Implanted vascular access devices
An implanted central venous access device, often referred to as an implanted port or by the popular brand name Port-A-Cath, is a device placed under the skin without any portion of it exiting the skin. It consists of a single or double injection port with a self-sealing silicone septum covering a metal or plastic reservoir called the body. The catheter connects the port and reservoir to a central vein, typically the superior vena cava. An implanted port can be used to administer medication including chemotherapy, to deliver fluids, and to draw blood samples.
This type of central access device is inserted in the surgical suite or in the radiology department. The most common site for implanted port placement is the anterior chest, just below the clavicle. Other less common sites for implanted port placement include the upper arm, the abdomen, and the back.
Implanted ports are available with single or double lumens. A double-lumen port has two noncommunicating reservoirs.
Advantages of implanted ports are that they are cosmetically appealing, they have the lowest risk of infection of all chest-accessed central lines, they allow patients to carry on virtually all activities including bathing and swimming when it is not in use, and they do not require exit-site care.
A disadvantage for the patient who has an implanted port is that accessing it can be painful. Check for standing orders for a topical anesthetic to reduce the discomfort associated with accessing the port.
To access the port, use a noncoring, non-barbed (Huber) needle. Noncoring needles have a deflected point that helps avoid septal injury by slicing through the septum without coring out a tiny piece of it each time the port is accessed. Most facilities’ policies allow access to the implanted port with the same needle for 7 days.
Implanted ports may be open-ended or valved. Open-ended ports require heparin flushing while valved ports do not require heparin. You’ll find more details in the accepted practice section on valve tips and open-ended tips. And be sure to review your facility’s policies addressing the frequency of flushing. When an implanted port is not accessed, monthly flushing is usually sufficient.
Dougherty, L. (2006). Central venous access devices: Care and management. Oxford, UK: Blackwell Publishing. pp. 91, 95, 97.
Ignatavicius, D. D., & Workman, M. L. (2006). Medical-surgical nursing: Critical thinking for collaborative care (5th ed.). St. Louis, MO: Elsevier Saunders. p. 251.
Rosenthal, K. (2006). What you need to know about ports. Nursing2006, 36(1), 20-21.
Smith, S. F., Duell D. J., & Martin, B. C. (2008). Clinical nursing skills: Basic to advanced nursing skills (7th ed.). Upper Saddle River, NJ: Pearson Prentice Hall, pp. 1167-1171.