What to Expect at a Port Flush

An implanted port is two parts joined together. Macmillan Cancer Support describes it as "a tube with a rubber disc at the end. It sits under the skin." The disc is the part you can feel. The thin tube, called a catheter, runs from it into a large vein.

The American Cancer Society (ACS) notes that ports "are usually put in the upper chest or arm, but can sometimes go in the abdomen (belly) or groin depending on the patient's anatomy or medical condition."

Nothing sticks out. That is the point of a port, and also why maintenance visits exist: a line you cannot see still needs looking after.

To use a port, ACS explains, "a nurse or other health care provider will put a special needle through the skin and into the port. You might hear this called 'accessing' your port."

The special needle has a name. Macmillan states that "only the Huber needles should be used on your port." A Huber needle is non-coring, meaning the tip is shaped to part the rubber disc as it passes through rather than punch a small plug out of it. That is what lets the disc seal itself again after every use, over and over, for as long as the port is in.

An ordinary hypodermic needle used in a port damages the disc. If someone unfamiliar with ports is about to access yours, it is fair to ask which needle they are using.

You can also ask about numbing. Macmillan notes the skin over the port "can be numbed with an anaesthetic cream," applied around 30 minutes beforehand. Ask at booking rather than on arrival.

MedlinePlus puts it in one line: "flushing helps keep the catheter clean. It also prevents blood clots from blocking the catheter."

Two solutions may be used, in order.

Saline comes first. This is sterile salt water, pushed in slowly. MedlinePlus describes the technique as "gently pushing on the plunger" in small amounts rather than all at once.

Heparin may follow. MedlinePlus explains that "heparin is a medicine that helps prevent blood clots." It is left sitting in the catheter as a lock between uses. Not every port needs it, and MedlinePlus says your provider will tell you whether this step applies to you. Ask which your center uses, and note it, because the answer differs between hospitals.

ACS notes that ports "will be flushed before and after each use," so if you are in active treatment, flushing is already happening at every appointment.

When a port is not being used regularly, Macmillan states "the port will need to be flushed every 4 to 6 weeks." ACS puts it more loosely: "if the port won't be used for a while, you may need to have it flushed occasionally to keep the line working."

Intervals vary by device and by center. Get yours in writing, and get the next appointment booked before you leave. A missed maintenance flush is one of the ordinary ways a port ends up blocked.

It is short. The nurse washes their hands, puts on sterile gloves, and wipes the access point with an alcohol wipe. MedlinePlus lists those steps for any central line. The Huber needle goes through the skin into the disc, the nurse checks that the port is working, saline goes in slowly, heparin follows if it is prescribed, and the needle comes out.

You will feel a pinch as the needle goes in. If your port has become painful to access, or if the same spot is used every time and the skin is getting sore, say so. That is a fixable problem.

Ports are not temporary. ACS says they "can stay in for months or years," and Macmillan says a port "can be left in for weeks, months or, for some people, years."

An occlusion means the catheter is blocked. You may notice it as the nurse being unable to draw blood, fluid refusing to go in, or swelling or pain when the port is flushed. MedlinePlus lists "having trouble flushing your catheter" as a reason to contact your provider.

Blockage is not automatically the end of the port. Macmillan explains that "the catheter may be flushed with a solution to try to clear the blockage, or the port may need to be removed." Ask what your team tries first, and what a chest x-ray or dye study would add if the problem repeats.

A port sits in a large vein. Infection there is not a skin problem, it is a bloodstream problem.

The Centers for Disease Control and Prevention (CDC) is unambiguous about fever during chemotherapy: "call your doctor immediately if you have a temperature of 100.4ºF (38ºC) or higher." CDC warns that "fever may be the only sign that you have an infection, and an infection during chemotherapy can be life-threatening," and advises taking your temperature "any time you feel warm, flushed, chilled, or not well."

Contact your team straight away for:

• A temperature of 100.4 °F (38 °C) or higher, or chills.
• New redness, swelling, oozing or pus around the port site. ACS names "fever, chills, or new redness, swelling, or oozing around the site."
• Pain, bleeding, or fluid leaking at the site.
• Swelling of the hand, arm, shoulder, or neck. ACS notes a clot "can cause redness or swelling in your hand, arm, shoulder, or neck."
• Shortness of breath or dizziness.
• A dressing that is soaked, or a catheter that looks cut, cracked, or moved.

The National Cancer Institute also flags "swelling or redness, especially where a catheter enters your body" as a reason to call during cancer treatment.

If you go in, follow CDC's advice: "tell the person checking you in that you are a cancer patient undergoing chemotherapy." That sentence changes how fast you are seen.

• How often does my port need flushing when I am not in treatment?
• Is heparin used here, or saline only?
• Can I have numbing cream, and how far ahead do I apply it?
• Who books my next flush, and what happens if I miss one?
• Can my port be flushed anywhere closer to home, and who would I call?
• Can this port be used for scans with contrast and for routine blood draws?
• What are the signs of a blocked port, and what would you try first?
• Exactly what temperature should make me call, and what number do I use at night?

• MedlinePlus — Central venous catheter, flushing.
• Macmillan Cancer Support — Implantable ports.
• American Cancer Society — Intravenous (IV) Lines and Ports Used in Cancer Treatment.
• Centers for Disease Control and Prevention — Watch Out for Fever.
• National Cancer Institute — Infection and Neutropenia during Cancer Treatment.

Helpful next pages include Port Care at Home During Cancer Treatment, What to Expect at an Infusion Center, Blood Clots During Cancer Treatment, What to Expect at a Survivorship Visit, What to Expect When Cancer Treatment Is Delayed.