this area and avoid trauma.

 

Why a Port a cath for chemo ?

Chemotherapy cancer treatments can be taken in different forms : intravenous (this is the most common case), tablet, cream (for skin cancer), intraperitoneal, intrathecal and other more rare forms.

So, even in chemotherapy, the installation of a catheter port is not systematic. The Port is indicated only in case of intravenous chemotherapy which takes place in several cures.

The Port and catheters are frequently used in oncology, but also in other medical specialties.

 

Cancer : Chemo Port surgery, installation and placement

The Port will require surgery with either general anaesthesia or, more frequently, local  anaesthesia.

The surgery lasts less than 30 minutes. It is relatively fast. Doctors tend to state the installation of the Port a cath as a small operation. This was not my case and, as a patient, I’m always surprised to see that this surgery is trivialized. The installation of the Port can cause pain and stiffness in the neck (side effects that I will discuss below). However, it is a personal experience because, for some patients, there is no side effect. The installation of the Port a cath went very well, without any pain.

 

Port a Cath installation

The Port is installed by surgery and strict hygiene rules must be respected the day before and the day of the surgery.

 

So, take one or more showers with an antiseptic soap. In France, we use Betadine ©.

If you have any hair, you will need to shave it (or let a nurse do that).

Unless otherwise specified by the doctors, the patient should be fasting.

 

When installing the Port of Chemo, the surgeon can perform biopsy procedures. This option is rare, but it can happen, especially for not more than anaesthesia.

Port placement

The location of the Port a cath is at the top of the chest, just below the shoulder, under the collarbone. Under the skin, we only see the perfusion chamber and part of the catheter.

At the end of the installation, the surgical team checks the placement by X-ray. If the catheter port is misplaced, the surgeon rectifies its position immediately.

Because of its location, the port is invisible under clothing.

 

Chemo Port pictures and video

Here is a video that I find very educational about the installation, use and maintenance of an implantable chamber.

 

 

Chemo Port access and clothes

After its installation, access to the Port is very easy. It’s enough to just widen the collar of his top or shirt.

Moreover, as the infusions can last a long time, even a few days, it is necessary to think of having clothes compatible with the Port.

For example, you can wear shirts that are open in the front, ditto for pajamas. This avoids twisting to withdraw his business with the Port. Choosing suitable clothes makes life easier.

In that same spirit, it is better to avoid tight clothes on the neck, such as turtlenecks.

Using the Port a cath

At the level of use of the Port a cath, the infusion is done with particular needles. Before the infusion, the area of the skin will be anesthetized with a cream or patch a few hours before the procedure.

Once the infusion is in place, it is maintained by a sterile pad and a transparent dressing.

After each use, rinsing of the port and catheter is performed. This precaution avoids obstructions.

It is not recommended to take blood samples from the Port a cath. This practice increases the risk of infections and obstruction.

 

When discharged from the hospital, a card must be given to the patient to indicate the device number and its manufacturer. The ideal is to keep this card on oneself permanently, in his wallet for example.

 

Everyday life

With a Port a cath, the patient is able to live a normal life. When the healing process is completed, the patient is able to take showers without any problems.

All sports can be practiced except golf and scuba diving because of the pressure.

 

Chemo Port complications and side effects

After the installation of the Port, the patient has to lay down for an hour before being able to get up. He can return home during the day.

The intervention of a nurse may be necessary to check the condition of the wound and redo the bandages.

Most of the time, absorbable threads are used. If this is not the case, the sutures should be removed at D+7.

 

Surgery and installation of the Port may cause side effects. It is imperative that the patient reports to his doctors if he feels itching, redness, swelling and any abnormal signs.

The most common side effects of a Port a cath are pain immediately after the installation, infections, obstruction of the port or vein or hematoma formation as we will see below.

 

In addition, depending on the medical situation, it is possible that chemotherapy is planned after the installation of the catheter port. If this is the case, be careful during the first injection. If you feel pain, heat, burns, swelling, redness, you must inform your healthcare team. It may be a hematoma.

 

Cancer Port a cath and pain

Just after the installation of the Port, pain may occur in the neck. These pains are temporary.

However, depending on their intensity and duration, it is always important to have the opinion of your surgeon or family doctor.

 

Chemo Port infection

After the installation of the implantable chamber, an infection is always possible, especially if the patient is in aplasia. [place an internal link]

The first sign of an infection is a fever spike. An abscess may also occur.

In both cases, you must immediately go to the emergency room.

Prevention of infection of the Port is the strictest application of hygiene rules during infusions and their withdrawal.

 

Port obstruction

Port obstruction is most often solved by injecting a solvent. Unfortunately, it is sometimes necessary to change the entire device.

In case of obstruction of the vein containing the catheter, it is possible to take anticoagulants. Besides, the change of the Port is sometimes imperative. Vein obstruction can cause swelling of the arm or shoulder. Venous thrombosis can occur which is a medical emergency.

 

Arising of a hematoma

In 5% of the cases, just after catheterization, a hematoma can form, especially if anticoagulant is used. This might be painful.

The health care team should be advised of the presence of this hematoma.

 

Chemo Port removal

Once the treatments have all been administered and the examinations are reassuring, the doctors will suggest the removing of the Port.

 

The removal of the Port a cath is done under local anaesthesia. Unless otherwise specified, the patient doesn’t need to go through this procedure on an empty stomach.

The patient can get up right after the removal of the Port. He can go home.

Although some side effects are possible, removal from the Port often goes much better than expected.

Physicians can state that the patient can go about their usual activities or even go to work right after the removal of the catheter port.

This is probably the case for some patients.

For me, this has not been the case and, in my opinion, it is better to reserve a day of rest to manage the possible side effects of the withdrawal of the Port.

 

Chemo Port removal side effects

If the Port a cath was installed a long time ago (a few months or years ago), the tissue around it has recovered. The surgeon may have difficulty removing the Port.

In addition, once the effects of anaesthesia fade, pain may occur. Your medical team will need to tell you how to deal with it and how to reduce it.

Daily activities can be difficult to do (at work or at home). It’s better to plan a light day, with no particular constraint for you to rest. Avoid driving and drink plenty of water.

Most of the time, the used threads are absorbable.

In addition, you must be vigilant on any sign that seems strange to you (itching, burning, swelling, pain, fever) and notify your health care team for advice from a doctor.

In the days following the withdrawal of the Port, only have gentle activities, to not solicit the concerned area.