Home › Surgical Techniques › Chemotherapy Port
Surgical Procedure

Chemotherapy Port —
Safe, Comfortable
Long-term IV Access

A Chemotherapy Port (Port-a-Cath) is a small device implanted under the skin that provides reliable, painless, long-term intravenous access for chemotherapy, blood draws, and IV fluids — eliminating repeated painful needle sticks throughout your entire treatment course.

30–45 Min Procedure
Day Care / OPD Surgery
Lasts 5+ Years
No Repeated Needle Sticks
Performed by
Dr. Vinod T. Gore, Surgical Oncologist
📍
Centre
Sahyadri Manipal Hospitals & Silver Leaf Clinic, Pune
Why Every Chemo Patient Needs a PORT
5+ yrs
PORT can remain safely in place throughout and after the entire chemotherapy course
0
Repeated peripheral vein needle sticks needed during chemotherapy infusions
Day Care
Inserted and removed as a day procedure under local anaesthesia — no hospitalisation needed
Safe
For vesicant drugs that damage veins — Doxorubicin, Vincristine, Taxanes delivered safely
Understanding the Chemotherapy PORT

What Is a Chemotherapy Port (Port-a-Cath)?

A Chemotherapy Port — medically known as a Totally Implantable Venous Access Device (TIVAD) or Port-a-Cath — is a small, disc-shaped reservoir made of titanium or high-grade plastic that is implanted under the skin of the chest (or occasionally the arm). It is connected to a soft, flexible catheter whose tip rests in the Superior Vena Cava (SVC) — a large central vein near the heart.

Once implanted, the PORT provides immediate, reliable, painless IV access for the entire duration of cancer treatment. A specially designed Huber needle — which does not damage the port's silicone septum — is inserted through the skin directly into the port for each chemotherapy session. The port can be accessed hundreds of times without losing function.

The PORT is completely internal and invisible under the skin — there are no external tubes or catheters. Patients can bathe, swim, and carry on normal daily activities with the port in place. When not in use, it requires only a monthly flush with heparinised saline to keep it clear and patent.

A Note from Dr. Gore Surgical Oncologist · PORT Insertion Specialist

I strongly recommend a PORT for almost every patient starting chemotherapy — particularly those on multi-cycle regimens, vesicant drugs like Doxorubicin, or those with difficult veins. The difference in patient comfort is enormous. I have seen patients dread chemotherapy days not because of the drugs but because of the struggle to find a vein.

PORT insertion is a minor, well-tolerated, 30–45 minute procedure. It transforms the chemotherapy experience — from repeated painful cannulations and thrombosed veins to a single, painless needle stick each session. I insert the port under ultrasound guidance for maximum safety and use fluoroscopy to confirm catheter position before the patient leaves the theatre.

— Dr. Vinod T. Gore, MBBS MS FAIS FIAGES FARIS (Edin)
Device Components

The PORT Device — How It Is Constructed

A chemotherapy port is an elegantly simple device — engineered for decades of reliable use with minimal maintenance.

PORT Device — Component Guide
Cross-section — Implanted PORT
SILICONE
SEPTUM
Catheter → SVC
PORT Reservoir (Body)

Titanium or medical-grade plastic disc — 2–3cm diameter — houses the silicone septum and connects to the catheter. Sits 1–2cm under the skin.

Silicone Septum

Self-sealing centre of the port — accessed by Huber needle. Can withstand 2,000+ needle penetrations without leaking. Resists coring and damage.

Catheter

Soft silicone or polyurethane tube connecting the reservoir to the SVC. Tip position confirmed at the SVC–right atrium junction by fluoroscopy.

Huber Needle (Access Needle)

Special non-coring 90° angled needle used to access the port. Not a standard needle — cannot be substituted. Preserves septum integrity for hundreds of uses.

The PORT is designed for long-term reliable function — typically lasting 5–10 years of active use. The titanium reservoir is inert and biocompatible — it causes no local tissue reaction and is compatible with MRI scanning (MRI-safe ports are now standard).
MATERIAL 01

Titanium Reservoir

Lightweight, inert, MRI-compatible. The most commonly used material — completely biocompatible, no rejection, no corrosion. Low profile variants available for thin patients.

MATERIAL 02

Silicone or Polyurethane Catheter

Flexible, kink-resistant catheter — inserted into the subclavian or internal jugular vein. Tip positioned at the SVC/RA junction for optimal flow and to prevent thrombosis.

MATERIAL 03

Self-Sealing Silicone Septum

Rated for 2,000+ needle punctures in most PORT models. Returns to watertight seal after each Huber needle is removed. The most critical functional component.

MATERIAL 04

Single vs Double Lumen

Single lumen (most common) — one access point. Double lumen — two separate chambers for simultaneous infusion of incompatible drugs. Selected based on treatment protocol.

Indications

When Is a Chemotherapy Port Recommended?

A PORT is recommended whenever long-term or repeated intravenous access is required for cancer treatment — particularly when peripheral veins are inadequate or the drugs used are damaging to small veins.

Multi-cycle Chemotherapy

Any patient receiving multiple cycles of IV chemotherapy over weeks to months — breast, colorectal, lung, ovarian, gastric cancers and others. Peripheral veins become sclerosed and thrombosed with repeated cannulations. A PORT preserves vein health throughout treatment.

Essential

Vesicant Chemotherapy Drugs

Vesicants — drugs that cause severe tissue necrosis if they leak outside the vein (extravasate) — must be given through a central line. Doxorubicin, Epirubicin, Vincristine, Vinblastine, and Mitomycin C are examples. A PORT guarantees central venous delivery — eliminating extravasation risk.

Mandatory

Difficult Peripheral Venous Access

Patients with small, fragile, or damaged peripheral veins — from prior chemotherapy, obesity, chronic illness, or simply poor baseline venous anatomy — where repeated IV cannulation is painful, time-consuming, and unreliable. A PORT provides immediate, certain access at every session.

Essential

HIPEC Patients

Patients planned for Cytoreductive Surgery + HIPEC require a PORT for pre-operative chemotherapy (neoadjuvant) and post-operative adjuvant chemotherapy. The PORT is inserted at the time of or prior to the main HIPEC operation — ensuring seamless IV access throughout the perioperative period.

Recommended

Immunotherapy & Targeted Therapy

Checkpoint inhibitors (Pembrolizumab, Nivolumab) and monoclonal antibodies (Trastuzumab, Bevacizumab) are given every 2–4 weeks for 1–2 years. A PORT provides comfortable long-term access for these extended treatment courses without repeated peripheral vein damage.

Recommended

Total Parenteral Nutrition (TPN)

Cancer patients with severe malnutrition, GI tract involvement, or post-operative ileus who require long-term IV nutritional support — TPN through a PORT avoids the thrombophlebitis that TPN causes in peripheral veins and allows home TPN administration.

Selected Cases
The Procedure

PORT Insertion — Step by Step

PORT insertion is a minor surgical procedure performed as a day case under local anaesthesia with sedation, or occasionally under general anaesthesia. It takes 30–45 minutes and patients go home the same day.

BEFORE PROCEDURE

Pre-operative Assessment

Blood tests (coagulation profile, full blood count) and clinical assessment are performed. Site preference is discussed — right chest is standard (left chest if right side is unsuitable). Imaging review identifies best vein access. Consent is taken for the procedure and potential complications.

Anticoagulants (Warfarin, Clopidogrel) are paused 5–7 days before insertion where safe. Continue aspirin in most cases. No fasting required for local anaesthesia cases.
ANAESTHESIA

Local Anaesthesia & Sedation

The chest and neck area are cleaned and draped. Local anaesthetic (Lignocaine + Bupivacaine) is infiltrated along the incision line and pocket area. Intravenous sedation (Midazolam + Fentanyl) is given for comfort — the patient is relaxed and comfortable but breathing independently. General anaesthesia is used for anxious patients or paediatric cases.

A small pillow is placed under the shoulders to extend the neck and expose the infraclavicular area. Head turned slightly to the opposite side.
VEIN CANNULATION

Ultrasound-guided Vein Access

The internal jugular vein (IJV) or subclavian vein is punctured under real-time ultrasound guidance — which dramatically reduces the risk of pneumothorax and arterial injury compared to landmark-based blind puncture. A guidewire is passed through the needle into the vein and confirmed by X-ray screening (fluoroscopy).

Dr. Gore uses ultrasound guidance routinely — significantly safer than blind technique. The guidewire is advanced to the SVC under fluoroscopic vision. A small skin incision is made over the vein entry point.
PORT POCKET CREATION

Subcutaneous Pocket & PORT Placement

A second small incision (2–3cm) is made below the right clavicle. A subcutaneous pocket is created between the skin and the pectoral fascia — just large enough to house the PORT reservoir comfortably. The pocket depth is carefully calibrated: too superficial and the port can erode through skin; too deep and it becomes difficult to access with the Huber needle.

The catheter is tunnelled subcutaneously from the vein entry point to the pocket. The PORT reservoir is connected to the catheter and placed in the pocket. The PORT is sutured to the fascia to prevent rotation or flipping.
CATHETER TIP POSITION

Fluoroscopic Confirmation & First Flush

With the PORT in position, the catheter tip location is confirmed under fluoroscopy — ideally at the SVC/right atrium junction. A catheter tip too high (in the SVC) is associated with thrombosis; too low (in the right atrium) with arrhythmia. The PORT is then accessed with a Huber needle and flushed with heparinised saline to confirm free flow and correct position.

Both incisions are closed with absorbable sutures — no stitches to remove. A CXR is taken post-procedure to confirm catheter position and exclude pneumothorax.
RECOVERY & DISCHARGE

Same-Day Discharge

Patients are observed for 1–2 hours post-procedure for comfort and vital sign stability. Once stable, they are discharged home with analgesics and wound care instructions. The PORT is ready to use for chemotherapy from the day after insertion — once confirmed by CXR. No hospitalisation required.

Chemotherapy can begin through the PORT from Day 1 post-insertion (confirmed by CXR). PORT removal — when treatment is complete — is equally simple: a 15–20 minute procedure under local anaesthesia.
Types of PORT

Which TYPE of PORT Is Right for You?

PORT selection depends on treatment requirements, patient anatomy, and anticipated duration of use. Dr. Gore will select the most appropriate device at your pre-operative consultation.

Standard Single-Lumen Chest PORT

The most widely used — a single titanium or plastic reservoir implanted in the right infraclavicular region, connected to the subclavian or IJV via a single-lumen catheter. Suitable for the vast majority of chemotherapy protocols.

Best for: Standard multi-cycle chemotherapy, immunotherapy, targeted therapy. Single drug infusion per session. Most common PORT used in cancer practice.

Double-Lumen PORT

Two separate chambers within one reservoir — allowing simultaneous infusion of two incompatible drugs, or one lumen for drug infusion and one for blood draws. Larger profile — used when treatment complexity demands parallel access.

Best for: Complex regimens requiring simultaneous infusion of incompatible drugs, or patients needing frequent blood transfusions alongside chemotherapy.

Arm PORT (Peripheral Port)

Smaller reservoir implanted in the upper arm — accessed via the basilic or cephalic vein with catheter tip in the SVC. Less visible, no chest scar, ideal for patients who find chest PORT cosmetically concerning. Less common but well-established.

Best for: Patients unwilling to accept a chest PORT, those with prior chest surgery or radiation, or breast cancer patients where bilateral axillary involvement makes chest access complex.
Choosing the Right Device

PORT vs PICC vs Peripheral IV — Comparison

Not all intravenous access devices are equal. Understanding the differences helps patients and clinicians choose the right option for each treatment situation.

Feature Implantable PORT PICC Line Peripheral IV
Duration Months to years (5+ years) Weeks to months (max 6 months) Hours to days (72 hours)
External Component None — fully internal External line exits arm Cannula visible in arm
Bathing / Swimming Fully unrestricted Must keep dry / waterproofed Must keep dry
Vesicant Drug Safety Fully safe — central delivery Safe — central tip Dangerous — extravasation risk
Daily Maintenance Monthly flush only Weekly flush + daily dressing Re-sited every 72 hrs
Infection Risk Low (fully internal) Moderate (external line) Low–moderate per site
Thrombosis Risk Low (<5%) Moderate (arm DVT ~5%) Very low (superficial)
Insertion Complexity Minor surgery (30–45 min) Bedside procedure (20 min) Bedside cannulation
Removal Minor surgery under LA Simple bedside removal Simple removal
Best For Long-term chemotherapy (months–years) Intermediate-duration therapy Single infusions / short course
Caring for Your PORT

PORT Maintenance — What Patients Need to Know

A well-maintained PORT lasts for many years without problems. Maintenance is straightforward and requires minimal effort from the patient — most of the care is provided by the oncology nursing team.

  • You can bathe, shower, and swim normally once the insertion wound has healed (7–10 days)
  • No activity restrictions once healed — the PORT is internal and does not limit movement
  • Only a trained nurse or physician should access the PORT — using a Huber needle only
  • Tell airport security about your PORT — it contains metal (titanium) and may trigger security scanners; carry your PORT card
  • MRI scans are safe with modern MRI-compatible PORTs — always inform the radiology team
  • Report any redness, swelling, fever, pain, or discharge over the PORT site immediately

During Chemotherapy Cycles

PORT is accessed at each chemotherapy session with a Huber needle. Flushed with heparinised saline before and after infusion. Needle removed and dressing applied after each session — no overnight needle stays unless admitted.

Monthly Flush (Between Cycles / After Treatment)

When the PORT is not in active use (between chemotherapy cycles or after treatment ends), it must be flushed with heparinised saline once every 4 weeks to prevent clotting. This takes 5 minutes and can be done at the clinic or oncology centre.

Annual Review

If the PORT is retained long-term after treatment completion (for surveillance blood draws), an annual review is recommended — confirming it flushes freely and there are no signs of infection, thrombosis, or catheter migration.

PORT Removal — When Treatment Is Complete

Once chemotherapy is complete and the PORT is no longer needed, it is removed under local anaesthesia in 15–20 minutes as a day procedure. The reservoir is extracted, catheter withdrawn from the vein, and the small wound closed with a stitch. No hospitalisation required.

Why a PORT Makes Treatment Easier

Advantages of a Chemotherapy PORT

No Painful Cannulations

One Huber needle insertion per session — through the same port every time. Ends the cycle of painful peripheral vein searching at every chemotherapy visit.

Preserves Your Veins

Repeated peripheral IV access destroys veins over time — causing thrombophlebitis and sclerosis. A PORT completely preserves all peripheral veins for other uses.

Normal Daily Life

Fully internal — no external tubes. Patients can bathe, swim, exercise, and sleep normally. No dressings or clamps to manage between visits.

⚗️

Safe for Vesicant Drugs

Doxorubicin, Vincristine, and other vesicants are safely delivered to the central circulation — eliminating the devastating complication of peripheral extravasation.

Blood Draws Without Needles

Blood can be drawn directly through the PORT — eliminating the need for separate peripheral blood sampling in patients with poor veins.

⚡

Faster Infusions

Central venous access allows higher infusion flow rates than peripheral veins — some chemotherapy agents that require slow peripheral infusion can be given faster via the PORT.

Psychological Comfort

Patients who dread the cannulation experience at every chemo visit find that a PORT transforms their relationship with treatment — reducing anxiety and dread significantly.

Long-Term Reliability

A single PORT can serve for the entire multi-year treatment journey — neoadjuvant, adjuvant, immunotherapy, and surveillance blood draws — without replacement.

Risks & Complications

Possible Complications — Know What to Watch For

PORT insertion is a minor, well-tolerated procedure. Serious complications are uncommon — particularly when inserted by an experienced surgeon using ultrasound and fluoroscopic guidance.

PORT Infection

The most serious complication — infection of the PORT pocket or catheter-related bloodstream infection (CRBSI). Presents as fever, redness, pain, or discharge over the PORT site. Managed with antibiotics; infected PORT may require removal.

~3–5% · Most Serious

Catheter Thrombosis

Blood clot within or around the catheter — causing sluggish flow or inability to flush/aspirate. Managed with thrombolytics (Urokinase or tPA instilled into the PORT). Systemic anticoagulation if SVC thrombosis develops.

~3–5% · Manageable

Pneumothorax

Inadvertent puncture of the pleura during subclavian vein access — causing air in the chest cavity. Significantly reduced with ultrasound-guided insertion. Small pneumothorax may resolve spontaneously; large ones require chest drain.

<1% with USG guidance

Catheter Malposition / Migration

Catheter tip moves from the optimal SVC position — detected on CXR or when flushing is difficult. May require catheter repositioning under fluoroscopy. Confirmed position with each CXR after insertion.

1–2% · Correctable

PORT Flip / Rotation

The reservoir rotates in its pocket — making the silicone septum inaccessible to the Huber needle. Prevented by suturing the PORT to the fascia. If it flips, manual repositioning or minor surgical revision is needed.

<1% · Preventable

Extravasation from PORT

Drug leaking outside the PORT due to needle dislodgement, catheter fracture, or Huber needle misplacement. Extremely rare with correct Huber needle use — far safer than peripheral IV for vesicant drugs. Requires immediate cessation of infusion.

<1% · Preventable

Immediate warning signs — contact your team right away: Fever >38°C, redness/swelling/pain/discharge over the PORT, inability to flush the PORT, pain in the arm or neck on the PORT side, or swelling of the face/neck/arm (suggests SVC thrombosis). Early detection prevents minor complications from becoming serious.

Patient Questions

Frequently Asked Questions

Will I feel the PORT under my skin? Is it visible?▼
The PORT creates a small, firm, circular bump under the skin — visible as a slight raised area in the infraclavicular region of the chest (just below the collarbone). In thin patients it is more noticeable; in heavier patients it may be barely visible. You will feel the PORT when you press on the area, but it causes no discomfort when left alone. It does not move or shift with daily activities once it is sutured in place.
Does accessing the PORT (the Huber needle) hurt?▼
The PORT itself contains no nerves — but the skin over it is sensitive. Most patients describe the Huber needle insertion as a brief sting, similar to a routine blood test — significantly less painful than searching for a peripheral vein. Many centres apply a topical anaesthetic cream (EMLA) over the PORT skin 60 minutes before access, making it virtually painless. After a few sessions, most patients report that PORT access is far more comfortable than they expected.
How soon after insertion can I start chemotherapy through the PORT?▼
The PORT can be used for chemotherapy from the day after insertion — once the position has been confirmed by chest X-ray. There is no healing or waiting period required for the device itself. The chest wound (2–3cm) takes 7–10 days to heal — during which you should avoid submerging it in water, but otherwise normal activity is permitted. Most patients start their first chemotherapy cycle within 1–3 days of PORT insertion.
Can I have an MRI scan with the PORT in place?▼
Yes — modern implantable PORTs are MRI-compatible (MRI-safe or MRI-conditional at standard 1.5T and 3T field strengths). Always inform the radiology team and present your PORT identification card before the scan. The PORT may create a small artefact on the images in the immediate vicinity, but this does not affect the diagnostic quality of MRI scans performed for other body areas. CT scans and PET-CT scans are completely unaffected by the PORT.
How long will the PORT stay in place? When is it removed?▼
The PORT remains in place for the entire duration of treatment — typically 6–18 months of active chemotherapy. After treatment is completed, it is usually removed 3–6 months later, once your oncologist confirms all planned treatment is finished. Some patients keep their PORT for 2–3 years for surveillance blood draws if venous access remains poor. Removal is simple: 15–20 minutes under local anaesthesia, same-day discharge.
Do I need to flush my PORT myself between chemotherapy sessions?▼
No — flushing is performed by a trained nurse or physician using a Huber needle, which patients are not expected to do themselves. During active chemotherapy (every 2–4 weeks), the PORT is flushed at each session. When chemotherapy is temporarily paused or between major cycles, the PORT should be flushed at your oncology clinic approximately once a month. If you notice difficulty with flushing at any clinic visit, report it immediately — it may indicate early catheter thrombosis that can be easily treated.

Starting Chemotherapy? Book Your PORT Insertion.

If you are about to begin chemotherapy and your oncologist has recommended a PORT, book a procedure appointment with Dr. Gore. PORT insertion is performed as a day case — you can start chemotherapy within 24 hours of the procedure.

Book PORT Procedure Ask a Question

Related Pages

Chemotherapy

HIPEC

Immunotherapy

Cancer Investigations