All about Chemoport

A chemoport has a small round metal chamber (portal) with a rubber top (septum) and a flexible tube (catheter). It is placed completely under the skin on the chest below the collar bone. A catheter threads under the skin from the metal chamber into a large vein near the right chamber of the heart. Intravenous (IV) medicines and treatments can be given directly into the bloodstream through the port using a special type of needle.

When do we need a Chemoport in cancer treatment?

A chemo-port is used when a person needs intravenous (IV) access to receive fluids or drugs over a long period of time and the small veins in the body are thrombosed and can no longer be used.

Benefits of Chemoport

The most important benefit of chemoport is that it reduces the number of needle sticks.

Can stay in the vein for a long period
Reduces discomfort because IV therapy can be given more easily
Does not require a dressing once the skin has healed
Prevents the “burning” sensation sometimes felt when getting drugs by other IV methods
Does not restrict activity – You can bathe, exercise, swim and play once the incision heals and the needle is not in place. It requires no care at home

How is Chemo Port Placed?

The chemo port is placed in the operating room under general or local anesthesia.

The doctor makes a small cut in the skin below the collarbone where the port is placed and catheter introduced in a vein in the lower part of neck.
The catheter tip is placed in a large vein in the neck under ultrasound guidance and threaded just above the right chamber of the heart.
The other end of the catheter is tunnelled under the skin and attached to the portal.
Fluid is injected into the portal to ensure it is working correctly.
The portal is then placed in a small pocket under the skin in the chest and stitched to underlying tissue.
Absorbable stitches are applied and wound dressed
An x-ray is done to confirm catheter tip position.

Chemoport Insertion Procedure

The insertion of a chemoport is a vital step in ensuring patients receive their necessary treatments safely and comfortably. This procedure typically takes place in a sterile environment, such as an operating room, to minimize the risk of infection. Here’s a simple breakdown of how the process works:

Anesthesia: Before the procedure begins, the patient is given anesthesia, which may be general (making them fully asleep) or local (numbing the area). This ensures the patient feels no pain during the insertion.
Incision: The doctor makes a small incision below the collarbone. This is where the port will be placed. The incision is minimal, which helps in quicker healing and less scarring.
Catheter Insertion: A flexible tube called a catheter is then introduced into a large vein in the neck. This is often done with the help of ultrasound guidance, which allows the doctor to see exactly where to place the catheter. The tip of the catheter is positioned just above the right chamber of the heart to ensure efficient delivery of medications.
Port Placement: After threading the catheter under the skin, the doctor connects it to the chemoport. The port itself is then placed in a small pocket created under the skin in the chest area. It is securely stitched to the underlying tissue to keep it in place.
Testing: Once the port is in place, fluid is injected into it to confirm that it is functioning correctly. This ensures that the system is ready for use when treatment begins.
Closure and Recovery: Absorbable stitches are used to close the incision, and a sterile dressing is applied. After the procedure, an X-ray may be conducted to confirm that the catheter tip is positioned correctly.

The entire procedure usually lasts about 30 minutes to an hour, and patients can often return home on the same day. The area around the port may be tender for a short period, but it typically heals well within a week.

When can we start using a chemoport?

A chemo port may be used, often the same day or the next morning. The skin may be tender around the incisions for 1–2 days after the port is placed. The insertion site usually heals in next 5-7 days. The sutures at insertion site are absorbable within 12-15 days.

How a chemoport works?

Because the port is under the skin, it must be accessed using a special needle (Huber needle). When IV therapy is needed:

The skin is thoroughly cleaned with antiseptic. The needle is inserted through the skin and the rubber top of the portal.
The needle is attached to a short length of tubing that hangs down the front of the chest.
A small dressing is used to cover and protect the needle.
The fluid or medicine flows through the needle into the port, then through the catheter and into the blood.
After the treatment is over, the needle is removed.

Possible Complications

Infection in the skin at the exit site or in blood - Some infections can be treated with antibiotics.
Blood clots in the catheter or vein – The catheter may be flushed with a drug to try and dissolve the clot.
Subcutaneous port moves and irritates the vein- The port may be removed.
In case the port has severe infection or is blocked due to blood clots, rarely we need to remove the ports.

Caring for a chemoport

Because a subcutaneous port is completely under the skin, it needs very little care.

The skin at the injection site needs to be washed as normal.
A bandage is not needed when a needle is not in place.
Check the site daily for any redness, swelling or other signs of infection.

Removing a chemoport

A subcutaneous port will be removed when IV therapy is no longer needed. This is done in the operating room under local anesthesia, usually on outpatient basis.

When to call the doctor OR Call the doctor if:

There is any redness, tenderness, bruising or drainage at or near the port injection site
The person has a fever, aches or flu-like symptoms
The port moves or there is swelling, tingling or pain at or near the port injection site.

Dr Ashish Goel(Cancer Surgeon)

Associate Director, Surgical Oncology

Jaypee Hospital, Sector 128, Noida, Delhi NCR.