Ports and catheters used during chemotherapy
Ports and catheters are used in a number of medical treatments. For cancer patients, they may be used during surgery, for fluid removal, to give food or administer chemotherapy medicine.
Ports and catheters: What’s the difference?
Catheters are flexible, thin tubes inserted through the skin to provide direct access to a patient’s vein. Sometimes there’s an access point taped down to the outside of the skin, and other times the catheter goes completely under the skin. If it’s under the skin, a port is inserted to access it.
Together, the catheter and port are helpful when a care team needs intravenous (IV) access throughout an extended period of time (for example, for patients undergoing treatment regularly over many months). You’ve probably had blood drawn, and you know sometimes it’s difficult to find the vein. If you get pricked over and over, scar tissue may form, making it trickier to get to the vein. Catheters and ports provide a clean, semi-permanent access point to use for weeks, months or even years. This means fewer needle pricks. Once you no longer need it, your care team removes it.
Types of ports and catheters
Different types of devices may be used, depending on the length of your treatment, your ability to care for the catheter, and your treatment plan.
IV catheter: Also known as a peripheral IV, this is commonly inserted on the back of your hand by a nurse or other medical professional. An IV is for the short term, staying in for a maximum of two to three days. It’s removed upon leaving the care facility.
Peripherally inserted central catheter (PICC, or “pick” line): This catheter is for more long-term use and is placed at the inner elbow, where you would typically give blood. A local anesthetic—or numbing agent—may be used so you don’t feel pain while a nurse or other provider inserts the catheter tube into your vein with a needle. Once the needle is removed, the tube stays in the vein. The rest of the catheter is on the outside of the body. The PICC may be left in for weeks to months.
Central venous catheter (CVC): Similar to a PICC, this catheter provides longer-term access to blood vessels, but it’s inserted under the collarbone. “Central” means the catheter goes in a wider blood vessel much closer to the main blood supplier—your heart. A light sedation or local anesthetic is used during the insertion. The CVC may be left in for weeks to months. It’s also known as a central line or Hickman catheter.
Implantable port or port-a-cath: Unlike catheters, the body of a port goes under the skin, leaving a small visible bulge that the skin grows over. A surgeon inserts this into your arm or chest using conscious sedation (a light form of sedation), or a local anesthetic.
What are some benefits of catheters?
- With an already established access point, you may avoid getting needle-pricked each time you have chemotherapy.
- Multiple treatments may be administered at the same time.
- A secure and lasting access route prevents bleeding or bruising.
- Drugs are less likely to leak out of the vein.
- Sometimes having a catheter allows you to administer treatment at home through a wearable or portable pump.
What are some benefits of ports?
- Ports are useful if you require frequent treatment given over several days.
- There’s extended access to a “good vein” for administering medications.
- Ports allow your care team to also take blood for blood testing.
- Double ports allow two different medications or drugs to be given at once.
- Bathing and swimming are still possible with no extra caretaking.
What are the risks of getting a catheter or port?
As with any medical procedure, there are risks associated with getting a catheter or port.
For all catheters, it’s possible that these problems may happen during insertion:
- Sometimes other blood vessels near the site are punctured. This may lead to additional bleeding or bruising around the site of insertion.
- Very rarely, the catheter may be mistakenly placed in an artery (where blood flows away from the heart) instead of a vein (where blood flows to the heart). If that happens, it’s removed and placed correctly.
For central line catheters that are threaded toward the heart:
- The lung may be punctured and deflated, a condition called a pneumothorax. Ultrasound imaging may be used to guide the tube through the blood vessels and prevent this from occurring.
- The heart’s natural rhythm is sometimes disrupted for a moment. The heart rebounds to normal after your care team repositions the central line.
Problems that may potentially develop after insertion of a catheter or port are infections, blood clots or blockages, and movement or leakage of the catheter or port. Specifically:
- Skin infection around the site
- More serious infections
- Leaking from the catheter
- Blood clots
- Twist in the catheter tube
How to care for ports and catheters
Ports and catheters, though accomplishing similar things, require different care. Your cancer care team may guide you through how to take proper care of your catheter or port.
Caring for catheters
An IV (peripheral) catheter may be cared for by your nurse in the clinic. For central line catheters, some special care is required. The outside of the catheter is typically dressed with bandages to ensure that it stays in place and is comfortable. This dressing cannot get wet and should be covered when showering or bathing. The skin needs to be regularly flushed around the site of insertion to prevent infection.
Your care team may explain general care for central line catheters. Typically:
- Wash your hands before touching the catheter.
- Don’t touch the catheter if the tip cover is off.
- Clean skin around the catheter and change bandages when instructed.
- Keep the clamps and/or caps tight to ensure no air gets in. Extra clamps may be given to you in case they are necessary to seal off the catheter. Your care team may show you how to properly seal your specific catheter type.
- Don’t submerge the catheter in water. If the bandage gets wet, it should be replaced.
- Be aware of the catheter so it doesn’t get cut or broken. Sometimes it helps to tape the catheter down to your skin (with skin-safe tape) to prevent pulling and tugging.
Caring for ports
Since the port is entirely under the skin, the site of insertion heals over. The implanted port should be flushed out about once a month when not in use, but otherwise doesn’t require any special attention. You may be able to bathe, shower and swim as usual. Your care team may provide specific instructions, so you know when you can return to normal activities after its placement. A special needle is used to access the port when medication delivery or a flushing procedure is needed. This feels the same as any needle going into the skin, so it may be a little uncomfortable.
Your care team may provide specific instructions about how often to flush the area with fluids, when and how to change the bandage, and other recommended care for your catheter or port.
Make sure to examine the site of insertion for anything out of the ordinary. Call your care team if you notice:
- Redness, swelling, pain or bruising around the catheter port
- Significant bleeding around the catheter port
- Fluids leaking from the catheter
- Shortness of breath or dizziness
- Changes in your heartbeat
- The tube sliding out
- A blockage preventing liquid to go through the catheter or port—don’t attempt to force fluid into the catheter
How are ports and catheters removed?
Catheters are removed by a medical professional. The tube is lightly tugged on until it loosens and then carefully pulled out. Usually, this is painless, and no numbing medication is necessary.
Ports are inside of the body, so removal requires a small cut in the skin. Central catheters in the chest have a larger entry site, so they also may need more careful removal. A local anesthetic or conscious sedation may be used.
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