Port-a-Cath Insertion Consent 💉

📌 Procedure/Investigation

• Port-a-Cath (implantable port) is a small device implanted under the skin, usually in the chest wall, connected to a catheter that sits in a large vein (typically the superior vena cava).
• It provides long-term, reliable venous access for chemotherapy, IV medications, blood transfusions, and blood sampling.
• The port is accessed through the skin using a special needle (Huber needle) when needed.

✅ Indications

• Long-term chemotherapy or immunotherapy administration
• Frequent IV medications or blood transfusions
• Parenteral nutrition (TPN)
• Frequent blood sampling (especially in patients with poor peripheral access)
• Patients requiring long-term venous access (months to years)

🔍 Procedure Overview

• Usually performed under local anaesthetic with sedation, or general anaesthetic.
• Small incision made in the chest wall (typically below the collarbone).
• Catheter inserted into a large vein (subclavian, jugular, or cephalic vein) under ultrasound/fluoroscopic guidance.
• Port reservoir placed in a pocket created under the skin.
• Tip of catheter positioned in superior vena cava, confirmed by X-ray.
• Incision closed with sutures or surgical glue.
• Procedure typically takes 30-60 minutes.

✅ Benefits

• Reliable, long-term venous access without repeated needle sticks in arms.
• Cosmetically acceptable - port is hidden under the skin when not in use.
• Allows normal activities including showering (once healed).
• Reduces risk of extravasation compared to peripheral IVs.
• Can remain in place for months to years if well-maintained.
• Less maintenance than external catheters (e.g., Hickman lines).

⚠️ Risks & Complications

❓ Common Patient Questions

• Will it be painful? → You'll have local anaesthetic and possibly sedation. Some discomfort is normal after the procedure, which usually settles within a few days.
• Can I see or feel the port? → You may see a small bump under the skin and feel it when touched, but it's usually not visible.
• Can I shower/swim? → Once the wound has healed (usually 7-10 days), you can shower normally. Swimming may be allowed after full healing - check with your team.
• How long does it stay in? → Can remain for months to years, depending on your treatment needs.
• How is it accessed? → A special needle (Huber needle) is inserted through the skin into the port when needed.
• Will it affect my daily activities? → Once healed, most activities are fine. Avoid heavy lifting or contact sports that might damage the port.
• When can it be removed? → Usually removed when no longer needed, typically under local anaesthetic.

📝 Additional Notes

• A trained clinician (usually interventional radiologist or surgeon) should take consent and perform the procedure.
• Pre-procedure: Check coagulation profile (INR, platelets), review medications (especially anticoagulants), assess for allergies.
• Post-procedure: Monitor for signs of bleeding, infection, or pneumothorax. Chest X-ray to confirm catheter tip position.
• Port care: Requires regular flushing when not in use (usually monthly) to prevent occlusion.
• Access technique: Must use non-coring Huber needle to prevent damage to port septum.
• Consent should include discussion of benefits, risks, alternatives (PICC line, tunnelled catheter), and what to expect post-procedure.

💊 Special Considerations

• Check coagulation profile (INR, platelets) before procedure - may need to hold anticoagulants.
• Assess for previous central line complications or venous thrombosis.
• Consider patient factors: body habitus, previous surgery or radiation to chest, venous anatomy.
• Infection risk: Ensure sterile technique during insertion and access.
• Monitor for signs of infection, thrombosis, or port malfunction post-insertion.
• Educate patient on port care, signs of complications, and when to seek medical attention.

🔄 Alternatives

• PICC line (Peripherally Inserted Central Catheter) - external catheter in arm, suitable for shorter-term use.
• Tunnelled central venous catheter (e.g., Hickman line) - external catheter exiting chest wall, requires daily care.
• Peripheral IV cannula - for short-term use only.
• No central access - may limit treatment options or require frequent peripheral cannulation.

📎 External Resources

• 🔗 UCLH - Port-a-Cath Information