What follows is an email I composed for the Hereditary Angio Edema (HAE) Digest in response to requests for information, posted here for those who may not be on the Digest’s mailing list (to join the mailing list, which is open to HAE patients and their families, click here).
CARING FOR YOUR PORT
On the premise that no information shared is ever wasted and no one can ever have too much knowledge, here’s some great info on how to take care of your port.
First, let’s define “port:”
In medicine, a port (or portacath) is a small medical appliance that is installed beneath the skin. A catheter connects the port to a vein. Under the skin, the port has a septum through which drugs can be injected and blood samples can be drawn many times, usually with less discomfort for the patient than a more typical “needle stick.” The term portacath is a portmanteau of “portal” and “catheter”. Port-a-Cath is a brand name; others include Microport, Bardport, PowerPort (power injectable), Passport, Infuse-a-Port, Medi-Port, and Lifesite (for hemodialysis patients). The term Totally Implantable Venous Access System (TIVAS) is also used. Additionally, portacaths are a form of a “central venous access device” and are frequently referred to as such in the medical field.
It’s easier to take care of something if you know how it works:
A port consists of a reservoir compartment (the portal) that has a silicone bubble for needle insertion (the septum), with an attached plastic tube (the catheter). The device is surgically inserted under the skin in the upper chest or in the arm and appears as a bump under the skin. It requires no special maintenance and is completely internal, so swimming and bathing are not a problem. The catheter runs from the portal and is surgically inserted into a vein (usually the jugular vein, subclavian vein, or superior vena cava). Ideally, the other end of the catheter terminates just upstream of the right atrium. This position allows infused agents to be spread throughout the body quickly and efficiently .
The septum is made of a special self-sealing silicone rubber; it can be punctured hundreds of times before it weakens significantly. To administer treatment or to withdraw blood, a health professional will first locate the port and disinfect the area. Then he or she will access the port by puncturing the overlying skin with a 90° Huber point needle. Due to its design, there is a very low infection risk, as the breach of skin integrity is never larger than the caliber of the needle. This gives it an advantage over indwelling lines such as the Hickman line. Negative pressure is created to withdraw blood into the vacuumized needle, to check for blood return and see if the port is functioning normally. Next, the port will be flushed with a saline solution. Then, treatment will begin. Also, after each use, a heparin lock is made by injecting a small amount of heparin (an anticoagulant) into the catheter. This prevents development of clots in the system. The port can be left accessed for as long as required. The port is covered in a dressing to protect the site from infection and to secure the needle in position.
Check out this site to see what a port looks like before implantation and to see a quick video of a needle insertion: http://www.gynoncology.com/Movies/Portacath_Insertion.htm
This link is to a photo-essay by a gentleman using a port to get chemotherapy: http://diehlmartin.com/infusion/
- After the port is put implanted and the skin over the port is healed, you may return to normal activities.
- Live as normally as possible. The port is just a part of your life.
- The port needs to be kept safe. Ask your doctor before you play a contact sport.
- After the skin over the port is healed, you can get the skin wet.
- When there is no needle in the port, can take a bath, shower, or swim. You may wash the skin as usual. A dressing is only put over the port when a needle is in it.
- You should not swim or take a shower when the needle is in. You can take a tub bath while the needle is in only if you keep the dressing dry.
- You must change the needle at least once a week if the dressing is transparent (OpSite, Tegaderm, and Sorbaderm are some examples of transparent dressings).
- If using a gauze dressing, change the needle every 48 hours.
- Call your doctor right away if the site around the port shows bruising, swelling, redness, bleeding or pain, or if you have a fever over 101є F, have chills, or the port seems to have moved.
- A port puts you at higher risk for an infection when getting dental work. Before and after dental work, you should be given antibiotics, so see your doctor first.
- Look at the skin over the port every day. If the port stops working, or causes discomfort, return to the doctor’s office or hospital to have it checked as the port may be infected.
- If you cannot flush the port, or cannot get a blood return:
- Do not use force to flush the port. The pressure could loosen a plug so it is free to block a blood vessel. Forceful pressure could even break the port.
- Make sure the tubing is not clamped.
- Make sure the port needle is pushed in so it touches the back or the port.
- Raise your arms over your head, or lay on your side, and try again.
- If you still cannot flush the port or get a blood return, call your health care team.
- Signs of infection can be drainage or oozing, such as pus, swelling, tenderness, soreness, warmth, pain, redness at the exit site, redness along the catheter path beneath the skin, a temperature above 101F orally (check with your health care provider), or odor from the exit site. If you see any of these signs, call your health care team right away.
No-swell blessings to all,
DISCLAIMER: The above comments are based on the personal experiences and opinions of the writer, and any errors are unintentional oversights (or possibly just plain ignorance). Readers should always consult their own physician for current and official medical facts, advice and opinions. ALWAYS take everything anyone (including me) tells you with (preferably) two grains of salt (especially if aspirin upsets your stomach as this could result in an abdominal attack [grin!]) and please don’t call me in the morning if you don’t like what I say. Bright blessings for a happy and swell-free day.