Early experience with Chemoport Insertion and Management for Chemotherapy in a Tertiary Hospital, South-South, Nigeria-the COVID-19 Factor

Background: Chemoport has been seen as a useful device for long term venous access for infusion of chemotherapeutic drugs and other agents. There are few studies from resource poor countries reporting complications of chemoport. The aim of this early study is to evaluate the feasibility of chemoport insertion without image guidance, by closed technique without direct visualization of a major vein mainly internal jugular vein and to study the complications associated with the procedure. This is a prospective observational study which analysed four patients who underwent chemoport insertion. Objective: Report of our early experience with the insertion of Chemoport for chemotherapy in a tertiary referral hospital in South South, Nigeria-and the effect of COVID-19 on this procedure. To also create awareness that routine placement of chemoport can be done in the Division of Cardiothoracic and vascular Surgery for chemotherapy and the administration of other agents. Methods: The medical records of these patients were analysed for the patient characteristics, diagnosis, port related complications and their management. Result: Four patients with metastatic malignancy requiring chemotherapy or targeted therapy or both were included in this study. There were 3 female (75%) and one male (25%). Breast carcinoma account for 75% and occurred in the female and large bowel carcinoma account for 25% which occurred in the male. All patients underwent chemo port insertion under 1% local anaesthesia in the theatre under 1g of intravenous ceftriaxone as prophylaxis and post procedure the patients were started on oral cefixime 200mg daily for five days and an initial intramuscular pentazocine 30mg is started and change to oral diclofenac 50mg twelve hours for 3days but could be extended to 5days in those with low pain threshold except it is contraindicated. Visual analogue pain scale was zero immediately after the procedure and range from 4-6 two hours post procedure. The oral diclofenac was extended to five days in one patient. The ECOG was 0-2 in the four patients. None of the patients had any major intraoperative complications. Post operatively one patient was found to have a partial obstruction of chemo port catheter, later fracture and distal migration (25%) at the third course of chemotherapy. Catheter retrieval was planned but patient ECOG had dropped to 3 and considered a high risk for catheter retrieval. Patient was started on vasoprim 75mg daily to prevent catheter thrombosis. No surgical site infection was noted in this study. High complication rate is observed in this study because of the patient size and our early learning curve. Complication rate may be further reduced by using well designed procedure, Doppler duplex ultrasound guided puncture and fluoroscopy with contrast media. Job loss from COVID-19 pandemic, increasing poverty and the fall in naira-dollar exchange are other additional factors affecting affordability of Chemoport and image guided procedure making blind percutaneous insertion the only option. Conclusion: Chemoport insertion make administration of chemotherapy less traumatic and less of thrombophlebitis but not without complications.