Ports are implanted subcutaneously to provide repeated long‐term access (Weinstein and Hagle [465]) to the vascular system (other ports include arterial, epidural and peritoneal). Implanted ports require little care of the site because of the intact skin layer over the port, except when accessed. When not in use, the only care required is a regular flush to maintain patency (Weinstein and Hagle [465]). Other benefits include a reduced risk of infection (Bow et al. [48], Mirro et al. [318], Moureau et al. [336]), less interference with daily activities such as bathing or swimming (Wilkes [472]), and less of a threat to body image than with the presence of an external catheter (Biffi et al. [35], Bow et al. [48], Mirro et al. [318]). Patients with ports are often very satisfied with their access devices (Chernecky [72], Johansson et al. [232]).

Disadvantages of ports include discomfort when accessing is performed (particularly if placed deeply or in a difficult‐to‐access area). This can be overcome with the use of topical local anaesthetic. However, the tissue over the septum becomes callused or scarred and over time there is loss of sensitivity (Fougo [154], Hadaway [194]). Needle dislodgement with resulting extravasation and needle stick injury are well‐documented problems associated with ports (Dougherty [126], Schulmeister and Camp‐Sorrell [405], Viale [456]). There are also issues related to occlusion and ‘sludge’ build‐up, although newer designs are attempting to reduce these issues (Stevens et al. [429]). Finally, there can be problems with obtaining blood return (Moureau et al. [336]).

Implantation is a surgical procedure carried out under general anaesthetic, or sedation and local anaesthetic (Goossens et al. [176]). Some catheters are pre‐attached to the reservoir while others require attachment on insertion (Dougherty [123], Wilkes [472]). The most common veins used are the subclavian, the internal jugular, the femoral and the veins of the upper arm (Bodenham et al. [43], Hadaway [194], Pittiruti et al. [375], Weinstein and Hagle [465]). Samman et al. ([396]) recommend the jugular vein as the first site for access unless the patient's circumstances do not permit this approach. Ports must be implanted over a bony prominence and most commonly over the bony area below the clavicle; less commonly, they are implanted on the ribs or the forearm (Biffi [34], Wilkes [472]). Arm ports are becoming a viable alternative as they are easy to implant and have very low complication rates (Burbridge and Goyal [57], Goltz et al. [173], Krieger and Burbridge [249], Shiono et al. [413]).

The catheter is introduced into the superior vena cava via the subclavian or jugular vein (chest ports) or the basilic or brachial vein (upper arm ports), and fluoroscopy or ECG technology (for arm ports) is used to verify the placement of the tip. The catheter is then tunnelled to the pocket (Dougherty [123]). The pocket is made just under the skin, usually on a bony prominence for stabilization (Wilkes [472]). The port is then sutured into place to the underlying fascia. The suture line can be lateral, medial, superior or inferior to the port septum to remove it from the area where the port will be accessed because repeated access could cause stress to the suture line (Dougherty [123], Weinstein and Hagle [465]). The area is tender and oedematous for up to a week following implantation, and any manipulation or accessing may be painful. When immediate use is indicated, the port should be accessed and dressed immediately following insertion (Wilkes [472]).

Ports are associated with a low rate of complication, particularly infection (Barbetakis et al. [17], Beckers et al. [26], Biffi et al. [36], Dal Molin et al. [102]).