An implanted port (Port-a-Cath or TIVAD) is a small reservoir placed entirely under the skin, typically in the chest, connected to a catheter threaded into a large central vein. This device allows long-term access for delivering medications (like chemotherapy or antibiotics) and for drawing blood samples without repeated needle sticks. Routine maintenance, known as flushing and locking, involves injecting saline and sometimes a blood thinner into the port. Without this maintenance, the port system can quickly fail, leading to significant complications.
Port Occlusion and Device Failure
The most immediate consequence of neglecting port maintenance is mechanical blockage, known as occlusion. If the port is not flushed, residual blood or medication inside the reservoir and catheter tip can stagnate and clot. This coagulation forms a thrombus, or blood clot, which physically obstructs the device’s internal channel. Blockage can also involve the formation of a fibrin sheath, a layer of protein that develops around the external surface of the catheter tip inside the vein. Occlusions can be partial (infusion possible, but blood cannot be withdrawn) or total (inability to both infuse and withdraw). A blocked port cannot be used, often causing delays in treatment, such as postponing a chemotherapy session until the blockage is resolved.
Increased Risk of Systemic Infection
Beyond mechanical failure, an unflushed port increases the risk of serious infection. Stagnant blood and residual materials within the port and catheter act as a culture medium for bacteria. Bacteria, which can enter the system during access or migrate from the skin, multiply rapidly in this protected space. This growth can lead to a Central Line-Associated Bloodstream Infection (CLABSI), where the infection spreads directly into the patient’s circulatory system. Systemic symptoms include fever and chills. The infection can also manifest locally as redness, swelling, warmth, or drainage at the port site. Left untreated, a CLABSI can progress to sepsis, a life-threatening complication requiring immediate medical intervention.
Necessary Interventions and Potential Loss of Access
Once a port becomes occluded or infected due to lack of flushing, the treatment process becomes more complex than routine maintenance. For a port blocked by a blood clot, healthcare providers may attempt to restore patency by instilling a thrombolytic, or clot-dissolving, medication directly into the device. Specialized drugs, such as recombinant tissue plasminogen activator (tPA), break down the fibrin mesh of the clot and clear the line. The success of this declotting procedure is not guaranteed and adds time and cost to the patient’s care.
If the port is severely infected, particularly if the infection has spread or resulted in sepsis, the device almost always requires surgical removal. Infections that persist despite antibiotic treatment mandate prompt removal to prevent further complications like endocarditis. Losing the port means the patient loses reliable venous access. A new port may need to be surgically implanted in an alternative location, subjecting the patient to additional procedures, pain, and recovery time, which interrupts the primary course of treatment.