Interventional Radiology and Fluoroscopy
What is a Portacath?
A portacath is a small chamber or reservoir that sits under your skin at the end of your central line. The other end of the line sits in a large vein close to your heart. You can palpate the chamber of the portacath, but unless you’re very thin you can’t usually see it.
When you need treatment, your chemotherapy nurse puts a needle into the chamber and gives you injections or attaches a drip. The drugs travel from the chamber to the tubing and into your bloodstream. The portacath stays in place for as long as you need treatment.
What are benefits of having a Portacath?
A Portacath is a reliable way for nurses and doctors to give you intravenous (IV) medicines (medicines that need to go directly into a vein), IV feeds, or to take blood samples. The main advantage of a Portacath is that you can’t see it on the outside of your body. You don’t have a tube coming out of your chest, as you do with a central line.
But some people prefer a central line because they don’t like having a needle put in each time they need treatment. You might prefer the nurse to numb the area over the Portacath with a local anaesthetic cream before the needle goes in.
How is an implantable port used?
Just before you have any treatment or blood test, the nurse will clean your skin. The nurse will then push a special needle, called a Huber needle, through the skin and into the port. This should not be painful, but you may feel a pushing sensation.
Treatment can then be given directly into the bloodstream, or blood samples can be taken. If you are having a short treatment, the needle will then be removed. For longer treatments, you will have a dressing placed over the needle to hold it in place until your treatment is finished. The needle is then removed.
Are there any risks?
Serious risks and complications of having a Portacath inserted are very rare. However, as with any procedure, some risks or complications may occur. For example:
- Bruising. This is quite common and will normally settle a few days after the procedure.
- Infection. The insertion procedure will be carried out in a sterile condition to eliminate or reduce any sources of infection. However, infection may still occur (either local infection of the skin or within the bloodstream) at any time while your line is in place. Infections can usually be treated with antibiotics. However in rare cases we may have to remove the line.
- Line blockage. Regular flushing helps to prevent this. If it becomes blocked sometimes it is possible to unblock it.
- Thrombosis. Clots in the veins are very rare. They can cause arm swelling or prevent blood being taken from the line.
If the line is in place for a long time, breaks and damages can occur, although this is rare. The line may need to be replaced for these reasons.
What do I need to do to prepare for the procedure?
You come into hospital, have a Portacath inserted and go home the same day.
- You will usually need to have a blood test to measure full blood count and clotting before the procedure. Your Doctor or Clinic nurse specialist will tell you how to arrange it when they recommend a Portacath insertion.
- Please let us know if you are taking any medicines that thin the blood (for example Warfarin, Rivaroxaban, Dabigatran, Apixaban), as these may need to be withheld temporarily before the procedure. Call the Radiology Day Unit Sister for advice as soon as you get your appointment letter on 01642 854332.
You do not have to stop eating before the procedure, but you will be lying flat, so you should not have a large meal. You may drink water up to the procedure.
What happens before the Portacath insertion?
After you have arrived at the radiology day unit, you will be examined and assessed by a radiology nurse and given a hospital gown to wear.
You will be seen by a radiologist or radiographer (a health care professional who uses imaging machines to diagnose and treat illnesses) who will discuss the procedure with you. You will be given the opportunity to ask any questions you have.
Giving my consent (permission)
The staff caring for you will ask your permission to perform the procedure. If you decide to go ahead, you will be asked to sign a consent form that says you have agreed to the procedure and that you understand the benefits, risks and alternatives. If there is anything you don’t understand or you need more time to think about it, please tell the staff caring for you.
How is the Portacath inserted?
You will be taken into the x-ray room, and asked to lie flat on the table. Your health care professional will then inject a local anaesthetic into your skin to numb a few small areas on your chest and neck. You might feel some pressure on your chest or arm during the procedure, but you should not feel any pain.
The health care professional will make 2 small cuts in the skin. These cuts may be called incisions. The first is made to create a pocket under the skin for the port. It will be about 3 to 4cm long. There will be a smaller incision above this. This is where they will put the catheter into the vein. This incision is usually less than 2cm long.
If the port is being put into a vein in the chest, the incisions are made on the upper chest. If the port is being put into a vein in the arm, they will be on the inner side of the arm, although the arm is mostly avoided as a place for it.
Will I feel any pain?
The local anaesthetic can sting a bit. However after the local anaesthetic, you should not feel any pain during the procedure. You may however feel some discomfort after the procedure when the local anaesthetic wears off. You may want to take paracetamol tablets for the pain. You may also have a little bruising.
What happens after the Portacath insertion?
After the Portacath placement you will go to the radiology day unit for about 20 minutes. You will be offered a cup of tea or coffee. The Portacath insertion should be no worse than having a ‘filling’ at the dentist. You may drive yourself home, but some patients prefer to be driven. We are happy for you to use public transport if that is convenient to you.
Taking care of your Portacath at home
It is best to avoid strenuous exercise for a few weeks after surgery, so your body can heal. Your doctor or nurse can give you information about this.
If the port is in your arm, do not let anyone take your blood pressure or take blood from a vein in that arm. Do not lift anything heavier than 7kg (15lb).
Only the Huber needles should be used on your port. Do not let anyone use any other type of needle. You may want to wear a medical ID bracelet saying you have an implanted port.
The port should not interfere with your daily life. If you need more information, you can ask your Health Care Professional at the hospital where you are being treated.
Keeping your Portacath working
After each treatment, a small amount of fluid is flushed into the catheter, so it does not get blocked. The port will need to be flushed every 4 to 6 weeks if it is not being used regularly.
The nurses at the hospital can teach you how to do this. They can also teach a partner, family member or friend. Or a district nurse can do it for you at home. Your port will not need any other care.
How will I know if something is wrong with my Portacath?
If you experience a cold and shivery attack during or after flushing your line, contact the doctor or nurse caring for you immediately. This could be due to an infection in the line. The line is in a large vein close to your heart, so it is important to treat any infection as soon as possible.
Important
You should also contact the hospital straight away if:
- You experience pain, redness or swelling in your arm or neck on the same side of the body as your line
- The port has moved
- You feel breathless
- Your line becomes damaged or develops a leak
How is the Portacath removed?
When you do not need the port any more, it will be taken out. A health care professional will do this for you. A local anaesthetic is used to numb the area, or sometimes a general anaesthetic is used.
The health care professional will clean the skin over the site of your port with antiseptic. They will make a small incision over the site and remove the port and the catheter. They will gently pull the catheter out of the vein. The wound is then stitched and covered with a small dressing.
You may feel a bit sore and bruised after your port is removed. You can ask your doctor or nurse which painkillers you should take to help with this.
Please contact the radiology day unit at The James Cook University Hospital on 01642 854332 if you have any questions or concerns about this procedure.
Useful websites
Radiation dose and risk
X-rays use ionising radiation which can cause cell damage that may, after many years or decades, turn cancerous. The risk of this happening is very small compared to the normal lifetime risk of developing cancer which is 1 in 2.
We are also all exposed to background radiation every day. The risk of long-term effects is considered when the healthcare team decide whether someone needs an x-ray examination and radiation doses are kept as low as possible.
For this examination radiation dose levels are typically equivalent to around 1-2 years of background radiation. The associated risk is less than 1 in 1000 – Low.
Is there anything I should tell the staff?
For patients who have ovaries and are between the ages of 12 and 55, the x-ray department has a legal responsibility to ensure that this examination is performed within TEN DAYS of the first day of your menstrual period.
Contact us
If you require further information, please contact us on:
Telephone: 01642 854822
Email: [email protected]
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