Your Child Needs A Port

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Your child needs a Port

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What is a port?

A port is a special intravenous (IV) line that is placed completely inside the body. It is used in some children who need IV therapy for a long time.

A port consists of two parts: a small chamber, called the port, made of metal with a soft silicone top, and a long, soft, thin, flexible tube, called the catheter. One end of the catheter is attached to the port and the other end is inserted into one of the large veins leading to the heart.

Some medications cannot be given through regular IV lines and some medications require frequent, painful needle insertions. A port will provide a more comfortable and convenient way to receive medications, such as chemotherapy, IV nutrition and fluids, and from which to have blood samples taken. Your child will receive IV therapy by having a needle inserted through the skin into the port. The port and catheter allows medication to be delivered into the bloodstream.

How is a port inserted?

An interventional radiologist or surgeon will insert your child’s port in the Image Guided Therapy (IGT) department or in the Operating Room (OR). IGT uses special equipment to perform procedures that may have required traditional surgery in the past.

During the procedure, the tip of the catheter is inserted into a vein in the neck and positioned in the large vein just above the heart, where the blood flow is fast. This placement allows for better mixing of medications or IV fluids.

The other end of the catheter is tunneled under the skin a short distance where a small incision is made to create a space, called the pocket. The pocket is where the port sits, under the skin. The tissue and skin are then stitched closed.

Equipment such as ultrasound and fluoroscopy, a special x-ray machine, may be used during the procedure, or a chest x-ray may be taken after the procedure to ensure the port is in the correct position.

How long will the procedure take?

It will take about an 1-11/2 hours to insert the port. Before the procedure, the doctor inserting the port will meet with you to explain the procedure, answer your questions and get your consent.

Since your child will be receiving general anaesthetic, you will also meet with the anaesthetist before the port insertion. The anaesthetist is the doctor that will give the ‘sleep medication’.

What preparation will my child need before the procedure?

If your child is already in the hospital, you will meet a nurse from the Vascular Access Service who will explain the procedure and answer your questions. If your child is an outpatient, the medical team looking after your child will explain the procedure to you.

It is important to talk to children about what will happen before any procedure. Children feel less anxious when they know what to expect. Talk to your child in a way that he or she will understand. It is important to be honest. Tell your child that he or she will not wake up during the procedure but will wake up afterward. If you are not sure how to answer your child’s questions, ask the Child Life Specialist on your unit for help.

On the day of the procedure, your child will be receiving a general anaesthetic. This means that he or she may not have any solid food on the day of the procedure before the surgery. Your child can have fluids as follows:

milk or formula may be given up until 6 hours before the procedure breast milk may be given until 4 hours before the procedure clear liquids, such as apple juice or ginger ale, may be given until 2 hours before the procedure for the 2 hours before the procedure your child should have nothing at all to eat or drink, and that includes no gum or candy

It is very important that your child’s stomach be empty during and after the anaesthetic. An empty stomach reduces the chance of throwing up and choking. If your child has special needs during this time, ask your doctor for advice.

Your child may also need blood tests before the procedure. This is for your child’s safety. Your child’s doctor will arrange this.

Will my child feel any pain?

Since your child will be receiving a general anaesthetic, he or she will not be able to hear or feel anything during the procedure.

After the procedure, some children may feel mild pain or discomfort in the neck or chest area for the first day or two. If this happens, ask your nurse or doctor if something may be given for pain. Often children feel like they have a stiff neck due to the neck bandage. It is good and safe for children to move their necks like usual. Once your child has healed completely, he or she should not have any pain or discomfort from the port.

What are the risks of inserting a port in my child?

Any procedure can carry some risk, and every procedure is judged by weighing the benefit for your child against the risk it may pose. Procedures vary from low risk to high risk, up to and including death.

A port insertion is generally considered low risk, but the risks of the procedure will vary depending on the condition of your child, the age and size of your child, and other problems he or she may have.

The risks of a port insertion can include:

failure to find an open vein that will accept the port catheter bleeding or bruising infection clotting air in the lungs or veins rupture of a blood vessel abnormal heart rhythm death (very, very rarely)

During the procedure

During the procedure, you will be asked to wait in the waiting area. When the procedure is over and your child starts to wake up, you may be with your child. Once the port is inserted, the doctor will come out and talk to you about the procedure.

What can I expect after the procedure?

You will notice two large bandages on your child, one on the neck and one over the chest area. These bandages are sterile, which means they are put on in a special way to keep the site as germ-free as possible.

The neck bandage is cloth-like and will be removed within a few hours. There will be a bandage over the port and where the incision is. It is normal to see a small amount of blood under this dressing. There will also be small, thin, white band-aid strips on both the neck and chest incision areas. These band-aids should not be removed; they will fall off on their own within 2 weeks.

The incision should be kept clean and dry and covered by a bandage for 5-7 days, or until well healed. Once the incisions have healed, there is no need to place any type of dressing or covering on the port when it is not being used because it is all kept safely under the skin.

How is the port used?

When your child needs medicine, a needle is inserted through the skin and into the port. This is called accessing the port. An anaesthetic cream can be used to help numb the skin above the port where the needle is being inserted. Many children feel that this cream helps to reduce the pain of the needle. Ask your doctor to order the cream if you would like to use it.

The nurse will clean your child’s skin and poke the needle through the skin and into the port. The needle will be covered by a bandage to keep it clean and to keep the needle in place. The nurse can then give the medications through the needle and into the port. When your child has finished the medication, the port will be flushed with a medication called heparin and the needle will be removed. Heparin helps to prevent the port from becoming blocked, so that it will work well every time you come to the hospital.

How long can the port stay in?

A port can stay in for months or years.

Once your medical team is confident that the port is no longer needed, they will make arrangements to have it removed. Ports are removed under general anaesthetic. This procedure takes about 1 hour. Eating and drinking restrictions and blood work preparations on the day of the procedure are similar to when the port was inserted.

Can the port fall out?

The port cannot fall out or be pulled out, however, if the port is accessed with a needle, the needle can be pulled out accidentally. If the needle is pulled part-way or all the way out, it may cause the port to become blocked. This could also cause some skin irritation if medications leak from the port onto the surrounding skin. To prevent this from happening, it is very important to make sure that the port needle is covered with a bandage and that the needle tubing is taped to your child’s body.

What should I look out for?

You should contact your Community Care Nurse, the Vascular Access Service at the hospital, or your doctor or clinic nurse if you see any of the following signs of problems:

Your child has fever or chills. Bleeding, redness or swelling around the port or neck. Leaking or drainage at the port site. The port is hard to flush or won’t flush at all. There is pain when the port is being used.

Because each child’s situation is different, you should also ask your doctor if there are any specific instructions related to your child.

When your child has healed from the initial insertion, there will be no special care for your child’s port at home. If there is no needle in place, there is no need to cover the port site with a bandage. If your child does not need medication through the port for a long time, the port will need to be accessed with the needle and flushed with new heparin every 4-6 weeks or after each treatment to prevent the port from becoming blocked. This can sometimes be done at home or it can be done at the hospital in clinic. This will be arranged by your doctor or nurse.

Are there any activity restrictions?

After the port is inserted, your child will be able to resume most activities. This includes going to daycare or school, and playing some sports and games, such as bike riding or tennis. Rough sport that may result in a hit to the port area should not be done as this may damage the port.

When there is no needle in place, swimming or water activity is allowed once the incisions have healed. When a needle is in place, your child should not go swimming and the bandage should be kept dry. Letting the port needled get wet increases the chances of your child getting an infection.

Port facts

It is important that you know a few facts about your child’s port. If you experience a problem and have to call the Community Care Nurse or the Vascular Access Service, it will be helpful to give them the following information about your child’s port, as well as information about the problem.

Date of insertion

Port type

Single lumen Double lumen

Port utilization:

Blood products Chemotherapy TPN Medications Other