10 things to know about ports, the ones for blood not ships

by Stephen Cobb on February 10, 2014

The following 10 points about “ports” that are installed in patients who need to endure a lot of blood drawing come from my wife, Chey Cobb, who was diagnosed with hereditary hemochromatosis or HH in 2008. As you may have read elsewhere on this site, HH can result in your body having too much iron. This can be measured by checking your ferritin level. Ferritin is “a ubiquitous intracellular protein that stores iron and releases it in a controlled fashion”. (Wikipedia)

The standard treatment for people with excess iron, as indicated by higher than desirable ferritin numbers, is to draw blood. When you give blood it removes iron from your system, and that is one reason the Red Cross does not allow you to give “whole blood” more than every 56 days. But people who suffer from iron overload may need to be bled many times per month for a period of months in order to reduce excess iron (as determined by repeated ferritin tests). The point is, frequent blood draws can be hell on your veins.

Having blood drawn for medical reasons is called a phlebotomy. When blood is drawn for therapeutic purposes, as in the case of HH patients, it is called therapeutic phlebotomy (TP). One option for those whose veins are hard to find, or who find they don’t tolerate needles very well, is to have a portacath or “port” installed:. This a small medical appliance that is installed beneath the skin and a tube or catheter connects the port to a vein. Recently, several people on the Facebook Hemochromatosis page have asked about ports. What follows are my wife’s experiences with, and thoughts about, this technology:

1. If you are scared of surgery and/or find it difficult to recuperate from invasive procedures, don’t do it.

2. Don’t listen to all the hysteria and horror stories about ports. Millions of cancer patients get them every year as standard procedure. They need to provide doctors with access to their veins for their chemo treatments and a port relieves the stress of trying to find a new vein every day.

3. If you have to undergo an “aggressive” series of phlebotomies (more than once weekly) and don’t get a port, your veins will become scarred and it will be more difficult to find a good one. If your veins are small and/or hard-to-find, definitely consider a port!

4. There are external ports and under-the-skin ports (called, “portacath” or “subcutaneous port”).

5. External ports need to be kept very clean to prevent infections. Under-the-skin ports sometimes get infected, but the infections are rare and are usually easily treated with antibiotics. (The under-the-skin infections were often because the patient had an infection already in his body, but the symptoms hadn’t yet shown themselves.)

6. There is a good web page for under-the-skin ports, again from their use with cancer patients. (When I had my port for HH phlebotomies it was all handled through the oncology department, which sometimes helped me keep my own problems in perspective.)

7. The surgery for either port is done on an out-patient process. The procedure only takes 45 minutes to an hour.

8. The surgery itself is not painful, but the recovery may take a day or two. About eight hours after the procedure, you will feel pain, but will probably have been given pills for it. You may be advised to sleep in a lounger with your head raised for one or two nights. The pain goes away completely after a couple of days.

9. The ports are placed near your collarbone. The external ports look like a test tube and a pipe hanging from your collarbone. The under-the-skin ports appear as a quarter-sized “bump” under the skin.

10. The external ports can be seen through shirts, but the under-the-skin types usually can’t be seen. (When I had my port I would wear tank tops and no one noticed the bump.)

Chey concludes: These points are based on my generally positive experience with a port, your mileage may vary. In the end the choice to get a port may depend on how squeamish people are: “I tend to see complaints from people who were apprehensive about getting them, but not many complaints from people who seemed to be ‘braver’ about the whole thing.”

{ 15 comments… read them below or add one }

Jacki February 10, 2014 at 6:30 pm

Thanks for this information. As an HH patient who’s had breast cancer, they can only pull blood from one vein and I also need fluids as I have low blood pressure and pass out. They have started to put the IV drip port in my arm and use that to get my initial readings and use the largest inside vein on my arm for phlebotomy. The nurses are saying that at some point I will scar up and then they’ll have to find other places. A port would be a nice option rather than a painful pin cushion! Thank God for this site and all the information shared!

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Stacy May 21, 2014 at 10:32 am

I was diagnosed with HH in September 2012, and had a port installed almost immediately because the phlebotomist was unable to draw the large volume of blood from the vein in my arm. I have always had difficulty with blood draws peripherally, so the port has been a blessing. My issues have arisen with doctors who refuse to use the port for blood-letting. I moved to a new town and decided to change doctors. My new doctor told me the port was not designed for blood-letting, and he said he would only bleed me peripherally. It took passing out in the lab tech’s chair for them to begin to use the port. I have contacted several doctors in the area, and have been told that the port is not designed for blood-letting, and they refuse to use it for such. I have since transferred back to my original doctor almost 100 miles away to reduce the stress of proving the necessity of the port.
I don’t understand why doctors won’t listen to patients with ports, particulary when the port was installed SPECIFICALLY for blood-letting. Common sense says that I would not have had the surgery to have the port installed if it was not necessary.

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Stephen Cobb May 26, 2014 at 9:29 pm

Amazing! I am at a loss for words. Some doctors can be soooo ignorant, not to mention uncaring.

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Karen Bird November 19, 2014 at 12:37 pm

I have an under skin port a cath for my phlebotomies. My first couple attempts of blood draws from my arms were unsuccessful. i was poked three to four times with rolling veins than once one was accessed it calapsed. I will have my 8th blood draw in two weeks. Best decision my medical team made. So much easier for everyone.

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Sandra November 19, 2014 at 2:40 pm

I was diagnosed in Dec 2010. I had a port placed right away because I have very small veins and the Dr. recommended that I get a port because they did not want to put my veins thru trying to get a vein. I have had no problems. I have not had to have a phlebotomy in about a year and a half, my Ferritin has stay below 20 ever since it finished with my phlebotomies. So I still have to go get the port flushed every 4-6 weeks, but my physician does not want to have it removed.
I do not regret getting my port at all. Good luck.

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My Sevilla November 19, 2014 at 6:53 pm

Thank you

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Lesa (aka-LostDesertGirl) January 5, 2015 at 9:47 pm

I’ve been receiving chemotherapy due to a chronic rare disease/syndrome for over 9 years. I also had been stuck so much my veins we shot before i even began. My port is truly a gift from God!

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Diane May 5, 2015 at 7:39 pm

I am happy to hear you have had a positive experience from your portacath.
However, being a nurse of many years and a cancer patient, you have failed to
list the many problems that can be associated with a portacath. Infection is number one problem that I teach all my cancer patients about when dealing with their portacath. Possible hemolysis of blood drawn from the port and
always suggest if they have any veins to have a venipuncture done for the most
accurate labs. Heparin that is placed in the ports after use can also interfere with some lab results. If you were a cancer pt. you would understand that those lab
results are what your chemo dose is based on. Many ports do not draw well and have had to have TPA placed to open the port. These are just a few of
the reasons I teach all my patients, cancer or otherwise to have a venipuncture
if there are any veins present. This has been researched and in compliance with evidence based nursing.

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Stephen Cobb June 27, 2015 at 6:06 pm

Diane – Your input is appreciated.

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Karl October 4, 2015 at 5:12 pm

I don’t have HH but I do have polycythemia and need a phlobotomy every 4 to 6 weeks. The veins in my arms are getting to bad, they have a really hard time getting the blood out. They also have to use the largest needles they have so the blood will flow. I have a Vortex port , by RITA Medical Systems,implanted now but they tell me that it can’t be used for blood draw, only in flow due to a flap to allow only one way flow. My doctor said he isn’t aware of any ports that can be used for phlobotomy. Can anyone give me the name of a company that makes an implantable two way port.

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jody March 10, 2016 at 8:08 am

I’m having a port placed tomorrow, thank you for all the valuable information.. I have polycythemia and have been having blood draws every 2 weeks for 3 years now.. what veins I had are now shot… I’m nervious about the placement but hopeful for much easier blood draws in the future!

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Donald April 22, 2016 at 6:33 pm

I had a powerport put in last week , it be use in few weeks for my phlebotomies and I been told it will work very well for them .

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Charleen September 9, 2016 at 11:57 am

Can you get a bad blood reading on potassium with a power port?

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Stephen Cobb March 11, 2017 at 6:09 pm

Sorry – we don’t have an answer on this one.

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Beverly February 22, 2017 at 10:03 am

My husband has an implanted port. He has lung cancer and that was the first thing they did. He loves it as he hates being poked so many times. As he is also on coumidin he needs a blood draw every week. I have 2 things that baffle me.
1. There is no one in the lab at our hospital that draws blood from a port. The first visit I insisted they find someone to do it. They notified the Diagnostic dept. That nurse said since they had to use Heparin it would contaminate the blood sample. Not so…his oncologist takes a vile of blood and throws that one away then draws the fresh one. So I finally got a nurse to do this that knew what she was doing. So moral of story don’t give up until someone LISTENS to you.

2. My husband has been in and out of hospitals. The radiology dept. at the hospital uses a mask and also has my husband put one on in a secluded room when accessing his port, they said this is hospital policy. The same hospital where my husband was a patient the nurses never used one.
His nurse practitioner at the oncologist office doesn’t wear one, but the nurse where he has blood drawn from coumidin does. I think everyone should wear a mask when accessing his port due to his immune system being so vulnerable. I have asked but I get looked at like I have 2 heads. Comment anyone?

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