If you do not have good veins to insert an IV easily and reliably into a large vein in your arm, you may need to consider a port. Above is an example of a port.

A port is a miniature “pin cushion” device that is inserted underneath the skin of the upper chest (usually the left side). There is a hollow tube that comes off the port, tunnels under the skin and enters into the internal jugular vein in your neck.

When your port is accessed, a nurse takes a special needle and inserts it through the skin into the center of the hub of the port. This is the clear solid gel like area on the port pictured above.

Placement of a port is a minor surgical procedure that requires a light “twilight” anesthesia and not a general anesthesia. A local, numbing medicine is injected into the skin. A few sutures are required to secure the port and close the incision.

The risks of surgical placement of a port include collapsing the lung, infection, and formation of a blood clot in the jugular vein. A jugular vein or subclavian blood clot is not life threatening but may require removal of the port or blood thinning medications. Blood clots involving the port are not uncommon. Seek medical attention if you notice swelling in your neck, face, or arm, especially if swelling in the neck or arm is on the same side as your catheter. Lung collapse is uncommon, but can occur at the time the port is placed or several days after. Seek medical attention if you have shortness of breath, or pain taking a breath after your port is placed. Minor soreness in the area after port placement is common. Infection is uncommon, but can occur. If the port site is painful, swollen, or reddened seek medical attention. If you have unexplained fever, sometimes the port is removed as it can be the site of infection.

A port may lose its “return” but still “flush.” This is not uncommon. This occurs when the catheter tubing develops a small blood fibrin clot on its tip. This will allow the nurse to flush, or push, fluids through the port, but will act as a “ball valve” and not allow the nurse to pull back blood from the port. A “clot buster” medicine called Cathflo (Activase) may be instilled into the catheter to see if this dissolve the fibrin clot and enable the nurse to draw blood from the port. A minor inconvenience of not having a “return” from the port is bloodwork will have to be drawn by a separate blood stick in the arm. If the port flushes easily, but does not return, it generally can still be used, but a dye study (called a portogram) may be ordered to ensure the port is in proper position.

Ports should be flushed periodically to increase the rate of long term patency. This involves flushing intravenous fluid and a blood thinner such as heparin into the port. If you have your blood work drawn or treatment administered through the port, it will be flushed at that time. Recommendations on how often to flush the port may vary among doctors. Manufacturers often cite 4 weeks, but some studies suggest interval of 4 to 12 weeks are acceptable.

A port may not be needed if only a short course of chemotherapy is planned (for example, 4 chemotherapy treatments) and a patient has adequate veins. Some chemotherapy drugs, called vesicants, can cause significant injury to the tissues if they inadvertently leak outside of the IV they are administered through. This is called extravasation. If a high risk vesicant chemotherapy drug is to be used, a port may be placed to lower the risk of extravasation. Ports are underneath the skin, PICC lines come through the skin surface and are easier to remove, but have higher rates of infection.

Once chemotherapy is finished the port is removed. Many patients elect to keep the port in place for 1 to 2 years in case they need to restart chemotherapy. Whether to remove the port depends on the personal preference of the patient, doctor, and the risk of cancer recurrence.

Most ports can be used to administer CT scan dye during the time of a CT scan. They also can be used if you need to undergo a surgery, receive antibiotics, or blood transfusions.