Vascular access
Totally implantable chemotherapy port
A port, or totally implantable venous access device, is a small reservoir placed under the skin of the chest and connected to a catheter that reaches a large vein near the heart. With it, chemotherapy and other medicines can be given and blood can be taken through a single needle in the skin over the reservoir, sparing the arm veins. Placing it is a short procedure under local anaesthesia and sedation that, in most cases, does not require a hospital stay.
What the port is for
Chemotherapy usually lasts for months, and many drugs irritate the arm veins. The port avoids repeated punctures, lowers the risk of the drug leaking out of the vein and allows long infusions to be given safely.
It is recommended for long treatments and for people with difficult veins. The decision to place a port is made together with the oncologist or the doctor in charge of your care.
What the port is like
The reservoir is roughly the size of a large coin and has a silicone membrane. It sits under the skin, usually below the collarbone. A thin catheter runs from it under the skin to the internal jugular vein, in the neck, or to the subclavian vein, with its tip near the entrance to the heart.
From the outside, you only see a small bump. To use the port, the nurse punctures the membrane with a special needle (Huber needle), which does not damage the silicone.
Port, PICC or external catheter
| Device | How it sits | Typical duration | Day to day |
|---|---|---|---|
| Port (totally implantable) | Entirely under the chest skin | Months to years | No dressing when not in use; bathing and sport allowed once healed |
| PICC | Enters through an arm vein, with a part outside the skin | Weeks to months | Weekly dressing and care to keep it dry |
| External tunnelled catheter | Part of it outside the chest skin | Weeks to months | Used in specific situations, such as bone marrow transplant |
How the port is placed
- It is placed under local anaesthesia, usually with sedation.
- The vein is ideally punctured under ultrasound guidance, and the position of the catheter tip is checked with fluoroscopy (real-time X-ray).
- A small incision, a few centimetres long, makes room for the reservoir and is closed with stitches.
- The procedure usually takes about 30 minutes, and you usually go home the same day.
- The port is tested before you leave the room and can be used the same day.
- The procedure is done in an operating theatre with a C-arm (mobile X-ray) or in the catheter lab. Patients should arrive at the hospital or clinic fasting and, if the procedure goes without complications, go home straight afterwards.
Care after placement
Day to day
- In the first few days, keep the dressing clean and dry. Mild pain and bruising (haematoma) at the site are common.
- In the first few weeks, avoid heavy exertion with the arm on the port side and tight straps over the site, such as bag straps. Keep wearing your seat belt; if it bothers you, protect the site with a small pad.
- Once healed, bathing, physical activity and sport are allowed, avoiding direct knocks on the reservoir or along the catheter.
- When the port is not in use, the team needs to flush it regularly so it does not block. The interval follows the service's protocol: usually every 4 or every 12 weeks.
- If you were given a port identification card, carry it when you are seen at other services.
Seek care the same day if
- you have a fever or chills, especially right after the port is used;
- there is redness, pain, warmth, discharge or swelling over the reservoir;
- the arm, neck or face on the port side swells;
- you have chest pain or shortness of breath;
- the skin over the reservoir becomes thin, dark or breaks open.
If the team has difficulty infusing or taking blood through the port, let the surgeon know. The cause can often be treated without removing the device.
Possible complications
Complications are uncommon when the port is placed using ultrasound and fluoroscopy. Right after placement, minor bleeding or a haematoma may occur. Pneumothorax (air between the lung and the chest wall) and haemothorax (blood collecting in that same space) are rare with ultrasound-guided puncture of the jugular vein. Other complications, such as accidental puncture of an artery or of lymphatic vessels and their consequences, are even rarer when the correct technique is used.
Later on, infection, thrombosis of the vein, blockage of the catheter, displacement and thinning of the skin over the reservoir may occur. Many blockages clear with a medicine given inside the catheter. Some infections require the port to be removed.
Removing the port
At the end of treatment, when the oncologist agrees, the port is removed in a simple procedure under local anaesthesia that usually takes less than 10 minutes. It can also be kept for a while if further treatment is possible, as long as it receives regular maintenance.
Frequently asked questions
Does the port show under clothing?
Only a small bump shows under the skin, more visible in slim people. With clothes on, it is usually not noticeable.
Does it hurt when the port is accessed?
You feel the needle prick, similar to a blood test. If the team allows it, an anaesthetic cream applied beforehand reduces the discomfort.
Can I bathe and swim with a port?
Once healed, yes, when no needle is connected. During an infusion, the area with the needle must be kept covered and dry.
Can I have an MRI scan with a port?
Most current ports are MRI-compatible under certain conditions. Always say that you have a port and, if you have one, show the card with the model.
How long can the port stay in?
It can stay in for years if it is working, has no complications and its maintenance is up to date.
References
- Sousa B, Furlanetto J, Hutka M, et al. Central venous access in oncology: ESMO Clinical Practice Guidelines. Ann Oncol. 2015;26(Suppl 5):v152–v168. doi:10.1093/annonc/mdv296
- Nickel B, Gorski L, Kleidon T, et al. Infusion Therapy Standards of Practice, 9th Edition. J Infus Nurs. 2024;47(1S Suppl 1):S1–S285. doi:10.1097/NAN.0000000000000532
About the author
Dr. Pedro Mellucci is a vascular surgeon in Presidente Prudente, Brazil, dedicated to vascular access for haemodialysis and chemotherapy: fistulas, grafts and catheters.
Meet Dr. Pedro Mellucci →