Vortex® ports

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.

We are a nurse-led team who specialise in intravenous lines (lines situated within a vein). We will arrange for your Vortex® port to be inserted by a radiologist and can provide expert advice before and after your port insertion. Please feel free to ring us on 020 3447 7491 if you have any questions.

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.

Leaflets about femoral lines and tunnelled lines are also available on our website here.

If you are an inpatient, the nurses and doctors on the ward will advise you on how to prepare. If you are an outpatient, one of the central venous access team members will give you detailed information about preparing for your appointment. You may need to have a blood test before the insertion.

Some patients have their Vortex® ports inserted under local anaesthetic alone but you may prefer to have an intravenous sedative as well. This is to help you relax. If you decide to have a sedative, you may need to attend a pre-assessment clinic to make sure you are fit for sedation.

If you take tablets or injections to thin your blood, these may need to be stopped for a short time. This is to prevent any bleeding during the port insertion. If you are an outpatient, you should discuss this with the doctor who prescribes your blood-thinning medicine. One of the central venous access team members will also talk through the plan with you.

If you have ever had an infection called MRSA, please let your doctor or nurse know. You may need to have a nose swab to see if the infection is still present before your Vortex® port can be put in.

We want to involve you in all the decisions about your care and treatment. The team looking after you will answer any questions you may have so please ask if anything is unclear. If you decide to go ahead, we will ask you to sign a consent form. This confirms that you agree to have the procedure and understand what it involves.

A doctor called an interventional radiologist will insert your port. To reduce the risk of infection, the doctor will wear a surgical gown with a hat and mask. You may be attached to a heart monitor and fitted with an oxygen mask.

To check the position of the port X-rays will be taken during the procedure.

It usually takes about 45 minutes to put the port in, but you should allow several hours for the appointment. This is because it will take time to check you in and prepare equipment. The doctor putting in your port will also need to talk it over with you beforehand. If you are having sedation, you will need some recovery time before going home. Your appointment may also be delayed if there is a patient who needs to be seen urgently.

If you are an inpatient, you will be taken back to the ward. If you are an outpatient, you should be able to go home on the same day. We will ask you to arrange for a friend or relative to accompany you home if you are having a sedative. Someone should stay with you overnight too.

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.

You should wait four weeks before the Vortex® port is used for a red cell exchange. This will allow any swelling to settle. If you need an exchange sooner than this, we will advise using your arm or femoral veins. It may be possible to use the port sooner for blood tests – the apheresis team will advise you about this.

A Vortex® port can stay in for several months or even years. It will be removed when you no longer need it or if there are complications. Removing the port is similar to inserting it.

Risks during insertion

Most Vortex® 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’s possible for an infection to develop in the skin around the Vortex® 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’s 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 sometimes 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.

Some people develop clots around the internal end of the line near the heart but without having any symptoms. For this reason, your haematology team will arrange for you to have a test called an echocardiogram, or ‘echo’, once a year to check for any hidden clots. An echocardiogram is a painless procedure which uses ultrasound to examine your heart. It is similar to an ultrasound scan used in pregnancy.

Malfunction

Sometimes the Vortex® port fails to function properly. This may be because it has not been positioned correctly or has moved. If this happens, the port will need to be removed.

Blockage

Vortex® ports can sometimes become blocked. We can usually unblock them by using a special flushing solution.

Pain when the port is used

When the port is used, a special needle is inserted through the skin. If you are having a red cell exchange, you will have an injection of local anaesthetic to numb the skin before the needle is inserted. This may cause temporary discomfort similar to a blood test. Once the skin is numb inserting the needle should not be painful.

When the port is used for other reasons, such as blood test, you will not need local anaesthetic. This is because the needle used for blood tests is much smaller than the needles used for an exchange. If you prefer, you can ask your nurse to apply a numbing cream to the skin before the port is used for blood tests.

Difficulty in inserting the needle into the port

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

Scarring

Most people will have a scar about two centimetres long just to the side of the port. You will also have a small scar just above your collar bone.

If you are prone to keloid scars (scars that are larger than average), please tell the doctor inserting your port. It may be possible to position the port so that the scars are less visible.

This will depend on the type of treatment you are having. You should discuss your options with your doctor or nurse, or contact the central venous access team on 020 3447 7491 if you have any concerns.

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. This is a simple procedure where a needle is inserted through the skin into each chamber of the port and a heparin solution is injected. You will need to make an appointment to have this done.

While your port is in place, 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.

Central venous access team (Monday to Friday, 9am to 5pm)

Telephone: 020 3447 7491

Haemoglobinopathy clinical nurse specialist (Monday to Friday, 9am to 5pm)

Telephone: 020 3447 7359

Apheresis team (Monday to Friday, 9am to 5pm)

Telephone: 020 3447 1803

Supportive Care Unit (Monday to Friday, 8am to 8pm)

Telephone: 020 3447 1808

Out of hours

Oncology patients: 07947 959 020

Haematology patients: 07852 220 900

Teenagers and young adults: 07908 468 555