The Ease and Flexibility of Implantable Ports

A medical advance gives patients more freedom and less pain, and gives health care professionals a better way to deliver medication intravenously.

Patients with severe medical conditions like cancer have often endured repeated needle sticks as medical professionals accessed their veins to administer therapies and draw blood samples during the course of treatment.

Patients faced a stark trade off: the medication that might keep them alive reached their bloodstreams, but the cost was enormous. Continual needle pokes can devastate a patient's veins. In addition, the chemicals used to fight diseases like cancer can be very irritating if they come into contact with skin or surrounding tissues, and require patients to reschedule treatments to allow the affected tissues time to heal.

Garrett's story
When Eric Miller and his wife Nancy found out their 5-year-old son Garrett would have to undergo 64 weeks of chemotherapy, they were grateful that technological advances allowed their little boy to avoid such a painful process. In particular, the Millers had access to a medical device-an implantable port-that makes delivery of chemotherapy and other intravenous therapies easier on patients, and leads to better outcomes and fewer complications.

And like so many advanced medical technologies, implantable ports not only improve care for patients, they also provide a more cost-effective way to access the veins than other methods. Experts estimate that the cost of an implanted port equals about ten intravenous (IV) sticks.¹ For a patient like Garrett-whose veins were accessed dozens of times during his treatment—the economic advantage is clear.

In the summer of 2000, as Nancy watched Garrett playing T-ball, she noticed his balance was off-in fact, he was having difficulty just getting the ball onto the tee. She took him to the doctor the next day and he was diagnosed with a malignant brain tumor.

Garrett had surgery to remove the tumor, a two-week break, then six weeks of radiation therapy. During that time, he also had one chemotherapy injection each week.

After the radiation treatment, Garrett was scheduled for chemotherapy every six weeks for 64 weeks. Each treatment would involve eight hours of chemotherapy-during which he was hooked up to an IV bag on a pole. After that, he underwent rehydration therapy. For this he wore a backpack that carried the fluids that were delivered to his system. The whole process took about 27 hours.

The IV Port
Shortly before his radiation treatments began, Garrett had a port surgically implanted under his skin, just below his collarbone. The port was the size of about four or five dimes stacked on top of each other and placed on a nickel-sized triangular platform with smoothly rounded edges.

Through the port, Garrett received all six of his initial chemo injections. In addition, the port provided access for all of his subsequent chemo treatments, his rehydration therapy, and his weekly blood draws.

From the outside of a patient, a port appears as a small bump on the patient's skin. Inside the body, a flexible tube or catheter reaches from the port into one of the patient's larger blood vessels-giving the medication a route to the bloodstream.

Ports are made of biocompatible material such as titanium, which does not cause the body to react. The hard case has a self-sealing opening, or septum-about the size and feel of a pencil eraser-on the side that faces the skin, through which a needle can be inserted. That opening gives easy access to the system that delivers medication to the veins. Before each treatment, Garrett had numbing lotion rubbed on his skin above the port, which minimized the pain he felt when the needle was inserted into the self-sealing opening.

Improving quality of life
The implantable port gave Garrett more flexibility. During chemo, Nancy says, he was attached through his port to a medication bag on a pole. The cancer-fighting drugs were infused through a pump, which took from 8 a.m. to 4 p.m. He typically stayed in bed, during this time, but he could get up. He and another young patient often raced remote controlled cars during their treatments.

The advantages of the port were particularly evident during the rehydration portion of Garrett's treatment. After the chemo was delivered, Garrett would wear a backpack which held the hydration fluids that were being infused with a pump. "With the backpack, he was free to roam," Nancy says.

In fact Nancy and Garrett left the hospital during rehydration. They had to stay close to the hospital, so they couldn't drive from Denver to their Pueblo, Colorado home, but they could stay at Garrett's aunt's house in the area. Nancy says she even ran along side Garrett, holding his backpack as he rode a scooter. After the hydration was finished, usually around 11 a.m. the next morning, Nancy removed the needle from the port, the hospital sent someone to come and pick up the backpack and pump, and the two headed home.

While ports have been available for about twenty years, the type of port Garrett had implanted became available just six years before his treatment began. It was designed specifically for small people.

Before having the port implanted, Garrett's parents were given different options for the delivery of their son's chemo, including an external tubing system called a central venous catheter (CVC).

They did consider a CVC, an external tube which is tunneled under the skin to reach a major vein. But three tubes of this system would remain outside the skin, which caused concern for two reasons. First, says Eric, it would have had a serious impact on Garrett's quality of life. Because part of the device was external, Garrett would have been at greater risk for infection and accidental dislodgement. Playing with the family dog, wrestling with his two brothers and sister, and going swimming-all activities that Garrett loved-would have put him at risk.

Another advantage of the port over the CVC was purely emotional, his dad explains. "We didn't think about it at the time, but the stigma was a lot less. He was already bald. That just screams, 'I'm sick.' But if you have these tubes hanging out of you, it makes it worse. Having the port eliminates that," Eric says.

In addition, Garrett would have to be in the clinic for several hours during each chemo session as the cancer-fighting medication was delivered to his system. With the central venous catheter, he would have been less mobile during that entire period.

Better outcomes, fewer complications
As Garrett's experience shows, therapy with the use of ports has become incredibly flexible, says Sandi Pieger, a registered nurse from Connecticut who specializes in intravenous therapies. "The pumps and methods of delivery for drugs allow for the patients to travel as opposed to sitting in one spot attached to an IV bag on a pole. Some pumps are very portable and can be put into a pouch and strapped around a patient's waist to allow them to travel about," Ms. Pieger says.

In 32 years as a registered nurse, Ms. Pieger has seen horrendous complications from the delivery of chemotherapy medications with a direct IV. "If one drop of Adriamycin, a common chemo drug, is in a needle that works its way out of a vein, it can cause what is comparable to third degree burns in that area," she says.

In addition, for a young and active patient like Garrett, the potential for infection or accidental dislodgement of an external CVC is great. If such a mishap occurred, there would have been costs to treat the infection, or restore the CVC-including the time lost in his treatment regimen.

For situations like Garrett's-where patients face a condition that requires repeated and long-term access to their veins-ports are a cost-effective alternative to traditional delivery mechanisms. Health professionals like Pieger say ports lead to better health outcomes as well. And for patients like Garrett, their value cannot be measured.

Garrett is now a healthy 9-year-old boy-it has been more than two years since he finished his treatments. And though he lost nearly all of his vision because of the brain tumor, he remains very active. He's an avid tandem bicyclist-his older brother Ryan often rides on the front of the bike with Garrett on the back.

Garrett also rides tandem with his dad, who was recently selected for the Tour of Hope, a cross-country bike tour sponsored by Bristol Meyers Squibb to demonstrate support for cancer research. As one of 27 riders-all of whom have been touched by cancer-Miller rode from Los Angeles to Washington, DC. He wore Garrett's port around his neck for the entire ride, a testament to how profoundly it affected the Miller's lives and their future.

¹ Information provided by Bard.