Chemo-port insertion, also known as port-a-cath or implantable venous access device (IVAD) placement, is a procedure commonly performed to provide long-term access for chemotherapy, intravenous medications, or frequent blood draws. While image guidance such as fluoroscopy or ultrasound is often utilized to assist in the precise placement of the port, there are instances where the procedure is performed without direct imaging assistance.

When a patient requires a chemo-port but circumstances prevent the use of imaging guidance, the procedure becomes more reliant on the expertise and skill of the medical team. The process typically unfolds in several sequential steps, necessitating meticulous attention to anatomical landmarks and careful maneuvering.

Firstly, the patient undergoes a comprehensive evaluation to assess their suitability for the procedure without image guidance. This evaluation involves a detailed medical history review, physical examination, and potentially imaging studies like CT scans or X-rays to understand the patient’s vascular anatomy and identify suitable insertion sites.

Before the actual insertion, the patient receives local anesthesia to numb the area where the port will be placed. This helps minimize discomfort during the procedure. The medical team then meticulously marks the area, identifying the appropriate site for port placement based on anatomical landmarks and prior imaging, if available.

Once the area is prepped and sterilized, the interventional radiologist or surgeon begins the procedure. Using palpation and anatomical landmarks as a guide, a small incision is made in the skin, usually in the upper chest area below the collarbone. Through this incision, a subcutaneous pocket is created where the port will be positioned.

Next, using a combination of tactile feedback and anatomical knowledge, the medical professional carefully tunnels a catheter from the pocketed area to the target vein, typically the internal jugular vein or subclavian vein. This step requires precision to ensure the catheter is correctly positioned within the vein for optimal function and to minimize complications.

Once the catheter is in the correct position within the vein, the port itself is placed in the subcutaneous pocket. The catheter is connected to the port, and the incision is closed with sutures or adhesive strips.

Post-procedure, the medical team verifies the proper placement and functionality of the chemo-port by flushing it with saline solution and checking for blood return, ensuring that it is ready for immediate use. The patient is then provided with instructions on caring for the chemo-port, including guidelines for flushing, infection prevention, and recognizing signs of complications.

Performing a chemo-port insertion without image guidance requires a high level of expertise, as reliance solely on anatomical landmarks increases the risk of complications such as catheter malposition, accidental arterial puncture, or injury to nearby structures. Therefore, meticulous attention to detail, thorough pre-procedural planning, and extensive experience are crucial for the success and safety of the procedure.

While image-guided techniques offer enhanced precision and safety, circumstances such as resource limitations or contraindications to radiation exposure may necessitate the performance of chemo-port insertion without imaging assistance. In such cases, the medical team’s expertise, careful planning, and reliance on anatomical knowledge become paramount to ensure a successful outcome and minimize potential risks for the patient.