Procedures for Cancer Patients
Ports for Chemotherapy
Chemotherapy drugs can be administered in a variety of different ways into the veins. One of the most common methods is through a port that is surgically implanted into the arm or chest during a short outpatient procedure.
A port is composed of a plastic or metal reservoir that measures around the size of a quarter. The reservoir is connected to a small catheter that is designed to be placed into a vein. The port reservoir is placed just under the skin. The port reservoir has a soft rubber membrane along its surface that can be felt through the skin. During a chemotherapy session, the nurse or doctor can feel the rubber surface and place a small needle through the skin directly through the rubber surface and into the port reservoir. Once accessed, the infused chemotherapy drug(s) travel from the reservoir into the port catheter, the tip of which lies in a large central vein in the chest. Once placed, ports offer a long-term access to the patient’s veins for administration of chemotherapy. Ports may also be used for drawing blood and administering other IV medications and fluids. A port is placed completely under the skin, which affords conveniences to the patient not allowed by external catheters. For example, patients with a port can swim, bathe, shower, and exercise regularly after they have healed from the procedure.
Prior to the procedure, a nurse places an IV in the patient’s hand or arm so that a sedative may be administered during the procedure.
The patient lies flat on the procedure table and the skin at the base of the neck and the upper chest are sterilized. A local anesthetic is administered at the planned port placement site and extended under the skin towards the vein that will be used for venous access.
After adequate local anesthesia is provided, the doctor will make a small incision below the collarbone. A small space for the port is made under the skin. Next a small curved needle is guided under ultrasound from the small incision to the vein being used for access. Most commonly the jugular vein located at the base of the neck is used. A small wire is threaded through the needle and into the chest. The needle is removed. Over the wire, the catheter of the port is threaded into the vein and a live x-ray is used to guide positioning of the catheter. Typically, the catheter is placed so that its tip is located either just into the heart or just above the heart in a large vein called the superior vena cava. The catheter is then connected to the port which is then placed into the pocket and stitched in placed. The port’s function is tested for both giving fluids and drawing blood. After confirming its function, the small incision in the chest is stitched closed. An overlying sterile dressing is placed. The port is ready for immediate use.
Patients may experience discomfort around the incision site that can be relieved with over-the-counter medications if needed. Patients are provided with proper wound care instructions and are discouraged from engaging in strenuous activity or heavy lifting after the procedure. Once the incision heals, normal everyday activities may continue.
Dr. Kahn is a nationally recognized expert in minimally invasive therapies for placement of ports for chemotherapy. To learn more about treatments available at New England Endovascular Center call 413-693-2852 to make an appointment.