How is an Implantable Venous Access Port ( Intravenous Port / Port-A / Totally implantable venous access device, TIVAD) procedure performed?

An implantable venous access port (also known as an implanted port) is placed using a minimally invasive surgical technique.

In simple terms, the procedure involves inserting a catheter into a central vein and connecting it to a small reservoir that is embedded beneath the skin.

During the procedure, imaging guidance—most commonly mobile fluoroscopy (C-arm X-ray)—is used to confirm that the catheter tip is positioned at the optimal location, typically at the junction of the superior vena cava and the right atrium. Once correct positioning is verified, the catheter is securely connected to the port reservoir.

Before the port reservoir is placed beneath the chest wall skin flap, a subcutaneous pocket is created along an avascular plane between the pectoralis major fascia and the subcutaneous tissue.

The port reservoir (i.e., the injection chamber) is then placed into this pocket and fixed to the pectoralis major fascia with stay sutures to prevent rotation or displacement.

After proper function is confirmed by aspiration and flushing, the incision is closed. Following implantation, the port can be accessed repeatedly using a non-coring (Huber) [ Figure 1] needle for the administration of medications, chemotherapy, fluids, or blood sampling, thereby providing stable and long-term venous access. Figure 1 The difference between non-coring and coring needle.

A. Non-coring needle (Huber needle):

The needle opening is located on the lateral side.

This design creates a linear slit in the silicone diaphragm while preserving its self-sealing (water-tight) properties.

B. Coring needle:

The needle opening is located at the tip of the needle.

This design produces a circular puncture hole in the silicone diaphragm, which disrupts the self-sealing (water-tight) properties and may compromise port integrity.

A simplified overview of the implantation procedure (using a cephalic vein approach as an example) is outlined below.

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Procedural Steps

1. Preoperative Planning

1.Assessment of disease severity and the planned course of treatment

2.Preoperative vascular evaluation:

• Computed tomography (optional)
• Handheld ultrasound
  Purpose: to exclude superior vena cava syndrome and to ensure the availability of suitable native veins for catheter insertion

3.History of prior implantable port placemen

• Based on these considerations, the vascular access route is selected in the following order of preference:
• Superior vena cava routes (preferred): cephalic vein, thoracoacromial vein branches, internal jugular vein
• Inferior vena cava routes (secondary): great saphenous vein, femoral vein

2. Local anesthesia via subcutaneous injection

3. A 1–2 cm skin incision is made inferior to the clavicle

4. Blunt dissection through subcutaneous tissue to the muscle fascia, identifying the junction between the pectoralis major and deltoid muscles

5. Vascular exploration at the pectoralis–deltoid groove

Cephalic vein (A) or Thoracoacromial vein (B)

6. Catheter insertion through the selected native vein

7. Confirmation of catheter tip position using mobile fluoroscopy

8. Connection of the catheter to the port reservoir and secure fixation using the locking mechanism

9. Creation of a subcutaneous port pocket over the pectoralis major fascia

10. Fixation of the port reservoir to the pectoralis major fascia and placement within the pocket

11. Wound closure and completion of the procedure