Serenity Mirabito, MSN, RN, OCN, is a published oncology nurse writer who advocates for those surviving and thriving with cancer.
Douglas A. Nelson, MD, is double board-certified in medical oncology and hematology. He was a physician in the US Air Force and now practices at MD Anderson Cancer Center, where he is an associate professor.
Chemotherapy is a group of medications that destroy cancer cells. Many chemotherapy treatments are given through a vein. This is called intravenous (IV) administration.
Unfortunately, some chemotherapy medications are too dangerous to give in the small veins of the hands and arms that are typically used for IV lines. If this medication accidentally leaks out of the vein, it can cause tissue and skin damage to the surrounding areas.
Having a special vascular access device (VAD) called a port-a-cath (port) allows chemotherapy to be administered safely. The port can also be used for blood draws, other IV medications, and special imaging tests like CT (computed tomography) scans or PET (positron-emission tomography) scans.
This article explains what ports are, how they're used, and their potential benefits.
A port is a device that is surgically placed under the skin on either side of the chest, just below the collar bone. The port can also be placed in a different body area depending on the type of cancer and the person's medical condition. The procedure is done in the hospital, and most people go home the same day.
The port is made of two parts: the portal and the catheter. The portal is a small, heart-shaped drum. The top of the drum is made of self-sealing silicone so a Huber needle can puncture it. The remainder of the drum is plastic.
Some people may have a port with two portals or drums. Although completely under the skin, the portal will appear as a small bump on the chest.
The catheter is a thin plastic tube attached to the bottom of the portal. It's a few inches long and is surgically threaded into a large vein in the chest. Commonly used veins are the jugular, subclavian, or superior vena cava.
The port allows for the safe and easy delivery of medications, as well as the withdrawal of blood. There are no tubes or catheters outside the body when the port is not used. Once the surgical site is healed, swimming, bathing, and showering are allowed.
You and your oncologist (cancer doctor) will decide together whether you need a port. Factors to consider are:
Not everyone who receives cancer treatment needs a port. Some cancer medications are safe to infuse into the veins of your arms. Your oncology nurse will assess the veins in your arms to determine if you need a port.
The biggest benefit of a port is safety. Making sure chemotherapy is being administered in the safest way is reassuring for you and your oncology team.
Ports are also easy to use. There is no difficulty trying to find a vein. If chemotherapy is given daily or frequent blood draws are required, the Huber needle can be left in, decreasing the number of venous punctures you may need. A clear dressing is placed over the Huber needle to protect it while it's left in place.
In addition, the port device can remain in the body for many years, making follow-up imaging and blood work easy. Clinical guidelines need to be followed for managing and using infusion ports.
Before the port is accessed (punctured), a nurse will clean the skin above and around the port site. Cleaning the skin with an alcohol solution helps decrease infections.
The nurse will wear a mask during this procedure and use sterile supplies that are free from microorganisms. You shouldn't cough or breathe on your skin during this process. Turning your head to the opposite side is helpful.
Once your skin is dry:
Although it's convenient to use the port for labs, there are times you may need a venipuncture (blood drawn from the arm) instead. Here are some reasons your bloodwork may not be done through your port:
A nurse or phlebotomist (healthcare professional who draws blood) must be trained in the correct method of cleaning or flushing a port before it can be used to obtain a blood sample.
A port is a device implanted under the skin to give access to a large vein. They are used when a person needs frequent blood draws or IV medications. They are also used to administer chemotherapy drugs that are too dangerous to give through small veins. Their main benefit is safety, and they can be left in place long-term.
Being diagnosed with cancer and needing chemotherapy can be scary and stressful. Although the thought of getting a port may also be unnerving, it is essential for your safety and well-being during cancer treatment. Once the port site heals, you can resume normal daily activities and may not even know it's there. In addition, having a port can alleviate the worry of being poked numerous times. Once your treatment is over, you and your oncologist can discuss the best time for the port to be removed.
Depending on the type of cancer, you may need to keep your port in for up to a year after treatment. Many people, however, enjoy the ease of having a port and keep them in for years. As long as the port is properly functioning, there are no signs of infection, and it is flushed every 12 weeks, your port can stay in for the long term.
All registered nurses, nurse practitioners, and doctors can draw blood from ports. Other clinical staff, like phlebotomists, may need a special certification to draw blood from a port. Each state and organization has its own rules about who can access ports.
Sometimes a small blood clot called a “fibrin sheath” forms at the tip of the port's catheter. This clot prevents blood from being withdrawn from the port. The port device catheter can also become twisted or improperly positioned, preventing a blood return.
Drawing blood from your port hurts about the same as having blood drawn from your arm. Placing ice over your port site 10 minutes before the puncture can alleviate some of the discomfort. Numbing cream is available by prescription if you find your port puncture too painful.
Before your port is accessed (punctured) with a Huber needle, the nurse will clean your skin with an alcohol solution to prevent infection. Once the port is accessed, it is flushed with normal saline to clean or rinse the inside of the device.
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Li G, Zhang Y, Ma H, Zheng J. Arm port vs chest port: a systematic review and meta-analysis. CMAR. 2019;11:6099-6112.
Nurse.org. What is a port-a-cath?.
American Cancer Society. Tubes, lines, ports, and catheters used in cancer treatment.
American Society of Anesthesiologists. Practice guidelines for central venous access 2020: An updated report by the American Society of Anesthesiologists Task Force on Central Venous Access. Anesthesiology. 2020;132(1):8-43. doi:10.1097/ALN.0000000000002864
Centers for Disease Control and Prevention. Guidelines for the prevention of intravascular catheter-related infections.
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