IR Vortex® Port-a-cath Insertion

A Vortex® port is a special device that is inserted under your skin, usually on your chest just below your collar bone. It’s made up of two chambers and connected to a thin, flexible tube (catheter) placed in a large vein, normally in your neck.  

The port is used for automated red cell exchange treatment. It can also be used for taking blood samples and giving fluids or medicine into your bloodstream. 

To use the port, a nurse or doctor will pass a needle through your skin and into the port.  

If you are having a red cell exchange, two needles will be inserted – one for withdrawing blood and the other one for returning blood. When the treatment is finished, the needles will be removed.  

When not in use, the port will feel like a lump under your skin. If necessary, the port can stay in for several months and you can go home with it. 

Vortex® ports are usually used only if you cannot have your exchanges any other way. This may be because veins in your arms and groin are difficult to access, or because these procedures are too uncomfortable or painful for you. 

We will only offer you a Vortex® port if you are able to commit to attending your planned red cell exchange appointments regularly. This is because we think you are less likely to experience complications with a Vortex® port if the percentage of sickle cell blood is kept very low. 

When not in use, a Vortex® port is completely embedded under the skin and there are no external parts. This means you can bathe, shower or swim freely. The port is also easy to care for when it’s not used for treatments. It only needs flushing once every four weeks to stop it from getting blocked. 

If you are not sure why you are being offered a port, please speak to the team looking after you or one of the central venous access nurses.

The alternatives include:  

• Using the veins in your arms every time you have an exchange.  
• Femoral line – a temporary line which is inserted into your groin each time you have an exchange.  
• Tunnelled line – a long flexible tube that is placed under the skin just below your collar bone and tunnelled into a large straight vein in your chest. Unlike a Vortex® port, part of a tunnelled line lies outside the body. When not in use, a tunnelled line needs weekly flushing and dressing changes. 

Your doctor or nurse may have suggested a Vortex® port for you but if you would like more information about these alternatives, please talk to the team looking after you or one of the central venous access nurses.  

A port is different from other kinds of intravenous lines (lines situated within a vein). When not in use, it is completely embedded under your skin and there are no external parts. This means you can bathe, shower or swim freely. Other lines may need to be kept dry and require weekly dressing changes and flushing. A port is simpler to care for between treatments. If you are having a break from treatment, it only needs flushing once every four weeks. 

Implantable ports are used in many different situations. Some patients may need a port to avoid having needles put into their arms every time they need treatment or a blood test. Others need a port because of the type of treatment they are having, or to help reduce the amount of time they spend in hospital. 

If you are not sure why you are being offered a port, please speak to the team looking after you or one of the central venous access nurses.

Risks during insertion

Most port insertions go smoothly. There is a very small risk of puncturing a blood vessel in the chest, air entering your bloodstream or a collapsed lung. These complications can be serious but we take every precaution to prevent them and they are very unlikely to happen. 

Infection

It is possible for an infection to develop in the skin around the port or in the bloodstream. Contact your nursing or medical team, or one of the central venous access nurses, as soon as you can if you experience any of the following symptoms: 

• a high temperature (over 38°C) 
• feeling shivery 
• pain, redness or swelling around the port. 

If you have an infection, you will need to take a course of antibiotics and your port may need to be removed. 

Blood clot

It is possible for a blood clot (thrombosis) to form in the vein used for the port. If you notice swelling or pain in the shoulder, neck or arm on the same side as the port, contact your nursing or medical team, or one of the central venous access nurses, as soon as possible. If you have a clot, you will need medication to dissolve it. The port can often stay in place. There is also a small risk of a blood clot on the lungs. This is rare. If you experience chest pain or sudden shortness of breath, go to your local Emergency Department (A&E) or call an ambulance. 

Malfunction

In a small number of patients, the port fails to function properly. This may be because it has not been positioned correctly or it has moved. If this happens, the port will need to be removed. 

Blockage

Ports can sometimes become blocked. We can usually unblock them by using a special flushing solution. 

Pain

When the port is used, a special needle is inserted through the skin. This may cause temporary discomfort like a blood test or injection. If you prefer, you can ask your nurse to apply a numbing cream to the skin before your port is used. 

Difficulty in inserting the needle into the port

Sometimes it may take more than one attempt to successfully insert the needle. 

Radiation risk

During the procedure, you are exposed to X-rays. They are a type of radiation called ionising radiation. Interventional radiology (IR) is when we use medical imaging guidance to do minimally invasive procedures. The dose (amount) of radiation from these procedures is generally low. More complex procedures might involve a medium (moderate) dose of radiation. 

The Interventional radiologist and radiographer make sure that: 

• Your radiation dose is kept as low as possible. 
• The benefits of having X-rays during your procedure are greater than the radiation risks.

You will need to have a blood test to measure your full blood count (FBC) and clotting before the procedure. Your doctor or nurse specialist will tell you how to book your blood test when they recommend a Vortex Port-a-Cath. 

You should inform the imaging department prior to your appointment if you are taking any blood thinning medication. 

You need to attend to the Imaging Department at the time instructed on your appointment letter. You will be asked not to eat for six hours before your appointment time, though you can continue to drink clear fluids up to two hours prior to your appointment. Please take all your medication on the morning of the procedure unless you have been informed to omit it by your doctor or the Imaging department.  

On arrival you will be checked into the department by a nurse. The nurse will fill in some paperwork and do some clinical observations-like blood pressure and pulse. The Radiologist will come and explain the procedure and sign off the Consent form with you. This is where you have the opportunity to talk to the Radiologist doing your procedure and they will be able to address any concerns you may have.  

This procedure is commonly performed under local anaesthetic, however if you are expecting sedation, it is necessary that you have an escort to take you home and stay with you overnight. This is the policy for sedation, so if you are expecting sedation please ensure you make the necessary arrangements. If you are having sedation during the procedure, the nurse or radiographer will place a cannula into your vein prior to the procedure. 

If you have any allergies, you must let your doctor know. If you have previously reacted to intravenous contrast medium (the dye used for kidney x-rays and CT scans), then you must also tell your doctor about this.

We want to involve you in all the decisions about your care and treatment. If you decide to go ahead with procedure, by law we must ask for your consent and will ask you to sign a Consent form. This confirms that you agree to have the procedure and understand what it involves.  

The consent form is a form that both you and the operating doctor sign confirming that you have discussed the procedure and been informed of the risks/benefits/alternatives and have agreed to carry on with the interventional procedure. (You can have a copy of this form to take with you.) 

Please feel free to ask any questions that you may have and, remember that even at this stage, you can decide against going ahead with the procedure if you so wish.

You will lie on the X-ray table, generally flat on your back. A needle will be inserted into a vein in your arm, so that a sedative or painkillers can be given if required (This is generally not needed as the procedure is usually tolerated very well with just a local anaesthetic). You may have monitoring devices attached to your chest and finger and may be given oxygen. 

The procedure is performed under sterile conditions and the interventional radiologist and radiology nurse will wear sterile gowns and gloves to carry out the procedure. The skin near the point of insertion, usually the neck but occasionally the groin, will be swabbed with antiseptic and you will be covered with sterile drapes.  

The radiologist will inject some local anaesthetic into your skin on your chest and neck to numb the area. This may sting a little as it goes in. After this you should only feel pressure, and you should not feel any pain. Please let the nurse know if you are uncomfortable. 

The radiologist will make two cuts in the skin. The catheter will be inserted into the vein in your chest through one of these cuts. It will then be tunnelled under the skin to the second cut. The catheter is then connected to the port, which is inserted in the skin through the second cut and fitted into a space created under the skin. We will check the position of the catheter and port with the X-ray machine. If it is in the correct position, the cuts are then stitched, and dressing is put over the wound.

Some discomfort may be felt in the skin and deeper tissues during the injection of the local anaesthetic. After this, the procedure should not be painful. There will be a nurse, or another member of clinical staff, standing nearby looking after you. If the procedure does become uncomfortable, they will be able to arrange for you to have a painkiller through the needle in your arm.

Every patient’s situation is different, and it is not always easy to predict how complex or how straightforward the procedure will be. Generally, the procedure will be over in about an hour.

You will be taken to the recovery area on a trolley. A recovery nurse will carry out routine observations, such as taking your pulse and blood pressure. They will also look at the skin entry point to make sure there is no bleeding from it.  

You will generally stay in bed for about an hour, until you have recovered. The nurses will let you know when they are happy for you to be discharged from recovery. You will be allowed to go home after this but will need someone to escort you if you have had sedation.  You will need to take it easy for the rest of the day, but you can resume normal activities the following day. 

You will have a dressing on the port site and on the base of your neck. You will need to change these after 48 hours. Ideally the Port-a-Cath wound site should remain covered with the waterproof dressing for 14 days. Avoid soaking the dressing for long periods of time as it may peel off. Short showers should not cause a problem. 

If needed, the port can be used straight after it has been put in. You may feel a bit sore and bruised around the insertion site for a few days after the procedure. You can take mild painkillers, such as paracetamol, to ease this. Once the bruising has settled down the port should be painless. You may still feel some brief discomfort each time the port is used when the needle is being inserted through your skin. 

The Port-a-Cath can be used as soon as it is inserted. Before it is used, the skin will be cleaned. A needle is then pushed through the skin into the port. Treatment is then given through this needle into the Port-a-Cath. The treatment goes into the port and flows into the catheter and your bloodstream. 

Stitches

We usually use dissolvable stitches and they don’t need to be removed.  

Dressings

You will have two small dressings: one on the side of your neck and one next to the port. You can remove these dressings about seven days after the port has been inserted. Until then you should keep them in place. We usually use waterproof dressings so you can shower or bathe normally.  

Other care

If the port is not being used for treatment it will need to be flushed every four weeks to stop it from getting blocked. You will need to make an appointment in the Supportive Care Department to have this done. 

Things to look out for at home

While your port is in place, it is important that you contact your nursing or medical team, or one of the central venous access nurses, if you notice any of the following: 

• a high temperature (over 38°C) 
• feeling shivery 
• pain, redness or swelling around the port 
• chest pain 
• shortness of breath.

An implantable port can stay in for several weeks or months and it will be removed when you no longer need it. Removing the port is similar to inserting it. 

If you are likely to have more treatment at a later date, it may be possible to leave the port in. Please discuss this with the team looking after you. If you do decide to keep the port in, you will need to arrange for it to be flushed once a month.

Some of your questions should have been answered on this page but remember that this is only a starting point for discussion about your treatment with the doctors looking after you. Make sure you are satisfied that you have received enough information about the procedure. 

Contact and references

British Society of Interventional Radiology 

www.bsir.org 

For general information about radiology departments, visit The Royal College of Radiologists 

www.goingfora.com  

NHS Direct 

For health advice or information you can call NHS Direct on 0845 45647 or visit the website: www.nhsdirect.nhs.uk  

The NHS Clinical Knowledge Summaries website: www.cks.nhs.uk  

UCL Hospitals cannot accept responsibility for information provided by other organisations.

Please contact the Clinical Nurse Specialist (CNS) 

Direct line: Interventional radiology CNS: 079 7487 5629  

UCH Switchboard: 020 3456 7890 

Address:  

Interventional Radiology Imaging Department 

University College Hospital  

2nd Floor 

235 Euston Road  

London  

NW1 2BU 

Admin Queries Email: uclh.referrals.interventionalradiology@nhs.net 

Radiology Admin enquiries phoneline: 020 3447 3267 

Website: www.uclh.nhs.uk

Procedures:  

The Imaging Department, Level 2 Podium in the main University College Hospital building with the entrance on Euston Road (see map below).  

Travelling to the hospital  

No car parking is available at the hospital. Street parking is limited and restricted to a maximum of two hours.  

Please note the University College Hospital lies outside, but very close to the Central London Congestion Charging Zone.  

Tube  

The nearest tube stations, which are within two minutes’ walk are:  

• Warren Street (Northern and Victoria lines)  
• Euston Square (Hammersmith & City, Circle and Metropolitan lines)  

Overground trains  

Euston, King Cross & St Pancras and Kings Cross Thames link railway stations are within 10-15 minutes’ walk.  

Bus  

Further travel information can be obtained from http://www.tfl.gov.uk 020 3054 4040 14 

Hospital transport service

If you need (and are eligible for) transport, please call:

020 3456 7010 (Mon to Fri 8am-8pm) to speak to a member of the Transport Assessment Booking Team.

If you have a clinical condition or mobility problem that is unlikely to improve you will be exempt from the assessment process. However, you will still need to contact the assessment team so that your transport can be booked. If your appointment is cancelled by the hospital or you cannot attend it, please 020 7380 9757 to cancel your transport. 

University College Hospital Area Map