What Port Placement Is Really Like

An implanted port is a small chamber, roughly the size of a large button, that sits under the skin of your upper chest, usually an inch or so below the collarbone. A thin, soft tube runs from the chamber into a large vein near the heart. Chemotherapy, fluids, contrast, blood products and blood draws all go through it, which spares the small veins in your arms from repeated needles and from drugs that irritate them.

Placement is done by an interventional radiologist or a surgeon, almost always as a day case. In most centers you are awake but sedated: local anaesthetic numbs the skin over the chest and the base of the neck, and sedation through a drip keeps you drowsy and comfortable. Some centers use general anaesthesia instead. The procedure itself commonly takes about 30 to 60 minutes; some programs tell patients to allow around an hour.

There are usually two small incisions, one near the base of the neck and one on the chest, and the doctor uses ultrasound and X-ray to guide the tube into the right vein. You will not feel the tube being threaded.

Budget far more time than the procedure takes. Blood tests, waiting, and sedation recovery fill the day. You should not drive afterwards, so arrange a lift.

Sore, bruised, and oddly present. Pain at the incisions and along the tunnelled tube usually settles within one to two days, and bruising often looks worse before it looks better. Many people feel a pulling or tugging sensation when they turn their head or reach overhead during the first week, and sleeping on that side is uncomfortable at first.

A raised bump under the skin is normal, and it stays for as long as the port is in. You will be able to feel its outline, and so will a seatbelt, a bra strap, or a bag slung over that shoulder. Some people move the strap; some tuck a folded cloth under it.

Before you leave, ask about showering, driving, lifting and exercise. Common advice is to avoid lifting more than about ten pounds for a few days, keep the site out of baths and pools until healed, and leave contact sports until healing is complete.

To use the port, a nurse cleans the skin thoroughly and pushes a special right-angled needle through the silicone top. Most people describe a firm pinch rather than a sharp sting. The needle can stay in place for a multi-day infusion, covered with a clear dressing.

If the needle is the part you dread, say so. A prescription lidocaine-type numbing cream applied to the skin before your appointment makes a real difference, and cold spray is an alternative in clinic. Ask how long before the visit the cream needs to go on, because it takes time to work. You can also ask the nurse to vary the entry point slightly so the same spot is not used every cycle.

Only staff trained in port access should use it.

While the port is in regular use, flushing happens at each access. Between treatment blocks it still needs periodic flushing with sterile saline to stop it clotting or blocking. Intervals differ by center: some flush monthly, others state at least every twelve weeks.

Get your center's interval in writing, along with who books it and where it happens. This is the appointment most easily lost once active treatment ends.

• Call 911 or go to an emergency department if you suddenly cannot breathe properly or get chest pain, especially alongside swelling in the arm, neck or face on the port side.
• Call your cancer team straight away, at any hour, if your temperature reaches 100.4°F (38°C) or higher, or chills set in, particularly within a day of the port being used. A port sits in a large vein, and if you are also having chemotherapy the CDC treats fever as a medical emergency. They may want you at the cancer centre rather than anywhere else. If you cannot get through quickly, go to an emergency department and tell them you have a port and are on cancer treatment.
• Call your care team the same day if the port site turns red, warm, swollen or painful, or anything leaks from it.
• Call your care team the same day if the arm, neck or face on the port side swells, or new prominent veins appear across your chest. That can mean a clot in the vein.
• Call your care team the same day if the port will not flush, or blood will not draw back.
• Call your care team within a day or two if the skin over the port looks thin, shiny or is starting to break down.

Infection and clotting are the two complications ports are known for. Both are treatable, and both do better when reported early rather than saved for the next scheduled visit.

• National Cancer Institute — Chemotherapy to Treat Cancer
• NCI Dictionary of Cancer Terms — port
• MSK — How to Take the Needle Out of Your Implanted Port
• Centers for Disease Control and Prevention — Fever and Cancer Treatment