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1298 Technique of Intraperitoneal Chemotherapy: Normothermic and Hyperthermic

Table 3. Port Problems and Management

Problem Frequency % Problem Management

Difficulty accessing the 5-8 Deeply sited port Use longer Huber needle and keep patient still
port while infusing

Rotation of port Try to turn port upright, insert Huber needle and
infuse carefully with patient still

Consider resecuring the port with sutures

Obstruction 7-8.8 Perform fluoroscopic port dye study

Catheter kinked Laparoscopically assess and correct

Blockage due to adhesions Laparoscopically assess and correct

(Fig 3) May need to remove and insert new port or

discontinue IP chemotherapy

Leakage 5-12 Follow protocol for extravasation of
chemotherapeutic agents.

If source of leak not obvious perform port dye
study

Needle dislodgement Use longer Huber needle and infuse with patient
still

Catheter retraction (Fig 3) Remove port and insert new port on contralateral
Back-fill into catheter side

tunnel
Leak in catheter
Faulty port

Obstructed flow Manage as for obstruction

Discomfort or pain 8.4-67 Due to siting of port Try changing type of breast support. Sleep on
opposite side

Infusion-related Ensure infusate warmed infuse more slowly
change position during infusion

Infection 2.2-17 Cellulitis Antibiotics

Deep infection abscess Remove port and leave wound open
Drain IP abscess if present
Appropriate management for peritonitis

Bowel injury 1-5.3 Remove port
Appropriate management of bowel

Vaginal fistula <1% Remove port

Erosion of port through <1% Remove port
the skin

Note: There is variability in how complications are reported. Some papers report only complications leading to discontinuation of
chemotherapy. Additional references: Berry et al. Gynecol Oncol 2009;113:63-67, Gadducci et al. Gynecol Oncol 2000;76:157-162, Landrum
et al. Gynecol Oncol 2008:108:342-347, Makhija et al.Gynecol Oncol 2001;81:77-81, Davidson et al. Gyncol Oncol 1991;41:101-106, Black et al.
Gynecol Oncol 2008;109:39-42

perforation, can occur long after they have been used Groshong tip instead of a fenestrated IP catheter (14.3Fr
for chemoinfusion (19) they should be removed at Bard IP access), vaginal vault closure in double layer and
the completion of treatment (5). Examples of port placing port on right side when extensive dissection is
complications are shown in Figures 3 and 5. done on left side have been suggested as strategies to
minimize port related complications (20).
Simple techniques at port placement like adequate
incision, limited subcutaneous dissection, meticulous Delivery of Normothermic IP Chemotherapy
tunneling of catheter, single entry hole in the peritoneum,
double purse-string suture at the catheter entry point It is usually wise to wait between 2-4 weeks after placing
into the peritoneum, use of single lumen venous access the IP port before initiating IP therapy (13). If extra time
catheter (9.6Fr Bard venous access) catheter with is thought necessary for bowel healing to take place or