Published URL : National Courier

Published Date: 19th July 2016

By: Fauzia Pesnani


Cancer patients during their treatment get chemotherapy, blood transfusions, antibiotics, and intravenous (IV) fluids as well as to draw blood for tests. Some patients have difficult veins in their arms. Veins can be small, damaged by prior therapies or phlebotomies, or have a tendency to ‘roll’ away from needle. Therefore, sometimes the nurses may have to make three or four attempts each time in a different place in hands or arms to get the right kind of vein to give chemotherapy medicines. In our current scenario Port-a-Cath is not used commonly and most chemotherapy treatments are been given through an IV catheter. But this might not be the best option. Why is a chemotherapy port necessary? * Patient might need an IV every week or for several days in a row. It can be uncomfortable to be stuck with a needle so often. * Staff nurse might have difficulty putting a needle in a vein so often. * Some chemotherapy damages tissue if not injected directly into the vein. If the veins in patient’s hands and forearms are small or difficult to put a needle into, the risk is higher that chemotherapy will be injected into tissue around the vein. * If a cannula dislodges and is no longer positioned in the vein correctly then drug leaks into the area around the vein while being given, this is called extravasation. * Delivering chemotherapy to large veins is much preferred to the small veins in the arm. When chemotherapy runs into a small vein, it can damage the veins, causing scarring especially with repeated infusions. However, when infused into a large vein, the drug is immediately diluted by the bloodstream and delivered more efficiently to the entire body. * The hand veins are very fragile and can get easily destroyed by the medicines used in chemotherapy. To make these treatments easier, patient might get a medical device called a catheter or port. WHAT IS A PORT-A-CATH? A port-a-cath is an IV (intravenous) catheter that is placed under the skin in a patient who requires frequent administration of chemotherapy, blood transfusions, antibiotics, intravenous feeding, or blood draws. It is a central IV line, meaning that the catheter is threaded into one of the large central veins in the chest, which empties into the heart. The vein which is used most often is the right internal jugular vein. This vein is preferred because it is very close to the skin and easy to find with ultrasound. It runs straight down to the heart and has the lowest risk for problems during placement of the catheter, and subsequent use by oncology nurses. Patient just sees and feels a small lump, like a bottle cap under the skin. Commonly called a port, the term porta-cath is a combination of the words ‘portal’ and ‘catheter’. The ‘port’, or portal, is a small reservoir, about as big as a thimble, with a silicone septum that can be pierced with a needle. The silicone is self-sealing and can be punctured hundreds of times before the port must be replaced so it can remain in place for many years. The ‘cath’ or catheter portion is the plastic IV tubing which attaches to the port. The catheters are placed by an interventional radiologist or surgeon, under local anesthetic, using ultrasound to guide the catheter into the vein. The entire port-a-cath is inside the body, so that bathing and swimming are not affected. The catheters are placed by an interventional radiologist or surgeon, under local anesthetic, using ultrasound to guide the catheter into the vein. The entire port-a-cath is inside the body, so that bathing and swimming are not affected. Advantages of Port-a-Cath: * Ports make the administration of chemotherapy much safer. * Ports can remain in place for weeks, months, or years. * It reduces the need to insert needles into your arm veins making treatments more comfortable for you * It reduces the number of needle sticks. * It allows to give all IV medications and to take blood samples * Give treatments that last longer than 1 day. The needle can stay in the port for several days. * Do blood tests and chemotherapy the same day with 1 needle stick. * It gives more freedom to use arms normally in all daily activities. * When it is not in use, there is no special care of the port needed. * Blood transfusions or parenteral nutrition can also be administered through a port. How it is used: To use the port, the chemotherapy nurse feels the port between her/his fingers, disinfects the skin and inserts a special needle, called a Huber, through the skin and the silicone septum into the reservoir. The Huber needle is specially designed not to damage the silicone septum. Additionally, these needles are associated with a very low rate of infection. The port-a-cath can be used the same day it is put in. Caring for Port-a-Cath: Since Port-a-Cath is under the skin, there is very little need to do to take care of it. Once a patient has finished chemotherapy, the port is usually left in for a period of time, usually one year, in case further therapy or IV access is needed. It only needs to be ‘flushed” to keep it working every four weeks if it is not in use. If the port is no longer needed, it is removed by the surgeon or interventional radiologist, under local anesthesia. – – (The writer is head of Cancer Hospital (Nursing Services), Dr. Ziauddin Group of Hospitals).