A port/catheter system , abbreviated as port, port-catheter, or port system, provides long-term access to the vascular system. The system is implanted below the protecting skin barrier. The implantation is a relatively simple procedure which can be performed on an out-patient basis under local anesthesia.
The port/catheter system consists of a titanium port chamber and a catheter. The titanium chamber is sealed by a silicone membrane. Administration of medications, parenteral nutrition, and blood sampling are possible after inserting a special needle through the skin and the silicone membrane into the port chamber.

The port/catheter system ensures long-term access to the vascular system in which the catheter is usually placed into a vein. This allows access to the circulation at any time and prevents irritation of the veins that is generally caused by repeated venous injections.
The risk of infection is minimized by the protective skin barrier.
The system is most often used in cancer patients requiring extensive chemotherapy.
Quality of life is optimized because the system does not interfere with patient mobility and puncture of the port membrane is easier and is associated with fewer risks.
Normal activities such as sports, bicycling, etc. are possible.
The implanted port chamber lies slightly elevated just below the skin and is barely noticeable. The port can be palpated easily.

The port catheter tip usually lies in a large caliber vein, generally the superior vena cava, in the proximity of the right atrium of the heart. The catheter is generally advanced through the subclavian or jugular veins. The port chamber usually lies at the upper level of the right rib cage. The surgeon chooses the appropriate site.

Port/catheter systems are either implanted on an in-patient or out-patient basis in generally less than one hour. A maximum of two incisions are made to place the port chamber below the skin and advance the catheter into a large caliber vein. Patients can choose between general or local anesthesia. This should be discussed with the attending surgeon.
There may be slight swelling and pain at the site of implantation during the first few postoperative days but this is normal. If this should persist and progress to skin redness, fever, or bleeding a doctor should be consulted immediately to prevent complications.
The surgical incisions are either sutured or closed by adhesive strips. These can be removed painlessly on the 8th postoperative day. If a dressing is no longer necessary the patient may shower and eventually bathe after complete wound healing. Patients should refrain from physical exertion for the first 14 days. The port may be used for therapy immediately.

All FDA drugs intended for intravenous application can be administered via the port/catheter system. These include infusions such as saline, glucose, electrolytes, anti-neoplastic agents, and analgesics such as morphine. As well as parenteral nutrition e.g. fats, amino acids, and blood products (thrombocyte concentrates).

The port/catheter system can be used subsequent to puncture of the membrane with the special needle. Drugs are administered either:

• as a bolus: using a syringe after puncture of the membrane.
• as a brief infusion:Using typical infusion tubes connected to the port needle, a small volume of infusate (approx. 100ml) is administered over a period of 20-30 minutes. The infusion bottle is placed on the infusion stand in the typical hanging position.
• as an extended infusion:the infusion continues over an extended period of time (e.g. 24h) with the aid of an infusion pump

The physician will decide which and when drugs are to be administered. It is important to flush the port/catheter system after usage otherwise clogging can occur.

Instructions and care guidelines must be followed. Patients should also carry their ID cards in which all relevant details are documented.
IMPORTANT: The port chamber is not a reservoir for either blood or drugs ! It should only contain saline/heparin solution after flushing

Puncture of the port system requires using a special needle with a beveled tip. Only with these needles can punch defects of the silicone membrane be avoided. Needles are available in different lengths and bore diameters depending on which substances are to be injected.

Patients may either be in the sitting or supine position. Sterile technique is mandatory when puncture is performed to prevent infection thus ensuring long-term usage. Patients should turn their heads in the opposite direction of the puncture site and avoid speaking and breathing over the sterile field.

Sample procedure:

• Skin Disinfection
  Puncture area is prepped with an antiseptic solution (either transparent or colored)
• Puncture
  The special needle is advanced through the skin and silicone membrane into the port puncture site can be anesthetized 30 minutes prior to puncture with an anaesthetic chamber. The patient will feel slight pain at the puncture site. If necessary the ointment or spray.
• Testing function
  The doctor draws blood with a syringe to confirm access to the circulation and then flushes the system with 0.9% saline.
• Fixation
  For the duration of treatment the needle is secured with adhesive strips. Afterwards the system may be used again.
  IMPORTANT: A needle is strictly intended for single use only and should not remain in place for more than 48h (danger of infection).
  
  

Patients must check for signs of inflammation at the puncture site daily and take notice of any axillary lymph node swelling. Any changes should be brought to the attention of a physician and nurse at once.
Flushing of venous port systems with saline should be done if systems haven’t been used for prolonged periods. This can be once within a 4-6 week period to prevent clogging. This is usually done by the general practitioner when obtaining routine blood samples.
Connected port needles are checked daily by medical and nursing staff. Regular flushing of the systems is required after administration of infusions. This is particularly important after blood transfusions and infusion of differing medications which may possibly interact.
The venous system should be flushed once every 3-4 weeks with 20 ml 0,9% NaCl if it is not used for prolonged periods.
When applying a bolus, syringes of at least 10ml or larger are recommended. The same procedures are to be followed when extracting the needle. This ensures long term protection of the system.

The following complications are very rare but cannot be excluded:

Duration of port system implantation is influenced primarily by cautious, aseptic handling and regular flushing.
Port systems can remain in situ for several years. When no longer needed they can be surgically removed.
It is generally recommended that patients carry a special port needle to be used in the event of an emergency.

Bodily exertion should be avoided directly after surgery.
After healing of surgical wounds normal physical activity may resume. If a port needle is not connected patients are permitted to bathe, swim, and exercise as they have done prior to port implantation.

Ports are placed below the skin. A slight elevation of the overlying skin is barely visible. The exact position of the port however, can be easily palpated. The small surgical scars generally fade with time and become less noticeable.

No. We do however recommend informing all physicians as to the presence of a port system and to present the patient ID-card. This also applies when performing any diagnostic studies or in emergency settings.

Ports may be left in place for the duration of therapy. They can then be removed under local anaesthesia as a minor surgical procedure. In some patients it may become necessary to replace the port by another usually in long-term therapy.

The ID-card containing all pertinent information is most valuable and should be carried by patients at all times. This is especially true in emergency settings.
Patients should always request ID-cards from their surgeons or nurses and present them as required.

• Aspiration: drawing blood from the port with a syringe.
• Implantation: surgical placement of the system
• Intravenous therapy: application of a drug through a vein
• NaCl 0,9: physiologic saline for flushing of the system
• Parenteral nutrition: application of nutrients, electrolytes, vitamins, and trace elements into veins thus by-passing the gastrointestinal tract.
• Peripheral veins: veins of the arms and legs
• Bolus application: given as a single injection

This portcathetersystem in combination with special portneedles is also indicated for power injection ( high pressure) of radiopaque material into the vascular blood system.

The system is appropriate to a maximum flow of 5ml/sec at maximum pressure of 300 PSI/21bar. Stability is tested and the suitable systems or needles are indicated separately e.g.