PORT FOR

CHEMOTHERAPY
OBJECTIVES

At the end of this presentation learners will be able to define:

• What is port for chemotherapy
• When it is used
• Sites of insertion
• How it is inserted
• Types of port a cath.
• Possible benefits
• Possible risk related to port
• Nursing care
• CVCs( central venous catheters) are considered more manageable than a regular
intravenous (IV) catheter because they can stay in your body longer. Some CVCs can be
left in your body for weeks, months, or years. But a regular IV catheter can only stay in
for a few days. This means your oncologist or nurse will have to reinsert multiple IVs
into your veins over the course of your treatment.
• There are different types of CVCs that are used, but the most common are peripherally
inserted central catheters (PICC lines) and ports. The type of CVC you’ll need depends
on a few of the following factors, including which one your oncologist prefers:
• How long you’ll need chemotherapy
• How long it takes to inject your chemotherapy doses
• How many drugs you’ll receive at once
• Whether you have any other medical problems like blood clots or swelling
WHAT IS PORT?

• A chemotherapy port (also known as a "port-a-cath") is a small

device that is implanted under your skin to allow easy access to
your bloodstream.
• A port-a-cath, also referred to as a port, is an implanted device
which allows easy access to a patient’s veins.
• A port-a-cath is surgically-inserted completely beneath the skin
and consists of two parts – the portal and the catheter.
WHEN IS A PORT USED?

• A port can be used to draw blood and infuse chemotherapy drugs.

• It can also be used if you need transfusions of red blood cells or platelets.
• Without a port, or a PICC line, a new intravenous needle (IV) will need to be placed each
time you have chemotherapy, and separate IV lines will need to be placed if your require
IV fluids or a blood transfusion.
SITES OF INSERTION

• Juglar vein
• Subclavian vein
• Superior vena cava
• Ideally it is inserted in SVC
just upstream of the right atrium
HOW IS A PORT INSERTED?

• A port is most often inserted during a same-day surgical procedure that can be performed with a
local anesthetic.
• Most physicians prefer that you have your port placed at least one week before beginning
chemotherapy (if possible) and studies suggest that having your port placed at least eight days
prior to an infusion reduces the risk for complications.
• If you are having a surgical procedure for your cancer, such as a lobectomy for lung cancer or a
mastectomy for breast cancer, your surgeon may insert a port at the same time your other
surgery is performed.
• When a port is placed during surgery, you will already have a general anesthetic in place.
• How-To Access a Port:
• A Port Access Kit (sterile gloves, CHG(chlorhexidine gluconate) cleanser, central line dressing kit, skin
protectant)
• A Biopatch (or disc impregnated with CHG)
• Masks for yourself and the patient
• Needless Connector
• A 90 degree, Non-Coring Port needle (also called a Huber needle) or PowerLoc needle for PowerPort
• Sterile Normal Saline flush syringe
• Explain the procedure to the patient. Perform hand hygiene and apply clean gloves
• Locate and palpate the port.
• Place a mask on the patient and nurse.
• Perform hand hygiene again.
• Open the sterile port access kit and create a sterile field. Add your non-coring needle, Biopatch, and
sterile 10cc syringe to the field.
• Apply sterile gloves.
• Attach the flush to the non-coring needle and purge the air by priming the line until you see the saline
drip from the needle tip.
• Scrub the site clean with CHG from the kit using a back and forth/up and down motion for the
amount of time indicated on the directions, typically 30 seconds to 1 minute in each direction.
• Allow the antiseptic to dry on the skin.
• Stabilize the port with the index finger and thumb of your non-dominant hand.
• With the needle at a 90 degree angle from the skin, insert the needle into the center of the portal
chamber until you feel the needle hit resistance at the back of the chamber.
• Aspirate the syringe to assess for blood return and verify placement.
• Once blood return is verified, flush the tubing and clamp. Connect the needless connector.
• Apply the Biopatch around the needle with the blue side up.
• Apply skin protectant around the site.
• Cover the entire site with a transparent dressing. All sides should be occlusive. If patients have
sensitivity to Tegaderm, Opsite may be used.
• Label the site with date, time, and nurse’s initials.
• Re-access the site and change the dressing according to hospital policy.
• Once a port is cleared for use, a patient may receive intravenous therapy through it for the
course of his/her treatment. An adult portal chamber can take about 2,000 punctures on
average, which may last a patient several years.
 DIFFERENT TYPES OF PORTS

• A port can be single or double lumen.

• Single lumen ports are most common and typically sufficient for patients requiring
scheduled intravenous therapy.
• However, having a double lumen port is advantageous for patients who often receive
multiple intravenous therapies at once. If two intravenous agents aren’t compatible in the
same line, you can infuse both simultaneously in different port lumens without
complication. The double lumen port also allows concurrent infusion of medication,
chemotherapy, blood products, or parenteral nutrition. It is also beneficial for drawing labs
without interruption of an infusion.
 POWER PORT
• 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". Ports are used mostly to treat hematology and oncology patients.
• Lightweight for patient comfort
• Easily identifiable
• Power injectable
• Comprehensive Patient Discharge Packet
• Receive contrast-enhanced CT
• The PowerPort® device is the first port indicated for
power injection (when used with a PowerLoc® Safety
Infusion Set Family† device). It combines reliable
venous access with the unique ability for power-injected
Contrast-Enhanced Computed Tomography (CECT)
scans. Power-injected CECT scans produce superior
images to help better manage patient care. Such scans
are often used to track tumor markers or perform
pulmonary embolism studies.
• The palpation bumps and unique triangular shape of
PowerPort® Implantable ports make them easily
distinguishable from non-power ports. The PowerPort®
devices offer easy, flexible placement and access.
POWERLOC

• The PowerLoc® safety infusion set is the

ideal device for accesing PowerPort®
devices. This combination of power
injectable devices enables contrast agents to
be power-injected. As a result, tissues show
up more clearly in CECT scans, making it
easier to monitor patient condition.
BENEFITS AND ADVANTAGES

• Greater comfort: A single needle stick through your skin is usually all that is needed to
access your port. With IV therapy and traditional blood draws, sometimes many needle
sticks are needed to find a good vein, especially if your veins have been damaged from
repeated blood draws and infusions. (Chemotherapy can cause changes in your vein that
make them very difficult to puncture with a needle.)
AVOIDING DELAYS:

• Not only do you avoid the delay of having your nurse attempt to find a good vein to
draw blood or infuse chemotherapy, but having a port can reduce the time needed to
prepare your hand or arm for the procedure.
LOWERING THE RISK OF "EXTRAVASATION:"

• When an IV is used, medications are more likely to leak (extravasate) into the tissues
surrounding your hand or arm. Since many chemotherapy medications are caustic to
tissue, a port can reduce the risk of inflammation-related to leakage of these medications.
EASIER BATHING AND SWIMMING:

• Since a port is completely under the skin, you can usually bathe and even swim without
being concerned about the risk of infection.
POSSIBLE DISADVANTAGES OF A CHEMOTHERAPY PORT

• The risk of the surgical procedure to install the port: Any surgical procedure can carry
the risk of infection. Uncommon complications (those which occur in less than one
percent of people) of insertion can include
• bleeding (such as if the subclavian vein is punctured) and
• a pneumothorax (collapse of the lung) if your lung is accidentally punctured during the
procedure.
INFECTION:

• The risk of infection varies in studies but isn’t uncommon. If a port becomes infected, it
will often need to be removed and replaced. Research is evaluating methods of reducing
this risk, so it is important to talk to your oncologist about how to properly manage your
port.
THROMBOSIS:

• A clot may form in the port or catheter, causing it to stop working. Between 12 and 64
percent of people who have a port placed for chemotherapy will develop a thrombosis
(clot) in the catheter (often causing a need for the port to be replaced.)
MECHANICAL PROBLEMS THAT CAUSE THE PORT TO
STOP WORKING:

• In some cases, mechanical problems, such as movement of the catheter or separation of

the port from the skin, can cause a port to stop working.
LIMITATIONS IN ACTIVITY:

• Though activities such as bathing and swimming are usually okay, your oncologist may
recommend holding off on exercises to strengthen your upper body or arms until your
port is removed.
SCARRING:

• Given the gravity of cancer treatment, a scar from the port is a relatively minor
drawback. But some people may find a scar on their upper chest disturbing for cosmetic
reasons or because it is a symbol that you once went through chemotherapy.
HOW IT DIFFERS FROM A PICC LINE

• PICC stands for "peripherally inserted central catheter." A PICC line is usually placed in a
vein for shorter-term treatment (for example, for access that will be needed for one to six
weeks only). PICC lines are placed in your arm closer to your skin (subcutaneous) and do
not reach as close to your heart as a port catheter.
HEPARIN TO BE FLUSHED

• Normal saline is used to flush fluids through, a heparinized saline solution is usedto
maintain patency while maintaining access or to discontinue access. Usually, aPort-A-
Cath is flushed with 10mL of normal saline and locked with 2.5mL normal saline mixed
with 2.5mL of heparin 100 units/mL for a 5m total volume.
DOES PORT REQUIRE HEPARIN

• The catheter may be flushed with normal saline, and it does not require heparin to
maintain patency. The PowerPort* implantable port is indicated for patient therapies
requiring repeated access to the vascular system. The port system can be used for
infusion of medications, I.V.
NURSING MANAGEMENT
PRE-INSERTION CARE

Provide and document patient teaching. Include the following: purpose,

placement, insertion procedure, and post-insertion care, including what to report
to the nurse.

The following bloodwork may be considered: CBC, INR, PTT to assess for
coagulopathies and thrombocytopenia.
INSERTION CARE

• An implanted vascular access device (IVAD) or infusion port may be inserted in

interventional radiology or in the operating room. In interventional radiology, the procedure
is preformed under local anaesthesia using fluoroscopy to facilitate correct tip placement.
• Two small incisions are made. A small incision slightly larger than the diameter of the device
is made and a small pocket for the port is created under the skin.
• Another very small incision is made above this site and the catheter is threaded through the
vein until the distal end is situated in the lower 1/3 of the SVC. The port is sutured in place.
• IVADs are flushed and heparin locked at the time of insertion.
POST-INSERTION CARE

• Immediately, and for the first two hours post insertion, assess the insertion site for
bleeding, redness or swelling. The patient's level of comfort and any abnormal sensations
at the site should be assessed. Any abnormal sensations should be reported to the
physician immediately. These symptoms may include pain upon inspiration, burning, or
throbbing.
• Steri-strips may be applied to the site or a skin adhesive may be used to close the incision.
Immediately following insertion, the site is covered with a sterile gauze dressing; this
should be removed 48 hours following insertion. If steri-strips are applied, remove 5-7
days post-insertion.
• The patient should be encouraged to keep the incision dry when showering or bathing for
the first week by applying saran wrap over the wound.

• If complications are noted, refer to the nursing actions outlined in the complications
section.

• All patients should be aware of safety precautions and signs and symptoms to report to
the health care professionals.
• flushing the port with 20 mLs normal saline following drug
administration or blood sampling and every 4 weeks when not
in use.
COMPLICATIONS

Three major complications of all CVADs:

• 1. Occlusions - may be mechanical, thrombotic or non-thrombotic.
• 2. Infection
• 3. Venous thrombosis
 REFERENCES

• Bard, C. R. Inc. (2013). Various medical device images. Bard Access Systems, Inc. Retrieved October
2012 from http://www.bardaccess.com Camp-Sorrell, D. (2010). State of the science of oncology
vascular access devices. Seminars in Oncology Nursing, 26(2), 80-87.
• Camp-Sorrell, D. (2009). Accessing and Deaccessing Ports: Where is the Evidence? Clinical Journal of
Oncology Nursing, 13 (5), 587-590.
• Health Canada (2011). Health Alert: Complications of Catheter Pinch-off Associated with Central
Vascular Access Devices. Canada: Author.
• Infusion Nurses Society. Infusion Nursing Standards of Practice, Journal of Infusion Nursing, 2011.
34,1S January/February