A chemo port, often called a port-a-cath, is a small device surgically placed under the skin, usually in the upper chest, connecting to a large vein. It is designed to allow healthcare providers to easily draw blood and administer various treatments, including chemotherapy drugs, fluids, and even contrast solutions for imaging, without needing repeated needle sticks. This device can remain in place for weeks, months, or even years, offering comfort and convenience by reducing the need for frequent vein access. While highly beneficial for long-term medical care, especially for cancer patients, the presence of a foreign object in the body carries a risk of infection.
Understanding Chemo Port Infections
A chemo port infection occurs when bacteria or other microorganisms enter the port system, leading to inflammation and potential complications. Infections can develop in different ways, ranging from localized skin infections at the port site to more serious bloodstream infections. The risk of infection is generally low, estimated to occur in about 2% of cases.
Infections can arise from various sources, most commonly from bacteria on the skin. During the insertion procedure, despite sterile techniques, microorganisms can be introduced. After placement, bacteria can enter through the needle insertion site, travel along the catheter, or colonize the port’s internal components. Common bacteria implicated include Staphylococcus species, along with other gram-negative bacteria and fungi like Candida species.
Recognizing Infection Signs
Recognizing a chemo port infection early is important for prompt medical attention. Signs can be categorized into local symptoms at the port site and systemic symptoms affecting the whole body. Local signs include redness, swelling, tenderness, or increased warmth of the skin over the port.
A discharge or pus coming from the port site or incision is another clear sign of a local infection. The skin might also feel firm or indurated. Systemic signs, which indicate a more widespread infection, include a fever of 101.4°F (38°C) or higher, chills, and general body aches or malaise. Some patients might also experience new or increased pain at the port site, or swelling in the arm on the same side as the port. If any of these signs appear, it is important to contact the healthcare team immediately.
Preventing Infection
Preventing chemo port infections involves consistent and careful hygiene practices. Handwashing is the first line of defense; wash hands thoroughly with soap and water for at least 20 seconds before touching the port or any related supplies. If soap and water are not available, use an alcohol-based hand sanitizer. Anyone assisting with port care, including family members or caregivers, should also adhere to strict hand hygiene.
Maintaining a clean and dry dressing over the port site is also important. Dressings should be changed every seven days or sooner if they become wet, dirty, or loose. When showering, cover the port and dressing with plastic wrap, securely taped, and keep the area away from direct shower spray to prevent moisture from reaching the site. When the port is not in use, it is generally safe to swim or bathe once the insertion site has fully healed, but always confirm with the medical team.
Certain activities should be avoided to prevent damage or infection. During the initial healing period, avoid heavy exertion and strenuous upper body exercises that could strain the port area. While the port is accessed, strenuous physical activities and contact sports should be avoided. Regularly flushing the port with saline or heparin helps prevent blockages and microbial colonization.
Responding to Suspected Infection
If a chemo port infection is suspected, contacting the healthcare team without delay is important. Symptoms such as fever, chills, new pain, redness, swelling, or drainage around the port warrant immediate medical evaluation. Self-treating is not advised, as professional medical advice is necessary to properly diagnose and manage the infection.
Upon reporting symptoms, the healthcare team will likely perform diagnostic tests. These may include blood cultures, where blood samples are taken from both the port and a peripheral vein to identify the specific microorganism causing the infection. Imaging studies, such as an ultrasound, might also be used to assess the area around the port for fluid collections or abscesses. Treatment typically involves antibiotics, which may be administered orally or intravenously, depending on the severity and type of infection.
In severe or persistent infections, or if the port is the clear source of a bloodstream infection, removal of the port may be necessary. The wound may be left open to heal and then closed once the infection clears.