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MethodsThe Port-a-Cath system (Pharmacia) is totally implantable and consists of a silicone catheter attached to a 2-5 x 1-3 cm stainless steel chamber with a self sealing injection port. Under local or general anaesthesia, and full aseptic conditions, the catheter is introduced surgically into a central vein and the position of the tip is checked radiographically. Through a second incision lower on the chest wall a subcutaneous pocket for the portal is made by blunt dissection. The catheter is tunnelled subcutaneously and connected to the portal, and the wounds are closed.2 Huber needles, which slice through the silicone septum without coring it (fig 1), are used to inject drugs percutaneously into the portal. Between courses of treatment the needle is removed, leaving intact skin overlying the portal.In the course of eight months the system was implanted in nine patients (eight of them female) with cystic fibrosis; their age range was 13-38 (median 22) years. As percentages of predicted normal3 their median (range) FEV1 was 32% (17-47%) and FVC 30% (26-62%). They were all chronically colonised by Pseudomonas aeruginosa, and had required a median of four (range 2-12) hospital admissions for intravenous antimicrobial chemotherapy within the previous year. Peripheral venous access had become unsatisfactory in all of them, and six had required central venous catheterisation. Three patients had diabetes mellitus.In view of poor respiratory function Port-a-Cath implantation was performed under local anaesthesia in eight patients, but one patient underwent general anaesthesia at her own request. The cephalic vein was cannulated in three patients, the external jugular in five, and the internal jugular vein in one patient. The position of the portal was carefully chosen preoperatively to ensure that it interfered as little as possible with chest physiotherapy. In patients regularly

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