Totally Implantable Venous Access Devices (TIVAD) PORT-A-Cath

  • Reference Number: HEY1094/2020
  • Departments: Gastroenterology, Nutrition Support

Introduction

This leaflet has been produced to give you general information about a Port-A- Cath insertion and the ongoing care. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with your clinical nurse specialist.

What is a Port-A-Cath?

A Port-A-Cath is a small medical device which is the main form of a central venous access device. Central venous access devices are small, flexible tubes placed in large veins for people who require frequent access to the bloodstream to administer either intravenous fluid or parenteral nutrition.

The Port-A-Cath is made of two parts:

  1. A soft, thin hollow plastic tube known as a catheter. The tube is tunnelled under the skin with the tip sitting just outside the heart.
  2. A port or disc (Approximately 2.5- 4cm in diameter), is inserted in the chest and attached to the tube/catheter.

The catheter tip will lie in a vein just above your heart and the other end connects to the port in the chest. The Port-A-Cath shows as a small bump underneath the skin, you will be taught how to access the device to administer your treatment at home.

What is a Port-A-Cath used for?

Port-A-Cath’s are often used when giving medications for patients whose veins are weak or very narrow, or for those on long term treatment or therapy. Doctors may recommend the use of Port-A-Cath for patients who regularly require Parenteral Nutrition or Intravenous fluids. A Port-A-Cath can be left in for a long period of time, so it can be used throughout your treatment.

Can there be any complications or risks?

Serious risks and complications of having a Port-A-Cath inserted are very rare. However, as with any procedure, some risks or complications may occur. The vascular surgeon or vascular radiologist will explain these to you.

  • Bruising. This is quite common and normally settles a few days after the procedure.
  • Infection. The insertion procedure is carried out in a sterile condition to eliminate or reduce any sources of infection. However, infection may still occur from local infection of the skin or from within the bloodstream. Infections can be treated with antibiotics – in extreme cases you may have your Port-A-Cath removed.
  • Thrombosis or clot. Sometimes a clot of blood can form at the tip of the Port-A-Cath. To prevent this, a blood thinning solution can be locked inside the port and the catheter when it is not in use. Training will be provided from one of the commercial home-care companies.
  • Lung puncture. This happens when the lung is accidentally punctured during the procedure. It is a very rare complication and happens to one in every 1,000 patients. We may keep you in hospital for a few days until the lung has healed.

Are there any alternatives?

Other alternative forms of central access may have previously been used for example having a Tunnelled line or a peripherally inserted central catheter (PICC).

How do I prepare for insertion?

You come into hospital, have a Port-A-Cath inserted and go home the same day. In some cases you may be brought into hospital the evening before.

  • You will need to have a blood test to measure full blood count (FBC) and clotting before the procedure. Your doctor or clinic nurse specialist will arrange this.
  • If you are currently receiving chemotherapy, a blood test is needed within one week of the procedure. If you are not currently on chemotherapy a blood test within 8 weeks of the procedure is fine. If you have had a blood test for any other reason with in this time we can use the results.
  • If you are taking any medicines that thin your blood, such as antiplatelet medicines (for example aspirin or clopidogrel) or anticoagulant medicines (for examples warfarin, apixaban or rivaroxaban), please tell your doctor or the nurse as you may need to stop them temporarily before your procedure. Also tell your doctor or nurse if you have diabetes as you may need to alter the dose of your diabetes medicines, as you will need to fast before the procedure.
  • If you have coronary stents or metal heart valves in place then you should not stop these drugs but please let the department know before to coming to the hospital.

Please read the information leaflet.  Share the information it contains with your partner/carer and family (if you wish) so that they can be of help and support.  There may be information they need to know, especially if they are taking care of you following this examination.

What will happen?

You must not eat or drink for six hours before the procedure. You may need to be given a sedative, which may make you feel sick if you have just eaten. You may drink clear, non-milky fluids, such as black tea, black coffee or water up to two hours before the procedure. You will be advised when your procedure is arranged.

What happens before the procedure?

After you have arrived at the X-ray department, you will be examined and assessed by a radiology nurse and given a hospital gown to wear. A small plastic tube (cannula) will be inserted into a vein in your arm. This means that we can give you a sedative during the procedure, if you need it.

You will be given the opportunity to ask the vascular surgeon or the vascular radiologist (a doctor who uses X-rays to diagnose and treat illnesses) any questions you have.

You will also need to sign a consent form, before the procedure can take place to say that you understand what it involves. If you would like more information about our consent process, please speak to a member of staff caring for you.

How is the Port-A-Cath inserted?

If the Port is being placed in Radiology you will be asked to lie on the X-ray table or if it is to be placed in Theatre you will be asked to lay on a trolley. The area for the insertion will be cleaned with antiseptic fluid and draped with sterile towels.

The radiologist will inject some local anaesthetic into your skin on your chest and neck to numb the area. This may sting a little as it goes in. After this you should only feel pressure not pain. Please let the nurse know if you are uncomfortable.

The radiologist will make two cuts in the skin. The catheter will be inserted into the vein in your chest via one of these cuts. It will then be tunnelled under the skin to the second cut. The catheter is then connected to the port, which is fitted into a space created under the skin. We will check the position of the catheter and port with the X-ray machine. If it is satisfactory the cuts are then stitched or dissolvable stitches are applied. A dressing is put over the site.

Will I feel any pain?

The local anaesthetic injection will sting momentarily. The examination should be pain-free but you may still feel pressure where the doctor is working. If you experience any pain during the procedure please tell the nurse so pain relief can be given to you.

Once the local anaesthetic wears off you may have some pain or discomfort. Pain medication such as paracetamol can be taken to ease the discomfort.

What happens after the Port-A-Cath has been inserted?

After the insertion you may stay in radiology recovery if you are attending as a day case or you may return to the ward for additional observation. Your blood pressure and pulse will be measured frequently at first and then at regular intervals and a clip on your finger will measure the oxygen level in your blood. This is not painful.

The nurse will tell you when you can get up and move around. You will have two dressings on the port site and on the base of your neck. These require changing after 48 hours.

Arrangements will be made with your commercial home-care provider to remove the dressings and to review the site.

You will need a responsible adult to take you home by private transport.

Care of the Port-A-Cath

The Port-A-Cath requires very little maintenance once the skin has healed. It is not visible to the outside but a small bump may be felt where the port was inserted. You may have a shower, bath or swim.

Your Port-A-Cath needs flushing once every four weeks when not in use. It will be flushed pre and post your home infusions of either intravenous fluids or parenteral nutrition. Training will be provided with your home-care provider.

How will I know if something is wrong with my Port-A-Cath?

If you have a temperature, chills or feel unwell, please contact the clinical nurse specialist looking after you. This could be an early sign of infection.

Also let your nurse know if you are experiencing pain, redness or swelling on the pocket or disc site and if your arm, chest, neck or shoulder feels swollen and painful. Your clinical nurse specialist may need to arrange admission to hospital for you to be assessed. An alternative route for administration of your treatment may also be required.

How is the Port-A-Cath removed?

When you no longer need the Port-A-Cath it will be taken out. This is usually done in the department where you had it inserted. Local anaesthetic will be applied to the area. A small cut is then made over the port site and the Port-A-Cath is removed. As the catheter is attached to the port, this will be removed at the same time. The wound will then be stitched and dressed.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact your clinical nurse specialist in the Nutrition Team on:

Tel no 07827 937025 or the Vascular team caring for you.

You will need a responsible adult to take you home by private transport. We do not recommend that you use public transport as it is unsafe if you feel unwell. You will also need somebody to stay with you overnight.

When can the Port-A-Cath be used?

The Port-A-Cath can be used as soon as it is inserted. Prior to accessing the Port-A-Cath the skin will be cleaned, a topical local anaesthetic may be used. A special needle is then pushed through the skin into the port with a short extension set; this should be changed every 7 days. Treatment is then given via this needle into the Port-A-Cath. The treatment goes into the port and flows into the catheter and your bloodstream.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.