Introduction: On the assumption of safety, speed and low cost, some authors postulate that the surgical cut-down technique under fluoroscopic guidance should be the technique of choice for port-a-cath application. However several clinical trials comparing venous cut-down with the percutaneous Seldinger technique concluded that Seldinger technique even without guidance was quicker and more effective. The aim of this study is to clarify the safe, simple, effective and quick management of difficulties encountered during clinically guided percutaneous port-a-cath application. Patients & methods: the study included 320 patients already on/ or scheduled for chemotherapy regimen for different malignancies and planned for port-a-cath insertion. The percutaneous route without radiological guidance was the technique used unless otherwise was indicated. Technically, the subclavian veins were the preferred venous access sites. The patients were clinically assessed and consents were taken. The difficulties and problems encountered during port insertion were studied in addition to the way they were dealt with in analytic way. Results: The 320 patients included in the study were 171 males (53.43%) and 149 females (46.57%) with a mean age of 37.5 ± 27.5. The mean time for percutaneous port insertion was 14±5 minutes. Difficulties were encountered in identified and dealt with 34 cases (10.62%). Conclusion: The percutaneous port-a-cath application supersedes the open route as it is technically easier and faster and still safe. Radiological guidance is only indicated in limited circumstances. Clinical experience and certain technical tricks can almost replace the need for radiological guidance and can also manage most of the encountered difficulties and the resulting problems successfully.