Port Care at Home During Cancer Treatment

MedlinePlus describes an implanted port as three joined parts. First, the portal or reservoir: "a pouch made of hard metal or plastic." Second, the silicone top, "where a needle is inserted into the portal." Third, the catheter, a thin tube that "carries medicine or blood from the portal to a large vein and into the heart."

The whole device sits under closed skin. The catheter tip ends "at the right side of your heart (right atrium)." Most ports go in the chest, though MedlinePlus notes they "may also be placed in the arm." After healing, "you will be able to feel and see a quarter-sized bump under your skin where your port is."

That closed skin is the reason ports are easier to live with than a line hanging out of your chest. When no needle is in, there is nothing to snag and no dressing to guard.

Accessing a port means pushing a needle through skin and through the silicone top. MedlinePlus says "a trained provider will stick a special needle" through both layers, and that "a numbing cream can be used on your skin to decrease the pain of the needle stick."

The special part matters. Nursing standards published on the NIH National Library of Medicine Bookshelf state that a noncoring needle, often called a Huber needle, must be used. A regular sharp needle cuts a tiny plug out of the silicone each time, and after enough sticks the top leaks. Standards also call for sterile technique with a mask, chlorhexidine antiseptic on the skin, and letting that antiseptic dry completely before the stick. Numbing options include lidocaine cream or a small lidocaine injection.

If you feel every access, say so. Numbing cream usually needs to go on well before you arrive, so ask for a prescription rather than assuming nothing can be done.

A port that is not flushed can clot shut. MedlinePlus tells patients that "about once a month, you will need to have your port flushed to help prevent clots."

Nursing standards on the NIH Bookshelf follow the same shape: a port left idle gets a saline flush on a set interval, and some designs are then locked with a heparin solution afterwards. During active treatment it is flushed after each infusion. The interval, the solution and the exact volumes are not the same for every port. They depend on the model, on whether it is open- or valve-ended, on your clotting risk and on the policy of the unit that placed it, so the numbers that matter are the ones written on your own order.

Three technical points are worth knowing, because they explain instructions that otherwise sound fussy.

• Use a 10 mL syringe or larger. Smaller syringes generate much higher pressure and can damage the catheter.
• Check for blood return first. Standards call for attempting to draw back blood to confirm the line is open before flushing anything in.
• Push in bursts. MedlinePlus puts it plainly: "inject the saline slowly into the catheter by gently pushing on the plunger. Do a little, then stop, then do some more." That stop-start swirl scrubs the inside of the catheter better than one steady push. On the final lock, the syringe is withdrawn while still pushing, so nothing gets sucked back in.

For multi-day infusions the needle stays taped in place. Now you do have a dressing, and the rules change.

NIH Bookshelf standards call for changing a transparent dressing every 7 days, changing a gauze dressing at least every 48 hours, and changing any dressing immediately if it becomes damp, loose, or visibly soiled. During continuous access, the needle itself is changed every 7 days.

An accessed port must stay dry. A deaccessed port does not. MedlinePlus says that "when your port is not being used, you can bathe or swim, as long as your provider says you are ready for activity." Contact sports need specific clearance.

Some families are taught to flush at home; many are not, and that is fine. If you are, MedlinePlus gives the frame.

Wash your hands "for 30 seconds with soap and water," including between fingers and under nails. Confirm the syringes are what was ordered: saline syringes are usually clear and heparin syringes are usually yellow, and MedlinePlus tells you to "make sure the strength and dose are correct" and to check the expiration date. Unclip the clamp, wipe the end of the catheter with an alcohol wipe before attaching the syringe and again after. Push in bursts. Put the clamp back on the catheter when you are done.

One rule has no exceptions. If it will not flush, MedlinePlus says: "Do not force it. Call your provider if it is not working." Forcing a clotted catheter can push a clot into the bloodstream or split the tubing.

Two fever thresholds are in play, and you should use the stricter one. MedlinePlus tells port patients to call for a fever over 100.4°F (38.0°C). The Centers for Disease Control and Prevention sets a lower bar during chemotherapy: "call your doctor immediately if you have a temperature of 100.4ºF (38ºC) or higher." If you are getting chemotherapy, 100.4°F is your number, day or night.

• Call 911 or go to an emergency department if you become short of breath, lightheaded, or get chest pain during or just after a flush, or if the skin over the port opens and the device is exposed. Tell the staff at check-in that you have an implanted port and are on chemotherapy, because that changes how quickly you are seen.
• Ring your care team the moment the thermometer reaches that number, day or night, if you are having chemotherapy. CDC calls that a medical emergency, and a port infection with low white cells can turn serious within hours. If nobody answers quickly, go to an emergency department and tell them you have an implanted port and are on chemotherapy.
• Call your care team the same day if you reach the fever number above at any other time, or you feel hot and shivery with no thermometer to hand. The same applies to redness, warmth, drainage or new pain over the port, to a port that looks or feels as if it has shifted under the skin, and to swelling or leaking of fluid around the site while it is being used.
• Call your care team within a day or two if the port will not flush easily, will not give a blood return, or the needle site stays sore for days after the needle comes out. Do not force a blocked catheter while you wait.

Which brand and model is my port, and is it power-injectable for CT scans? Am I on saline-only locking or saline plus heparin, and at what strength? What is my flush interval between treatment cycles? Who flushes it if I am traveling? Do I need numbing cream, and can you send it to my pharmacy? What number do I call after hours?

Write the answers on the port ID card and keep it in your wallet. Radiology, urgent care, and any hospital you land in will all want it.

See also Practical Help for Caregivers and Managing Medications as a Caregiver.

• https://medlineplus.gov/ency/patientinstructions/000491.htm
• https://medlineplus.gov/ency/patientinstructions/000157.htm
• https://www.ncbi.nlm.nih.gov/books/NBK594495/
• https://www.cdc.gov/cancer-preventing-infections/patients/fever.html