Indian Journal of Surgical Oncology (September 2020) 11(3):394–397

https://doi.org/10.1007/s13193-020-01067-w

ORIGINAL ARTICLE

Chemoport-associated Complications and Its Management

Kumar M. Vinchurkar 1,2 & Preeti Maste 3 & Manoj D. Togale 4 & Vishwanath M. Pattanshetti 4

Received: 27 January 2020 / Accepted: 1 April 2020 / Published online: 3 May 2020
# Indian Association of Surgical Oncology 2020

Abstract
Chemoport is being routinely used to administer chemotherapy, blood, blood products, total parenteral nutrition, and also to draw
blood for investigations. We started using chemoport in our institute. We use it exclusively to administer chemotherapy. We
analyzed our results of chemoport usage and confirm that the rate of complications associated with chemoport usage is at par with
the available literature. We also conclude that with regular use, the intra-op and post-op complications will reduce further.

Keywords Chemoport . Complications . Wound dehiscence . Infection . Blockage

Introduction Aims and Objectives

With the continued research in medical oncology, many can- The aim of our study was to determine the complications
cer patients are receiving multiple lines of chemotherapy. associated with the use of chemoport and management of
Intravenous access is a major issue for these patients. The the complications.
totally implantable devices were introduced in 1980s [1].
Since then, chemoport insertion is commonly used to gain
vascular access for these patients. It can be used to administer
intravenous fluids, blood, blood products, parenteral nutrition, Materials and Methods
and to draw blood for investigations. Chemoport use is asso-
ciated with complications. We analyzed our cases of We studied the patients in our hospital who underwent
chemoport-associated complications and discuss management chemoport insertion from May 2012 till November 2018.
of complications. The study group comprised of 98 patients who underwent
chemoport insertion. Of these, 78 cases received chemothera-
py for breast cancer, 12 patients had carcinoma ovary, 4 cases
had colorectal cancer, 2 patients had carcinoma stomach, one
patient had periampullary adenocarcinoma, and one patient
* Kumar M. Vinchurkar had leukemia.
vkumar_007@yahoo.com The chemoport insertion procedure was performed under
general anesthesia in all cases. In all cases, we gained venous
Preeti Maste access through internal jugular vein. In 15 cases, we accessed
drpreetikv79@gmail.com
the left internal jugular vein as they had undergone modified
Manoj D. Togale radical mastectomy on right side (Fig. 1). The reservoir was
zapmanojtogale@yahoo.com
placed beneath the skin on the pectoral region, and catheter
Vishwanath M. Pattanshetti was tunneled through the subcutaneous plane into the internal
drvmshetti@gmail.com jugular vein. The tip of the catheter was placed at the junction
1
of superior vena cava and right atrium. We routinely use C-
Department of Surgical Oncology, JNMC KAHER, Belagavi, India
arm to confirm the position of the catheter tip. The port was
2
KLES Dr Prabhakar Kore Hospital & MRC, Belagavi, India used after 48 h of insertion in 87 cases. In 11 cases, the needle
3
Department of Microbiology, KLES Dr Prabhakar Kore Hospital & was inserted on-table, and the port was used for chemotherapy
MRC, Belagavi, India infusion after 24 h. We use the chemoport to administer che-
4
Department of General Surgery, JNMC KAHER, Belagavi, India motherapy only.
Indian J Surg Oncol (September 2020) 11(3):394–397 395

had the same issue during the 3rd cycle. In both the cases, the
port usage was withheld and the extravasated drug was aspi-
rated percutaneously.
Three cases had wound dehiscence which was repaired
Chamber placed
surgically, and the use of chemoport continued. Two cases
in left pectoral had reservoir rotation. The reservoir was untwisted surgically
region
and used to administer chemotherapy.
Three patients developed catheter-related thrombosis
which was managed by anticoagulants and removal of the
port.
There was no mortality due to complications associated
with the use of chemoport.

Fig. 1 Showing placement of the port in the left pectoral region in an
operated case of right side carcinoma breast
Results
The patients were followed for at least 6 months after
chemoport insertion. We analyzed the complications during
the procedure, post-operative period, and delayed complica-
tions as well (Table 1).
None of the patients had pneumothorax or intra-operative
bleeding. In 3 cases, the left common carotid artery was punc-
tured, recognized immediately. The needle was withdrawn
and compression applied for 5 min. None of them developed
hematoma.
Three patients developed signs of catheter infection imme-
diately after administration of 1st cycle of chemotherapy. The
organisms isolated (Table 2) included Burkholderia (P.)
cepacia, Klebsiella pneumoniae, and Coagulase negative
Staphylococcus species. The chemoport was removed imme-
diately and appropriate antibiotics were administered for
2 weeks.
One patient had extravasation of the chemotherapy agent
during the first cycle of chemotherapy and one more patient
Discussion
Most chemotherapy drugs have significant venous toxicity
and often developed venous thrombosis if administered
through peripheral veins [2].
This is associated with significant pain. To overcome this,
the totally implantable venous access devices were developed
in the early 1980s [3].
External venous access devices are also available. These
are relatively cheaper. However, TIVAPs last longer, have less
infection rate, and make the patient more comfortable [4].
We do not have any experience with the external central
venous access catheters. TIVADs provide easy access to ad-
minister chemotherapy drugs, blood and blood products, and
parenteral nutrition to cancer patients. They are also used to
draw blood for investigations and inject contrast for radiolog-
ical studies [1, 5].
In our patients, we used the TIVADs exclusively for ad-
ministration of the chemotherapy agents.
The use of TIVADs is definitely associated with complica-
tions if proper care is not taken during insertion of the device.
Complications can occur due to long-term indwelling of the
TIVADs as well. Injury to the adjacent structures during in-
sertion gives rise to early complications [6].

Table 1 Complications encountered and their management

Complications Numbers Percentage Consequence

during usage

Blockage 3 3.06% Removal of port

Port infection 3 3.06% Removal of port
Wound dehiscence 4 4.08% Re-suturing of the skin and continued use of port
Extravasation of 3 3.06% In 1 case, drug aspirated with syringe and needle and port used during subsequent chemo. In 2 cases,
drug massive extravasation and port was not used subsequently
Reservoir rotation 2 2.04% Re-explore, untwist and continue use during subsequent chemo
Nil 83 84.69% –
396
Table 2 Organisms isolated and antibiotic sensitivity
Extracted organisms
Burkholderia (P.) cepacia
Klebsiella pneumoniae
Coagulase negative Staphylococcus species
Early complications include hemothorax, pneumothorax,
injury to large blood vessels, air emboli, cardiac arrhythmia,
and malposition of the catheter. In our study, none of the
patients had early complications. This is in accordance with
the recent studies which confirm decreasing incidence of early
complications with improved technique and use of advanced
technology during insertion of TIVADs [7].
Literature mentions arterial puncture in 2 to 4.5% cases of
external venous catheterizations, resulting in arterial injury in
0.1 to 0.5% cases [8, 9]. In our series, 3 cases (i.e., 3.06%),
arterial puncture was noted during the procedure and measures
were taken (as described in the “Material and Methods” sec-
tion) to prevent hematoma formation.
Case series reports have reported major complications such
as air embolism [10], hemothorax [11], brachial plexus injury
[12], and pericardial tamponade [13]. In our study, none of the
patients had any of these complications.
Late complications comprise infections, venous thrombo-
sis, extravasations of cytotoxic drugs, mechanical dysfunction
of the catheter, and skin necrosis [14, 15].
In our series, wound dehiscence was the most common
delayed complication experienced in 4.06% of the cases.
This was probably because of thin skin flaps created during
the preparation for chamber placement. The other common
complication in our series was catheter-related thrombosis
(3.06%). Literature mentions catheter-related thrombosis be-
tween 1 and 5% [16]. Low-molecular weight heparin was
immediately started and TIVAD removed as they were non-
functional.
TIVAD-related infection was noted in 3.06% cases.
Literature mentions TIVAD-related infection up to 4.8% [8].
The causes explained for infection include frequent access,
administration of total parenteral nutrition, chronic steroid
use, neutropenia, thrombosis, and metastatic disease
[17–19]. The incidence of infection is higher for hematologic
malignancy as compared with solid tumors [20]. Intravenous
antibiotics were administered as per the culture sensitivity.
The TIVAD was removed in all 3 cases as they continued to
have fever.
Conclusion
We conclude that use of TIVADs is safe. The intra-op and
immediate post-op complication rates have decreased with
Indian J Surg Oncol (September 2020) 11(3):394–397
Sensitivity
Levofloxacin
Tigecycline
Vancomycin, moxifloxacin, and tetracycline
increased use of TIVADs. The long-term complications still
remain a challenge to overcome.
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