A chemoport or chemotherapy port is a type of implant placed under the skin of the patients undergoing intravenous chemotherapy treatment. It is a small device that enables easy access to the bloodstream.
A chemoport or chemotherapy port is a type of implant placed under the skin of the patients undergoing intravenous chemotherapy treatment. It is a small device that enables easy access to the bloodstream. It is primarily used to transfer red blood cells and platelets. Besides, the chemoport can be used to insert chemotherapy drugs into the blood.
There are different types of chemoport that vary with the length and type of the treatment.
Implantable Venous Access Port
Also called Port-a-Cath or Medi-port (terminologies coined by American Cancer Society), the port is drum shaped and can be made of stainless steel, titanium or plastic. The venous access port is generally placed under the skin of the chest or the upper arm. The catheter attached with the port is directly connected with the central vein.
Long term chemotherapy treatment requires this kind of port, which is used by injecting a non-coring needle through the skin inside the port. A non-coring needle is a specially designed needle that is more resilient than ordinary needles.
Tunneled Central Venous Catheter
Also called Hickman or Broviac, the central venous catheter is placed in a central vein in the chest through surgery. The tubes of the catheter hang externally and the medicines are filled in the tubes. The catheter has multiple openings and is placed inside the body for several months.
The PICC line is a temporary port made of plastic. It is in the shape of a catheter and can be positioned for several weeks. Generally used for short infusions of chemotherapy, the plastic catheter is placed into one of thelarger veins of the arm. The right positioning of the port is confirmed by an X-ray (Fluroscopy).
This is a type of port used in intraperitoneal chemotherapy (the most advanced form of chemotherapy used to treat abdominal cancer). The port is in the form of a catheter called Tenckhoff catheter, which is positioned in the abdomen.
It is a small device that enables easy access to the bloodstream (especially in the case of chemotherapy)
Insertion of chemoport is a minor procedure and only requires half a day.
First, the doctor examines the medical history of the patient thoroughly after which, the latter is subjected to a blood test to measure the blood count and detect if there is any clot. The patient is asked not to take any anti platelet medicines like aspirin or clopidogrel, or any blood thinning medicines like warf or arin (if the patient is taking any). However, if the patient has coronary stems or metal heart valves, such medication cannot be discontinued even for a short time. In such cases the doctor follows some alternative means.
The patient is not allowed to eat or drink anything except water for six hours before the insertion. He/she can drink water till two hours before the procedure.
The patient should have at least one family member or friend with him/her in the hospital during the procedure and should arrive at least 30 minutes before the scheduled time.
The insertion procedure depends on the type of chemoport (or catheter) that is being used. Besides, there are some other factors, too that are taken under consideration. They include the type and duration of the cancer treatment, the malignancy of the tumor, and also the cost.
A PICC line is inserted into a large vein in the arm, especially one in the elbow region by a specially trained doctor or nurse. It’s not a surgical procedure; however local anaesthesia is applied to numb the tissue of the chosen region of the arm.
A Central line (also called tunnelled venous catheter or Hickman catheter) is inserted into a large vein under the collarbone (clavicle). From the collarbone the catheter is tunnelled under the skin and the other end of it exits the body through a different point in the upper chest. The procedure is performed through application of local anaesthesia or conscious sedation.
A port-a-cath is inserted under the skin of the chest through surgery. The insertion is done by a surgeon or a radiologist after the application of local anaesthesia or conscious sedation. A port-a-cath is positioned wholly under the skin from top to bottom unlike the other two catheters. Only a small bump shows on the chest which is numbed by putting cream on it during the treatment. Blood is drawn or medication is given by injecting a special needle into the rubber seal of the catheter through the skin.
Removal of chemoport is easy and painless. Anaesthesia is also not required in most cases. In case of PICC line, the doctor or nurse lightly pulls the tube till it is loose enough to be removed. In case of tunnelled catheter local anaesthesia or conscious sedation is needed. The surgeon or the radiologist makes a small hole on the collarbone, neck or chest and gently removes the catheter along with the port from there. There are a number of side effects of chemoports that have already been discussed. To avoid those risks of infections, clots, blockages, blistering of skin etc. the patient should visit the doctor regularly and follow his/her instructions meticulously. Catheters with tips outside the body require special care. The patient needs to flush the tube with sterile fluid everyday to prevent any sort of blockage. If the patient is not comfortable with flushing it himself/herself, he/she might appoint a staff from the hospital or the clinic to get the job done. The patient is required to take quite a few precautions to avoid the risks associated with chemoports.
The amount of the fluid taken should be small, so that the catheter doesn’t get blocked.
The patient should always keep his/her hands clean before touching the catheter. This minimizes the risk of infection to a great extent. Besides, when the cap is taken off, he/she should never touch the tip of the tube.
The area around the tube should be cleaned regularly and the bandages should be changed according to the strict instructions of the doctor.
The patient must make sure that the top or the clamps of the catheter are tight enough when not in use to prevent any passage of air.
There should not be any kind of break or scratch in the catheter. The port is removed when the patient does not need it any more. For some it is removed within a few weeks or months, for some others the port is removed after years.
Risk and Complications
There are a few risks associated with the insertion of chemotherapy ports.
Improper installation of the port may lead to infection. In very few cases (1% of the total cases studied) the infection causes bleeding in the subclavian vein (a paired large vein found on either side of the body).
If the port is not positioned properly by the physician, it can cause pneumothorax (accidental puncturing of lungs).
Some patients are allergic to implants. The port needs to be removed as soon as any sign of inflammation is noticed.
In about 12-64% of the total number of cancer patients studied, thrombosis occurs. Thrombosis is basically a clot that happens in the vicinity of the catheter area thereby hindering the functions of the port.
Patients with chemoports are often suggested not toindulge in rigorous sports activities, swimming etc. They even need to be extremely careful while bathing.
A permanent scar remains in the area where the chemotherapy port is inserted.
There are many benefits of chemoports:
Many patients have genetically small veins or veins that have been damaged due to an accident. Besides, some are scared of needles. Usage of ports reduces the insertion of needles considerably.
Chemoports lessen the risk of tissue and muscle damage, which occurs occasionally when chemotherapy leaks out of the vein.
Chemoports enable the patient to undergo different types of cancer treatments simultaneously. In such cases, double ports are used in place of single ports.
A patient who has a chemoport implanted in his/her body can undergo frequent blood tests without getting injected every time.
Chemoports prevent excessive bleeding, which is highly beneficial, especially for the patients, who suffer from low platelet counts due to recurrent bleeding.
In some cancer treatments patients need periodic infusion at home. Chemoports prove extremely functional in such cases. The cost of chemoport varies on the basis of its type, material and also the treatment procedure followed. Generally the cost of chemoports vary between 12,000 to 75,000 rupees. Besides, the cost also depends on the centre and the medical team the patient is choosing to get the insertion done.
Chemoport insertion involves a minor surgery and can be done on an outpatient basis. The patient is given local anaesthesia or conscious sedation during the surgery. First, the area where the port is to be placed is disinfected and numbed. Then a large needle is inserted, which acts as a channel for threading the catheter. The catheter is attached to the port which either remains outside the body or inside. Once the port is placed rightly, the needle is removed.
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