Some medical treatments require specialized approaches for medication delivery or blood access that go beyond standard methods. When long-term or frequent venous access is necessary, a dedicated medical tool can offer a more effective and comfortable solution for patients.
Understanding Implanted Venous Access Devices
An implanted venous access device (IVAD), commonly known as a port-a-cath or simply a port, is a small medical device placed completely under the skin to provide easy and long-term access to a patient’s veins. This device differs from a standard intravenous (IV) line, which is inserted into a small vein in the hand or arm for short-term use. A port offers a more secure and comfortable method, avoiding the need for multiple needle sticks.
The device consists of two main parts: a small reservoir or port and a thin, flexible tube called a catheter. The port, often described as about the size of a quarter, is a hard-walled chamber with a self-sealing silicone septum on top. This reservoir is placed just beneath the skin, in the upper chest. The catheter is connected to the port and threaded into a large central vein, such as the subclavian or jugular vein, with its tip positioned near the heart, in the superior vena cava.
Medical Needs for an Implanted Device
Implanted venous access devices are used for various medical conditions and treatments that require frequent or prolonged access to a patient’s bloodstream. For example, long-term chemotherapy regimens necessitate an IVAD to deliver potent medications directly into larger veins, reducing irritation and potential damage to smaller peripheral veins.
Beyond chemotherapy, IVADs are also used for prolonged antibiotic therapy, where patients may need intravenous antibiotics for weeks or months. Applications include frequent blood transfusions, administration of nutritional support like total parenteral nutrition (TPN), and repeated blood draws for diagnostic testing. The use of an IVAD helps preserve peripheral veins, which can become fragile or scarred from multiple needle insertions, and reduces patient discomfort and anxiety associated with repeated venipunctures.
Device Placement and Operation
The placement of an implanted venous access device is a minor surgical procedure, performed in an outpatient setting and takes about an hour. The procedure is done under local anesthesia, though a light sedative or general anesthesia may be used. The device is placed in the upper chest, just below the collarbone, but can also be implanted in the upper arm or in the abdomen.
During the procedure, a small incision, 1 to 2 centimeters, is made in the skin to create a pocket for the port. Another small incision, in the neck, is made to access a large vein, such as the subclavian or jugular vein. A thin catheter is then guided through this vein, with the aid of ultrasound and live X-ray (fluoroscopy) imaging, until its tip is positioned in a large vein near the heart, the superior vena cava. The other end of the catheter is tunneled under the skin and connected to the port, which is then secured in the prepared pocket.
Once implanted, the device functions by allowing a special non-coring needle to be inserted through the skin and directly into the port’s self-sealing septum. This needle creates a pathway through which medications, fluids, or blood products can be infused, or blood samples can be withdrawn. After the infusion or blood draw is complete, the needle is removed, and the septum reseals, preventing leakage and maintaining the sterile environment within the device.
Living with an Implanted Device
Having an implanted venous access device allows for a return to daily activities once the surgical site has healed. Patients can shower after 48 hours, though direct submersion in baths or swimming pools should be avoided until incisions are fully healed, which takes about a week. When the port is not actively being accessed with a needle, there are few restrictions on physical activities, including exercise, though heavy lifting (over 10 pounds) or vigorous arm movements might be restricted for the first week after placement.
Routine care and maintenance are important for the device’s longevity and to prevent complications. When the port is not in use, it needs to be flushed with a saline solution, once a month, to prevent blood clots from forming inside the catheter and blocking the device. If the port is being accessed, the dressing covering the needle and port site should be kept clean and dry, and changed weekly or if it becomes loose or soiled. Patients should regularly inspect the area around the port for any signs of complications.
Watch for signs of a problem, such as increased pain, swelling, redness, or warmth around the port site. Fever, chills, or any discharge from the site could signal an infection, which warrants immediate medical attention. Difficulty flushing the port, inability to draw blood, or pain during infusions could indicate a blockage or mechanical issue with the device. When the device is no longer needed, it can be removed through a minor outpatient procedure, similar to its insertion, under local anesthesia.