A port, or port-a-cath, is a small medical device implanted under the skin, typically in the upper chest, providing access to a large vein. Its primary function is to deliver intravenous medications, such as chemotherapy, antibiotics, or IV fluids, and facilitate frequent blood draws, protecting smaller veins from repeated needle sticks. Port placement is considered minor surgery, and patients are usually not “put to sleep” using general anesthesia. Instead, the procedure is most often performed using a combination of local anesthesia and conscious sedation.
Anesthesia Options for Port Placement
The standard approach for port placement uses local anesthesia combined with conscious sedation, allowing the patient to remain awake but deeply relaxed. Local anesthesia involves injecting a numbing agent directly into the planned incision sites on the chest and neck, ensuring the patient does not feel sharp pain during the surgery. This injection may cause a brief stinging sensation before the area becomes numb.
Conscious sedation, sometimes called “twilight sleep,” is administered intravenously to reduce anxiety and create deep relaxation. Patients are drowsy and comfortable, yet they remain responsive to verbal commands throughout the procedure. Many patients have little to no memory of the placement process afterward, contributing to a more positive experience.
General anesthesia, which involves complete unconsciousness and often requires a breathing tube, is rarely the first choice for adult port placement. It is typically reserved for specific medical circumstances, such as for pediatric patients who cannot cooperate, adults with extreme anxiety, or when the patient has a complex anatomy. The choice of anesthesia maximizes patient comfort while minimizing the risks associated with deeper sedation.
Preparing for the Procedure
Preparation begins with a review of current medications well before the day of surgery. Patients are often instructed to temporarily stop taking blood-thinning agents, such as aspirin or certain supplements, for several days prior to the procedure to minimize bleeding risk. Patients with diabetes will receive specific instructions for adjusting insulin or other medications due to fasting requirements.
A required period of fasting, known as NPO (nothing by mouth), is necessary before the procedure, usually meaning no food or drink after midnight. Some protocols, however, allow clear liquids up to a few hours before the scheduled time. Patients are usually asked to shower with an antibacterial soap the evening before and the morning of the procedure to reduce the risk of infection at the surgical site.
Upon arrival, an intravenous line will be placed in the arm or hand to administer the conscious sedation and necessary fluids. Due to the effects of the sedation, a responsible adult must drive the patient home and stay with them for the first 24 hours. Patients should wear loose-fitting, comfortable clothing that opens in the front to allow easy access to the chest area.
The Placement Process
The port placement is a sterile procedure performed in an operating room or interventional suite by a surgeon or interventional radiologist. The medical team cleans the skin on the chest and neck with an antiseptic solution and covers the area with sterile drapes. The procedure typically involves two small incisions: one near the collarbone for the port body and a smaller one near the neck to access the vein.
Using imaging guidance, such as fluoroscopy (a type of real-time X-ray) or ultrasound, the physician threads a thin, flexible catheter into a large vein, usually the jugular or subclavian vein. The catheter tip is positioned in the superior vena cava, a major vein above the heart, to ensure rapid dilution of medications. The catheter is then tunneled under the skin to the chest incision and connected to the port reservoir.
The port device is secured in a small pocket created just beneath the skin’s surface, where it will feel like a slight bump once healed. While the local anesthetic prevents sharp pain, patients often report feeling pressure or pulling as the surgeon works. The entire placement procedure is relatively quick, typically taking less than an hour.
Immediate Aftercare and Recovery
Following the placement, the patient is moved to a recovery area where nurses monitor vital signs until the effects of the conscious sedation wear off. This observation period usually lasts for one to two hours, and the patient must be fully awake and stable before being discharged. It is common to experience mild soreness, tenderness, and bruising around the incision sites for the first few days, which can generally be managed with over-the-counter pain medication.
Specific activity restrictions are put in place to allow the catheter to settle and the incision to heal properly. Patients are typically advised not to lift anything heavier than 5 to 10 pounds for the first three to seven days. Additionally, patients should avoid vigorous arm movements or exercises that pull on the incision area for about one week. The port can often be used immediately following the procedure for necessary treatments.
The incision site will be covered with a dressing, which should be kept clean and dry for the first 24 to 48 hours. Patients should call their healthcare provider if they notice signs of a complication. These include a persistent fever above 101°F, excessive pain not relieved by medication, or signs of infection like worsening redness, warmth, or pus draining from the incision.