Chemotherapy ports are specialised vascular access devise [VAD]. The VADs are classified into 3 according to the longevity of intended use. 1. Short term: IV catheters, Midlines. 2. Acute catheters: central venous lines or PICC i.e. peripherally inserted central catheters. 3. Long term: tunnelled catchers or implanted ports.
The thrombophlebitis following the irritant and hyperosmolar chemotherapeutic agents leave behind the bad marks and memories. That is seen as a major concern for the new patients for chemotherapy. Extravasation of chemotherapy from peripheral line poses a big clinical problem for treating team if left unnoticed. This issue has been circumvented by chemotherapy ports.
What is it?
Chemoport has two parts. One is chamber which is fixed in infraclavicular fossa i.e. in area below the collar bone. The chemotherapy drugs can be injected in the chamber. The camber has puncture resistant membrane.
The second part is the tube that carries the drug into the largest blood vessel draining to heart. This tube is tunnelled beneath skin into the neck and passed into jugular vein that leads to SVC [main vein to heart] – right atrium [first part of heart receiving blood] junction.
How to put it?
The procedure is carried out preferably in general anaesthesia with supine position and shoulder extension with arms by side. The operative areas are prepared with proper antiseptic solutions. The chamber is inserted 4 fingerbreadth below clavicle [collar bone] and fixed to underlying muscle [pectoralis major]. The jugular vein is punctured by identifying the specific anatomical landmarks and guidewire is inserted. C arm is used to check the entry and position of guidewire. One may get few ECG changes at this point. The tube is then cut at an imaginary mark that correlates with its tip position at sternal angle with help of C arm. The tube attached to chamber is tunnelled subcutaneously up to an incision made at entry point of skin puncture at guidewire entry in neck and tube is delivered out from it. A specific tearable sheath is transported over the guidewire via jugular vein into SCV. The tube is inserted fully into the sheath after removing guidewire. The sheath is teared and removed gently taking care that the tube does not come out the same time.
The C arm is again utilised to see the course of tube, smooth genu of tube turning and entering in jugular vein, position of tube at junction of SVC-heart. The forward and backward flow are confirmed in table.
Post procedure the chamber and tube remain unexposed and beneath the skin.
As the medicines are administered into the main blood stream directly so there is no thrombophlebitis. The repeated and more difficult venepunctures are thus avoided. That makes patient at comfort. Also, the chemoport five access to central blood stream for pathological tests.
The needle used to puncture the port chamber is not cutting needle like the ordinary ones. It has a hole from side and the needle has a 90-degree angle to it.
Since the port communicates to the central blood stream directly , the puncture of port chamber has to be utmost sterile activity.
The proper cleaning of skin with aseptic solution, puncturing and handling using sterile gloves is essential. The specially trained staff or a doctor has to be there.
Check forward and backward flow always:
There could be kinks, thrombus acting one way valve that can hinder to free back or forward flow. At times the tube can pinch between the rib and collar bone especially in case of sub clavian vein ports.
Ports are precious:
The port materials are costly and the ease to get chemotherapy is so much that the patients are emotionally attached to the experience with ports. There are few makes that turn the used ports into the ornament like wearables, just to emphasize.