When preparing for chemotherapy, you may hear your doctor or nurse mention a port; you will usually be given a choice to have chemotherapy infusions administered that way, or through an IV directly from the vein in your arms.
I opted for the port, and while I’m glad about that, there were some aspects I wish I had been better prepared for. So, here you go: the complete low-down about ports that I wish I had known.
What Is a Port, Exactly?
A port, or port-a-cath, is a disc placed under your skin, about 1-1.5 inches in diameter, connected to a thin flexible tube called a catheter. The end of this tube sits in a large blood vessel leading to your heart, which allows injected fluids (like chemo meds) to flow into your bloodstream, and can also be used to draw blood. Generally, ports are placed under the skin on the chest above the breast bone or below the collarbone, although mine was in the inside of my upper left arm (called a PAS-Port when in the upper arm, which stands for Peripherally Accessed Subcutaneous Port) - something to ask about when discussing the port with your doctor. The port is placed during an outpatient procedure.
Most ports are the size of a nickel or quarter and can be circular, oval, or triangle-shaped. They do not affect imaging such as CT scans, x-rays, or MRIs, or set off the alarms at airport security (although my dark humor thought it would have been hilarious if it did). Also, it is possible you will be prescribed a blood thinner as long as the port is in to prevent blood clots.
Why Get a Port?
During treatment your veins will be accessed frequently – and not just for chemo, but also for blood draws, or any additional transfusions or medication you might need. Having a port, therefore, means you can do all of these things without having to constantly put needles into your arm, and is generally recommended because it can protect small veins, is less likely to leak and damage the skin or other tissues, and, research has shown, hurts less.
In a nutshell – having a port means a lot less poking and prodding!
What to Expect During Treatment
When you go in for chemo, the nurse will stick a needle through your skin into the port, to the access point, which is basically just like opening it up. The needle connects to the catheter, to deliver chemo into the vein that goes directly to the bloodstream, or to draw blood for labs.
The initial poke feels a bit like a pushing sensation and can sting, and most doctors prescribe a lidocaine numbing cream like Emla to rub on the skin in advance of the procedure. I didn’t need to use the cream but was happy to have it on hand, just in case.
For short treatments, the needle will then be removed. For longer treatments, a clear bandage is placed over the needle while the port is being used, keeping it dry and in place until treatment is finished.
Flushing the Port
After accessing the port, before administering chemotherapy, the nurse will flush out the port line with saline water and sometimes heparin (a blood thinner); this will also be done after the infusion is finished. Flushing the port keeps it clean and prevents infection and blood clotting. If it isn’t being accessed regularly but is still in, it needs to be flushed once a month to keep it from becoming blocked.
There is a feeling and a smell to the port flushing. I remember it feeling very eerie – like chilly liquid running through my arm and up to my chest, and I remember the saline smell. To this day, that smell can instantly transport me back to the infusion room.
Port Insertion Procedure
Getting the port put in is a short procedure - outpatient for ports placed in the arm, and in a surgical setting for chest wall ports. I was told it was super simple, and wouldn’t cause much discomfort during or after. But I didn’t find that to be accurate, and as such, I wasn’t prepared for what I experienced.
When getting instructions before the procedure, you will be told whether you need to stop eating or drinking at a certain time, or stop taking any medications – if you are unclear, it is imperative to ask your nurse or care team.
The insertion is done in a procedure room where real-time imaging is used to make sure the catheter is placed correctly, and usually takes 30 -45 minutes, although some of the resources I found said it could take a few hours. I was definitely not there that long. You lie flat on your back on a procedure table and will be awake the whole time, with local anesthesia. Some sources I found say you may be put under conscious sedation, meaning you’ll be given something in your IV to relax you, but I did not receive that… if only I had!
The skin is cleaned and numbed with the local anesthetic, then the port incision, about an inch in length, is made (heads up that I only had one incision in my arm where the port was placed, but some sources said there can be two). The catheter, connected to the port, is then tunneled under the skin, threaded into the neck vein, and the port placed beneath the skin. During this process, an ultrasound is used to find the right vein, and a wire is placed through the port needle into that large central vein.
This whole tunneling part was what I wish I had been told about in advance. I could feel the tube being pulled up inside towards my neck and heart and thought it was going to choke me, I started gagging, and I had a total panic attack – I thought something was wrong. If I had known in advance I would experience a sensation like that during the port insertion, I would have been prepared and known to expect it. So, now you know and it won’t take you by surprise!
The incision is closed with sutures or surgical glue and covered with a dressing or bandage; sutures won’t need to be removed, as they get absorbed. Someone must be there to drive you home, then just rest the remainder of the day.
I was told there would be discomfort and tenderness around the incision site after the procedure for up to 48 hours, but I experienced rather intense feelings of burning and throbbing in the incision area for a few days. Over-the-counter pain meds helped – make sure you check with your care team to see if they are OK to take and stay on top of taking them, to keep the pain at bay.
Check with your facility, but some facilities allow you to use a heating pad on the lowest setting for the first 2-3 days to help lower pain and increase blood flow (this helps with healing).
The stitches will dissolve over time and the tape strips under the dressing will fall off on their own. You can’t shower or get the area wet for as long as your bandages are on, which could be up to a week or 10 days (here’s where we love the cleansing wipes and dry shampoos although you can ask for the plastic sleeves to protect the dressing while showering as well. Don’t lift anything greater than 15 lbs for 2 weeks, and report any signs of infection like fever, redness, or swelling. Make sure to review the risks of having a port with your care team, so you know the signs to look out for if something is abnormal.
Living With a Port
Once the incision heals, ports are simple to live with. The skin over it doesn’t need special care, it can be washed as normal, there are no dressings to change, and you can go on with normal daily activities. Depending on where your port is placed, it can be uncomfortable because things may rub against it — sleeping on it, or wearing a seat belt, for example — but seat belt covers, port pillows (yes, they’re a thing!), or soft towels help ease that discomfort.
The whole time my port was in, and for a few months, after it was removed, I felt the occasional dull ache/pain and throbbing conducive to incisions’ healing after surgery.
With the port under the skin, there is a small raised bump (about ½ inch), that you’ll be able to feel and see. If it’s on your chest area, it’s low enough that a loose V-neck shirt will cover it, or loose sleeves will cover it on your arm (note-link to clothing/tops here). It’s probably way more noticeable to you than to other people, but that doesn’t take away from the fact it can feel like just one more thing that looks different or screams “cancer patient.” However, I didn’t try to cover mine up. I was proud of it. To me, it was a badge of courage.
The port will stay in place as long as you need it, then be removed in a similar procedure as its insertion; I had mine taken out during my double mastectomy surgery when chemo was over. There will be a scar where the incision was, but that scar fades with time. In fact, mine is almost completely gone, and honestly, that makes me kind of sad; I felt it was like a warrior mark of what I went through.