A venous port is an implantable central venous access system consisting of a chamber placed under the skin and a catheter introduced into a large vein—typically the subclavian or internal jugular vein. These devices are commonly used in patients undergoing systemic oncological treatment. They allow for repeated, safe, and comfortable administration of anticancer drugs, particularly locally irritating cytotoxic agents, thus eliminating the need for multiple peripheral venipunctures and minimizing the risk of extravasation and vascular injury. However, their use is associated with both early and late complications.1 Early complications include bleeding or infection of the port chamber, pneumothorax, and improper catheter placement. Late complications comprise catheter-related thrombosis, port infection with subsequent sepsis, port obstruction, mechanical catheter damage, and skin erosion.

We present a case of a patient with advanced endometrial cancer who developed widespread port-related skin erosion. Six months after implantation of the port, which had been used uneventfully for administration of a 5-month chemotherapy regimen (paclitaxel and carboplatin combination), the patient was admitted to a regional hospital due to COVID-19 and staphylococcal sepsis. Intravenous antibiotic therapy with vancomycin was administered via the venous port, despite hospital staff lacking experience with such a device. Three weeks after discharge, the patient returned to our center for the initiation of second-line therapy.

On admission, massive skin erosion was observed over the port chamber and along a large section of the subcutaneous catheter tract (Figure 1). It probably resulted from the use of standard intravenous needles instead of dedicated Huber needles. The nature of the complication precluded further use of the port and necessitated its immediate removal. During hospitalization, the port was surgically removed, and the chamber pocket was sutured. The patient continues to receive intravenous immunotherapy with dostarlimab through peripheral veins.

Figure 1. Massive skin erosion over a vascular port

Venous ports are durable devices intended for long-term use; however, their reliable functioning depends on their correct handling by medical staff. It is absolutely critical to utilize dedicated Huber needles, which lack the sharp bevel typical of standard intravenous needles, thereby preventing damage to the port silicone membrane. Conventional needles can cut the membrane, causing irreversible microtears that lead to leakage and, over time, drug extravasation or complete port dysfunction. The use of a Huber needle is the current standard of care, and failure to adhere to it may seriously affect patient safety.2,3

Equally important is the technique of needle insertion, as an improper puncture method is the most frequent cause of skin damage, particularly in cachectic patients with thin subcutaneous tissue. The use of too long needles, incorrect insertion angle, frequent manipulations, or improper dressings may result in microtrauma and local ischemia of the skin, eventually leading to skin breakdown and port exposure.

This case demonstrates that venous ports must be handled only by appropriately trained personnel with access to proper needles and dressings. Inadequate handling and failure to follow established protocols not only increase the risk of port loss but also pose a serious threat to patient health, including interruption of cancer treatment and potential development of life-threatening infections. Although skin erosion occurs rarely (in 0.5%–1% of the patients with subcutaneous ports), its consequences may significantly impair outcomes in cancer patients.4,5