What is a Portacath?
A Portacath consists of two parts, a tunnelled line and an injection port; these are connected together underneath the skin. The tunnelled central venous catheter is a long, thin, hollow tube. One end of the tube (the distal end) sits just near the entrance to the heart. The other end connects to an implantable port that sits just under the skin on your upper chest. The port is about the size of a 10 pence coin and is about 1 cm thick. You can usually feel the port as a small lump underneath the skin and occasionally you can see a bulge underneath the skin, especially if you are thin.
What is a Portacath used for?
A port can be used to give you treatments such as chemotherapy, blood transfusions, high-calorie liquids or antibiotics. Ports can also be used when it is necessary to take samples of your blood for testing. This makes it possible for you to have your treatment without having to have needles frequently put into your veins. You can go home with the port in and it can be left in place for weeks or months or, for some people, years. A port is more discreet than a central line or PICC line because it lies completely under the skin and has no external parts.
How is the Portacath put in?
You will have your Portacath inserted in the operating theatre. This is usually done under local anaesthetic and sedation and takes about 45 minutes. You should feel relaxed and sleepy throughout the procedure but you may feel some stinging when the local anaesthetic goes in and some pushing and pulling during the procedure. There may some brief periods of discomfort.
First, I will examine your veins with an ultrasound machine to decide on the best vein (I usually use the axillary vein which sits just underneath the collar bone). Then I will clean your chest and neck with antiseptic solution, and numb the skin with local anaesthetic. After this I will put a needle and a wire into the vein whilst watching with the ultrasound machine. You will then have an X-ray to make sure it is all in the correct position; this is done whilst you are in theatre. Then I will make a small cut in the skin near your collarbone and thread the tube into the vein (this is called the insertion site). The tube is then tunnelled under the skin to reach the port. I will make a 2-3 cm cut in the skin on the chest and create a little pocket to put the port in. Once it is all connected I will close the cuts with dissolvable stitches and put a special superglue dressing over the wounds.
The position of the port will vary from person to person but I will try to ensure that it is in a comfortable position and is as discreet as possible. I will discuss this with you before the operation. You may feel a bit sore and bruised for a few days after the port is put in. A mild painkiller such as paracetamol will help with this.
How is the Portacath used?
The port can be used immediately after it has been put in. When you are about to have treatment or have a blood sample taken, the skin over the port will be cleaned and a special needle, known as a Huber needle or gripper needle, is used to push through the skin and into the port (see diagram below). You may feel a slight sting as this is done. Your treatment will then be given down this needle and will come out into the bloodstream at the end of the central venous catheter. Blood samples can also be taken in this way if needed.
Care of your Portacath
After each treatment a small amount of fluid is 'flushed' into the catheter so that it does not become blocked. The port will need to be flushed every 4 weeks if it is not being used. The nurses at the hospital may teach you (or a friend or relative) to do this if you feel able to; otherwise, a nurse can do it for you at the hospital or at your home. Apart from this, your port should not need any care at all. Only Huber needles can be used with the Portacath, do not let anyone use any other type of needle on your port. The superglue dressing over the wounds is water resistant but not waterproof. For the first week after insertion try to avoid getting the wounds too wet (showers are fine but not baths). Once the wounds have healed it is safe to bath.
How is the Portacath removed?
When you no longer need the Portacath it will be taken out. I will do this for you in theatre using local anaesthetic. Sedation is not normally required. The operation will take about 20 minutes. I will make a small incision through the old scar just above the port. Once the port and line are freed up then I will be able to remove them. I will close the wound with dissolvable stitches and put a superglue dressing over the wound.