Chemoport

Chemoport

A chemotherapy port is a device placed under the surface of the skin to allow easy access to administer chemotherapy drugs into the circulatory system.

A port has small titanium or plastic reservoir with a silicon cover. A small plastic catheter is attached to this reservoir that will be threaded into the vein.

Why chemoport is needed?

Chemotherapy can often be harsh on the skin and limb veins. These veins are often damaged by chemotherapy infusions by phlebitis or blocked by blood clots or obliterated by fibrosis. This can result in limb swelling, pain, and difficulty in accessing the veins for subsequential chemotherapy or blood sampling.  Also, if certain drugs spill over the skin or into the underlying tissue, it causes tissue damage, necrosis, and superinfections.

The insertion of chemoport helps to protect the patient’s body from these unnecessary damages to the limb veins and the limb. This port can be pricked up to 2000 times and can remain in the body for up to 5 years. When not in use, the patient can carry out all normal activities including sports.  It can be used to administer other intravenous drugs other than chemotherapy, fluids, nutritional products, blood, and blood products. It’s often needed to carry out various blood investigations during chemotherapy sessions. One additional advantage of chemoport is that blood can be withdrawn from it for these investigations, eliminating a vein prick.

Chemotherapy can be started on the same day of the procedure of insertion.

Types of chemo port-

There are two types of chemo ports. Intraperitoneal (IP) and central venous (CV). IP port allows access to the abdominal cavity for chemo drug insertion like in ovarian and gastrointestinal cancers. For most of the other cancers, a CV port is inserted into the central venous system via the subclavian vein (below the collar bone) or Internal jugular Vein (in the Neck).

Placement Technique-

Placemat / Insertion is a simple daycare surgery done either under general anesthesia or under local anesthesia with sedation, depending upon the patient. A surgeon makes a 3 to 4 cm cut and makes a pocket beneath the skin to place a reservoir. The choice of placement depends upon the patient and the entry point of venous access. It’s usually below the collar bone in front of the upper chest or it can be on the upper abdomen or outside the upper arm.  The catheter is threaded into the central vein of choice (like subclavian under collar bone of internal jugular vein in the neck) and placed in such a manner that its inner tip lies just above the heart. After insertion, there is usually a small bump underneath your skin that is usually not noticeable by others. The sutures are usually absorbable and need to be removed. The incision leaves a very thin scar looking like a wrinkle over time.

As with other surgical procedures, during recovery time at home, the patient should monitor symptoms like fever, redness, gaping, pus discharge at the surgery site, fever,  shortness of breath, chest pain, etc In case of such problems, you should report to the operating team/hospital.

Use and care-

For the patient, care of the port is easy. Immediately after insertion, keep the incision dry and clean. Once the sutures are healed which takes around 5 days to a week, the patient can engage in usual activities. The nurse who administers the medications performs most of the port care. Access is gained to the port by hubber needle connected to the tubing or by winged infusion set. Chemotherapy drugs are then infused through fluids (saline) through these tubing and needle connected to the reservoir. The nurse flushes it with saline and anticoagulant medicine like heparin to clear the lines and dissolve any blood that might get clotted and block the port. Once the blood is withdrawn if it has to be drawn for investigations or once the chemotherapy drugs are infused, the nurse flushes the port again and removes the needle inserted into the reservoir.

It is important to note that the ports that aren’t frequently used like after completion of all chemotherapy cycles, need to be flushed at least once in 4 to 6 weeks till it removed.

Removal Of chemo port-

Chemo ports are kept placed till at least 2 years after completion of chemotherapy cycles. It’s removed once the chances of recurrences are rules out by investigations at the end of your successful completion of 2 years of follow up.

Removal is usually a daycare procedure carried out under local anesthesia

The pocket under the skin is opened through the same incision that was used for insertion and the port is removed in one piece along with its catheter.

The incision is closed in the same manner as before with absorbable suture material that needs not be removed. It leaves no additional scar other than the existing one. It fades to a thin line or wrinkle over time and is usually not visible.

Probable complications-

During surgery or immediate postoperative period –

As with any other surgery, though very minimal, there are chances of complications like an injury to the lungs during central venous access. It can cause a leak of air in the chest cavity (pneumothorax) or bleeding inside the chest cavity (hemothorax) causing difficulty in bleeding. It may need insertion of the tube inside the chest cavity to treat the condition and needs hospitalization.

As chemo port is a foreign material placed inside a body, its prone to infection especially when the patient is diabetic. Infection can set in during surgery, immediately after surgery, or even during its use to infuse chemotherapy drugs during chemotherapy sessions. The symptoms like excessive redness at the site of the reservoir, fever, pus discharge from suture line, or collection of fluid in the pocket are some of the signs of infection. It needs good antibiotic therapy. The infection is usually self-limiting, but it may need premature removal of chemoport before it completes its purpose.

In spite of intermittent flush with anticoagulant medicines, there are minimal chances of formation of blood clots at the tip of the catheter. It causes a complete or partial blockage which renders the port useless. Neither any drug can be infused not blood can be withdrawn in such a situation. It too may need to remove the port prematurely.

Very rarely, the clot can disrupt and may cause embolism leading to heart failure (MI), pulmonary embolism, stroke, etc.

Warning symptoms-

  • Fever
  • Excessive redness at the port site
  • Pus discharge at the port site
  • Gaping of sutures
  • Shortness of breath
  • Chest pain
  • Dilated neck veins and swelling of the face-neck
  • Arm Swelling
  • Headache and vomiting
  • Ambulatory Chemotherapy program

The port can also be connected to the portable pump (filled with chemotherapy drugs) and the patient is discharged. Chemotherapy drugs will be slowly released at a fixed rate while the patient carries with his normal day to day activities at home. He has to come back to the hospital after few days for the removal of the pump.

Other central venous devices-

  1. Hickmann catheter- it is a catheter tunneled under the skin before entering into the venous system.
  2. PICC Line- is inserted through the arm vein and the tip is placed into the central venous system.

A part of the catheter is exposed to the outside Hence there are higher chances of infection than chemo ports and need regular dressings.

Our experience

We have been using chemoports widely and have around more than 400 chemo port insertions since the year 2010 with a majority of them using IJV approach and remaining via the SCV approach. Infections were reported in around 19 patients and only 3 were unsalvagable.  Thrombosis (clotting) and the blockage was reported in 9 ports out of which only one patient suffered from SVC Syndrome and one embolism. There are no cases of chest complications like pneumothorax or haemothorax., catheter fragmentation, or misplacement. These low failure rates make us a safe team to suggest and carry out chemo port insertions and handling them during and after chemotherapy sessions.

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