A chemo port (implanted port or central venous access device) is a small medical device placed under the skin, typically in the chest. It connects to a large vein near the heart via a catheter, allowing medications, such as chemotherapy drugs, to be delivered directly into the bloodstream. Ports simplify drawing blood and administering long-term, frequent intravenous treatments, bypassing smaller veins that can be damaged by caustic drugs or repeated needle sticks. While ports offer significant treatment advantages, they introduce a risk of infection, a serious complication requiring immediate medical attention.
Identifying the Signs of Infection
Recognizing the signs of a chemo port infection early is crucial, as symptoms fall into two main categories: local and systemic. Local signs occur at the port site and can include redness, swelling, or warmth around the device or along the catheter’s path (the tunnel tract). The patient may also experience pain or tenderness at the site, often increasing when the port is touched or used. Any visible pus or discharge from the skin overlying the port is a clear indicator of a local infection.
Systemic signs indicate a body-wide infection, often a central line-associated bloodstream infection (CLABSI). The most frequent sign is a fever, defined as a temperature of 100.4°F (38°C) or higher, which may be accompanied by chills or rigors. Fever and chills can sometimes occur suddenly after the port is accessed or flushed, a pattern known as a “port flush form infection.” Patients may also feel generally unwell, experiencing fatigue or malaise, making regular temperature checks important.
Immediate Steps and Medical Diagnosis
If any local or systemic signs of infection are noticed, the immediate action is to contact the oncology team or care provider without delay. Patients must avoid attempts at self-treatment, such as applying topical ointments or taking over-the-counter fever reducers without guidance, as this can mask symptoms. The medical team will perform a physical assessment and initiate diagnostic testing to confirm the source of the suspected infection.
Diagnosis centers on obtaining blood cultures, typically drawn from a peripheral vein and directly through the port itself. These cultures are compared using the differential time to positivity (DTP) method. If a pathogen grows in the port culture at least two hours sooner than the peripheral culture, it strongly suggests the port is the source of the bloodstream infection (CLABSI). Imaging, such as an ultrasound, may also be used to check for complications like a blood clot (thrombosis) or a localized pocket of infection beneath the skin.
Treatment Pathways for Central Line Infection
Treatment for a suspected or confirmed port infection begins with the administration of broad-spectrum antibiotics (empirical therapy), often including an agent like vancomycin to cover common culprits such as Staphylococcus aureus. This initial therapy starts immediately, before culture results are finalized, to stabilize the patient and prevent the infection from worsening. Once blood culture results identify the specific microbe, the antibiotic regimen is adjusted to a more targeted therapy.
A primary decision in managing a port infection is whether the device can be salvaged or must be removed. If the infection is uncomplicated and the patient is clinically stable, the port may be treated with systemic antibiotics combined with antibiotic lock therapy (ALT). ALT involves filling the port catheter with a high concentration of antibiotic solution and allowing it to sit for several hours to sterilize the inner surfaces. However, the port is usually removed if the patient has signs of severe infection, such as septic shock, or if the infection involves high-risk pathogens like Staph. aureus or fungi.
Port removal is also required for infections involving the subcutaneous pocket or the tunnel tract, as these are difficult to eradicate with antibiotics alone. If removal is necessary, it is a minor surgical procedure, and a new port can often be placed on the opposite side once the infection has cleared. If a pocket infection is present, the wound may be left open to heal by secondary intention, sometimes packed with gauze, to ensure all infected tissue is drained.
Strategies for Preventing Infection
Prevention of port infection relies on meticulous hygiene and strict adherence to established care protocols by both the patient and caregivers. Hand washing is the single most effective measure, requiring thorough cleaning with soap and water or an alcohol-based sanitizer before touching the port or any associated tubing. The dressing covering the port site must be kept clean, dry, and intact, and should be changed promptly if it becomes loose, soiled, or wet.
Sterile technique is required for all dressing changes, which are typically performed weekly by trained medical professionals. When the port is accessed, the skin and the needleless connector (hub) must be vigorously scrubbed with an antiseptic solution, such as chlorhexidine, for the recommended time (often 15 to 30 seconds), and allowed to air dry completely. Patients should avoid submerging the port in water (baths or swimming pools) and must protect the site with a waterproof cover when showering. Only trained healthcare staff should access the port, and patients should advocate for their care, ensuring all personnel follow proper aseptic protocols.