All Topics → Forum: Chemotherapy - Before, During and After → Topic: PORT PLACEMENT - Detailed description of process
Posted on: Sep 27, 2008 01:55 PM
tbird57 wrote:
Hi everyone
I just got my port placed yesterday and I had such a hard time finding a detailed description of the procedure, so I thought I would share this for anyone who is apprehensive or likes to know exactly what they are going to do to you:
1. I arrived at the hospital and registered. I was then taken back to the outpatient surgery/recovery area, got undressed from the waist up and took off my shoes, IV started, EKG hooked up, blood pressure and blood oxygen meter hooked up, and paperwork completed. A small bag of Levaquin antibiotic was hooked up to my IV.
2. I was taken back to a holding area outside the OR where they were going to place the port and the procedure was explained to me. It takes about 1/2 hour to actually place the port. They don't completely put you under for this procedure - they give you a sedative of morphine and fentanyl so that you "don't care" what they're doing, but you are awake and able to respond if they speak to you. The sedative is the reason why you have to stop eating 6-12 hours before the procedure, and the reason why you have to wait an hour after the procedure before you can leave. In addition to this sedative, they give you several local numbing injections in the areas where they are working in your upper chest below the collarbone and the base of your neck.
3. I rejected the sedative and did this procedure with locals only. Being able to go home quickly appealed to me, and I'm just the kind of person who feels like I'm not in control when I am sedated but not completely under - either put me completely under or nothing! So this worked well for me. (I asked the nurse if every man they worked on today had the "happy juice" and she emphatically stated, "you got THAT right!" - LOL)
4. They transferred me to the operating table from my gurney bed; actually, I transferred myself by sliding over. They gave me a warm blanket, took my right arm out of my hospital gown and gave me a small pillow for my head. They also pulled and taped my skin down on the right side to simulate where the skin would be when sitting up for chemotherapy. I was reconnected to the EKG, blood pressure and oxygen monitors too, and my hair covered with a surgical cap. An imaging device was placed over my chest so they could check the final position of the catheter above my heart to be sure it was correctly placed. They cleaned my skin in the surgical area with a strong blue solution and then draped my entire body and head in a blue surgical blanket. They had a frame under the blanket where my head was and made a "window" on the side so I could look out. A lovely nurse stood right by my head to soothe and talk to me throughout the procedure. I was awake and alert, and curious and continued to talk to the surgical team, asking questions about the process.
5. When I was prepped and ready, the surgeon came in. The first local injections were in the base of my neck on the lower right side, where they begin the process by threading the catheter into a large vein, and pushing it in until it rests just above your heart. The local injections sting and burn just like at the dentist, but once they take effect you are numb. Any discomfort comes from the pushing sensation in your neck and you can feel pressure in the side of your throat, but it's not painful, just uncomfortable and strange. The team kept me informed about what they were doing throughout and I kept them laughing with a funny story about a recent visit to the dentist which involved injections to the roof of my mouth - which was WAY more painful than this, I might add!
6. When they finished with the neck part, the doctor gave me several more numbing injections in the chest for the actually port placement part of this procedure. More stings and burns, but totally tolerable. In this part of the procedure, they make an incision in your chest for the port which is about the size of a quarter, placing it under the skin below your collarbone, and then they make a tunnel for the catheter sticking out of your neck (at this point), push it under the skin down to the port, and connect the two. There is a fair amount of pulling, pushing and tugging in this part of the process but it wasn't painful - again, just strange and uncomfortable. It doesn't last long, and then they begin to stitch you up. The subdermal layers are stitched with dissolving stitches and the top layer is glued with steristrips placed over the incisions. You will have one tegaderm dressing over a small gauze pad a the base of your neck, and another on your chest below your collarbone.
7. I was instructed to change the dressings every 2 or 3 days, and to keep the dressing on the neck wound for 5--7 days, and the chest wound for 10-14 days. I was given supplies for 3 rounds of dressing changes. I was told it was okay to shower by wrapping the site in saran wrap but no soaking baths and ensure the area is kept dry. The port can be used immediately, and does not need to heal before it can be accessed.
8. Because I didn't have the happy juice cocktail, I was able to get dressed and leave right away! A big plus to me. Last night, the surgical areas were numb, and really didn't completely wear off until the wee hours of the morning - about 10 hours later. There is very little pain involved, but it is uncomfortable to turn your head too much, and I am definitely favoring the area. I also could not sleep on my right side last night, but was able to sleep on my left side just fine. I don't plan on doing any housework today, but I'm able to do light cooking, work on the computer, etc.
9. There are very good pictures of what the placed port and scars look like on this site: diehlmartin.com/infusion/ ... .
I hope this is helpful. I was searching high and low for this kind of detail prior to the procedure, but couldn't find it. I wish us all the very best of health,
Teena
Posts 331 - 360 (485 total)
Aug 5, 2011 11:02 PM Grimbol wrote:
Ok port is in my arm and it is a permanent placement. Not a fun day but at least it's in, all ready for treatment day on Wednesday. I did have to remind them not to use the chloroprep, thank goodness, I caught them just in time.
Aug 6, 2011 12:59 AM ellenquilt wrote:
Grimbol, Good luck with treatment on Wednesday!
Aug 6, 2011 06:12 PM, edited Aug 6, 2011 06:16 PM by sas-schatzi
Grimbol. Congratulations on a good placement. Please keep us upto date on your experience. Arm placement came about in this past decade, not sure what year. I'm sure they gave you the no BP warning etc.
Please continue to try to get chloroprep added to your allergy list.It's keep in your computer record until the doc or pharmist follows aprotocol for removal.So, if ther isn't a ER or In house visit for years it's still will pop up in your record.
Chloroprep-----It's the IN disinfectant these days. Whats supposed to happen when you have an Allergy bracelet , is everyone besides asking you your name and checking your arm band is supposed to be doing the same with your allergy bracelet and re-asking your allergies. If someone approaches you and doesn't check your bands , put your arm up and say "According to hospital policy you are to look at my banding etc" If you really want to throw in a home run add "Verifying my information with each contact is a JACHO safety initiative" Accrediting institution.
Story time-----once picking up blood-------procedure: name sticker from chart checked against arm band and verified with patient>>>to blood bank>>>all numbers are checked by two people in blood bank. There was a set of numbers that didn't match, the tech said that's okay. I said it wasn't okay. The supervisor was brought in. I asked for a run of that number through the computer----Yup there was a patient in the hospital that carried that number, but different name. They could not figure it out. But what the supervisor did was the safest action. The patients blood was redrawn and a full type and crossmatch was redone. She was safely given the blood. What if I hadn't said no, it could have killed the patient. Also the patient was issued a new band correcting numbers/and a root cause mtg held. Just for completeness. Once back at the beside the blood is checked by two nurses against the bag and the paperwork, and the band& patients verbal verification of name.
Aug 19, 2011 03:03 PM, edited Aug 19, 2011 03:04 PM by Artemis
Aug 21, 2011 01:22 PM, edited Aug 21, 2011 01:40 PM by Flautalee
tbird57--Thank you very much for your detailed description of your port placement. I especially appreciate your mentioning that Levaquin was the antibiotic given during your surgery. I have a second primary tumor (yes, a different Triple Neg subtype) in the breast that I had a mastectomy 11 years ago. Apparently this is incredibly rare, but I am back to this "country of breast cancer" again.
Anyway, when I had a phrophylactic mastectomy on the other breast in 2001, I developed cellulitis, was hospitalized, and put on a cocktail of anitibiotics through a PIC line that I administered to myself at home. After a short time, the docs took me off Levaquin (one of several antibiotics that I was on) because I developed "chemical hepatitis." They didn't know whether the chemical hepatitis was from the anesthesia or from the Levequin. My liver enzymes had shot up to 1200 (norm is around 50, I think) and very gradually came down after the they stopped the Levaquin. I think they returned to above normal (60-100ish) within a few months, but it took until about a year ago for them to usually be in the normal range. So they were elevated a long, long, time. I will call my oncologist's assistant tomorrow to ask her to put allergy to Levaquin on my chart (I had forgotten about this until I read your post) so they don't give me Levaquin for the port placement this week.
One odd thing, though. When I was in Mexico last year, I developed a really serious GI diarrhea. I waited 3 days to see if it would improve. I actually had a doctor called to my room (a house call - it was wonderful!). He gave me a shot of something that stopped the diarrhea immediately and put me on Cipro that I took for several days. He said that I waited far too long to be treated. Anyway, I believe that Cipro is chemically related to Levaquin, but I didn't have any problem with it as far as I know, since my liver enzymes have been OK.
Since my liver may be "fragile" - my description - I told my oncologist on August 11 that I had decided to stop drinking completely - I'm a social drinker at most, and I asked if he thought that this was a good idea. He said," Yes." But when I am completely finished I will have some champagne or a good Dogfish Head Beer that they make in Delaware.
Thank you so much for the time you took to share this info with us. I start 6 rounds of Taxotere/Cytoxan every 3 weeks, followed by radiation, this coming Friday (8/26). I don't know whether the port will go in early this week or just before chemo. I really, really, don't look forward to the dressing changes - I have a problem with adhesives - everything but the clear IV dressing film pulls off the top layer of my skin, but I will manage, as we all do.
THANK YOU tbird57 - You may haved my life because if your liver isn't working well you can't have some chemotherapies.
Best to all of us. I was not computer literate in 2000 (when I had 4 rounds of A/C) - did they even have them then? These forums are really helpful to me this time around. I think this is a great website where we can help each othe as well as receive info ffom the experts.
Aug 24, 2011 09:25 AM olgah34 wrote:
I am afraid my port is misplaced, it is 2 weeks after, I have noticed big vein in my neck and pain in my chest , almost constant, goes to my throat and jaw. However, my surgeon told me that it happens sometimes, I mean big vein in the throat... I just have a constatn feeling, that something in my throat... I have my BMX next week, then in 2 weeks chemo, I don't want to have any problems...Anybody had problems like that?
Aug 24, 2011 10:28 AM ellenquilt wrote:
Olgah. I had the same sensation for a few weeks. Watch it and see if it dissipates over time.. My port hardly bothers me now. Occasionally a twinge here and there. Had it put in July 20. Started chemo July 22.
Aug 24, 2011 10:43 AM K-Lo wrote:
Me, too, Olgah. What I thought were major problems seemed to be the norm. But keep having them look at it for sure. The oncs, chemo nurses, surgeons can all take a look until you feel secure.
Down the road, you may want to try EMLA cream (prescription) to numb the skin for access. I apply it 2 hours ahead or so, then I let the chemo nurse use the cold spray as well. Many of the needle accesses caused zero pain. This is a treat.
Aug 24, 2011 12:26 PM olgah34 wrote:
Thank you, ladies, sooo much!
Olga
Aug 24, 2011 07:48 PM, edited Aug 24, 2011 07:48 PM by sas-schatzi
Aug 24, 2011 07:58 PM sas-schatzi wrote:
olga tried to list fluroquinoline drugs------apparently the site didn't allow C&P. Yuo are correct to have it added to your allergy list. For anyone else in a similar situation ask for a copy of the anesthesia record and a consultation with an anesthesiologist to review what possibly might have been another offending drug. In your case, it is likely to late to do this, but if you happen to be in the same hospital. You can obtain it from Medical Records. If you can't set up an individiual one on one with an anesthaesiologist before surgery for port.---- Take old anesthesia record with you to the prep area. If you can't get a copy , the anesthesia doc will still be coming to talk to you in the prep area. Talk to rhem regarding your concerns. ---Cipro-----ciproflocaxin is in the same family as levaquin---levofloxcin.
Good luck
Aug 24, 2011 09:34 PM Grimbol wrote:
Hi guys, I haven't posted here for a while. I had my first tx, was down for about 8 days then came back to life again. Next tx is next Wednesday, not looking forwad to that. Tonight the incision site from the port is bothering me! I'm quite adjusted to it and for the most part I like having it in my arm. However the last couple of days the incision site has been getting a little red and tonight it is itchy. I had disolvable stitches but it seems like at one end there is a knot that hasn't dissolved and that's where it's sore now. The final dressing came off on Monday, I couldn't see it before then. I promise I haven't been picking at it, although I really want to!!
So, should I go back in and have them check it out or is this ok and it will settle down on it's own? Any thoughts anyone? Thanks in advance :)
Aug 24, 2011 09:36 PM Grimbol wrote:
oh yes, Olga, I am sorry about your neck placement bothering you so much, makes me glad mine is in my arm, I would freak out a little if it was in my chest I think. My arm was very painful the first day and then lessened over the next few days until it was fine. The guy putting it in said I wouldn't have any trouble at all, huh, like to put one in him and see how he likes it!!
Aug 25, 2011 03:59 AM, edited Aug 25, 2011 04:03 AM by sas-schatzi
Grimbol------today is fri------definitely go have it checked today in the am by whomever put in the port. Sorry it's 330 am , You won't see this till whatever time tomorrow morning. The reason you want it checked-- the sight of the surgeon on the wound/incision is better than anything else. They may even ask you to meet them at ER. b/c it's there day in surgery.and they aren't in the office. Avoid Er charge by saying doc told you to meet them there. If they insist on making out a chart refuse and call doc's answering service to let them know you are in the ER waiting room.
This avoids -------you being concerned-------and avoids not having the actual doc looking at the site.
I have learned through life that all problems occur after 5 pm or on the week-end. It's Murphy's law. Hope you see this in the early am and call the office early. In our location many doc's offices close on friday. It's a bit of a joke really.
Call office at 8 am----if it's closed and their in surgery it gives plenty of time for a response----make sure cell phone is charged
If your doc's office is closed stay on the line and leave a message with the answering service for him to call you. They will ask why----tell them what you said here, and ask him where you can meet him so he can lay eyes on it--------feed the ego---------tell him/her you trust their judgement so much, you're concerned about going through the week-end without his/her opinion------and frankly that's the truth.------------don't hesitate on what I have said---------you need to protect your port.-----------PROACTIVE IS SELF PROTECTIVE--------these are the words you must live by to get the best care--------good luck
sorry there is a bit of redundancy here, but it is 4 am
Aug 25, 2011 08:40 AM Grimbol wrote:
ha-ha, thanks Sas, I will go in this morning promise!! I'll post later to let you know how it goes. It is easier again now, of course, but I will still go.
Aug 25, 2011 12:40 PM Grimbol wrote:
I went in, they said it actually looked ok, but they did take out the offending undissolved stitch, added some steri strips and sent me on my way. So, at least it's been looked at and been deemed to be ok and it won't interrupt chemo next week. hmm is that good??? yes I know it is really.
Thanks for your help.
Aug 26, 2011 03:18 PM sas-schatzi wrote:
Grimbol-------great------now you don't have to worry through the weekend
Aug 28, 2011 09:00 PM Denise2730 wrote:
Why do I need a port if I'm only going to have 4 chemo sessions?
Aug 29, 2011 03:03 AM, edited Sep 9, 2011 10:46 PM by sas-schatzi
Chilvur. Chemo can severely damage smaller vascular tissue. It is better to put the chemicals into a vein that is larger and can the chemicals can be more quickly diluted, so that the vascular tissues are undamaged.
You had node dissection on one side which means for the rest of your life , you only have one arm to draw from. Those veins in your good arm, you want to protect.----------enough info or not?
Sep 9, 2011 10:34 PM Grimbol wrote:
Can you help me? I'm sure if I read enough here I will find the answer, but being very tired I'm hoping for a quick answer! How do I stop the port from stinging sooo much each time they use it. I thought it would get eaiser over time but apparently the chemo gets you here too and it wont necessarily heal well inbetween txs. Plus I keep having to go for more meds and fluid. So, I believe there is a numbing cream you can use?? Can anyone tell me what it is?? Thanks.
Sep 9, 2011 10:49 PM, edited Sep 9, 2011 10:52 PM by sas-schatzi
EMLA---needs a doc prescription, put it on per directions-generally 1/2 hr before and a boost smear maybe ten-fifteen minutes before. Wash hands first or apply with a q-tip.
Ask the nurse to allow alcohol or chloroprep to dry first before they stick. The sting is coming from them. Think about what it has felt like when pouring alcohol over a cut
Sep 9, 2011 11:49 PM Grimbol wrote:
Thank you so much, they do dry the alcohol first, the nurse is very good, but she told me I could buy a cream at the pharmacy?
Sep 10, 2011 10:56 PM sas-schatzi wrote:
Grimbol-------I could be wrong, but EMLA I believe is still a perscription item. Anything less -------is well less. EMLA is the gold standard, if it has gone to OTC (over the counter ) good, but unsure.
Sep 11, 2011 09:02 AM Grimbol wrote:
hmm, yes I think you're right that EMLA is prescription, I was surprised that they didn't offer that and just said to try the pharmacy. Oh well, thanks for the name I will go back in and ask for this now. I'm not exactly a wimp but I don't like how sore it can be either.
Sep 11, 2011 09:56 AM ellenquilt wrote:
Grimbol: I asked about the EMLA cream but the nurse told me to try it without first because it can thin the skin. Just FYI, don't know if that matters. We do a 1-2-3 countdown and I take a deep breath as she puts it in and we do the reverse when she takes it out. Works okay for me, but each of us has different tolerance levels. To me it feels like a quick pinch and then it goes away. Not too bad
Sep 11, 2011 08:31 PM Grimbol wrote:
Thanks ellenquilt, I will persevere. I don't mind it too much I was really just surprised it wasn't getting easier. It is sore until they actually begin the infusion, and then it gradually fades. I'll give it more time and will probably survive fine, but thanks for all the help.
Sep 13, 2011 04:43 PM sas-schatzi wrote:
Ellen quilt---------please find a resource about the thinning of the skin-------very important that it is evidence based and not an urban legend. I'd do it , but not up to it , thanks sheila
Sep 14, 2011 12:39 AM kayb wrote:
Well this is anecdotal but my port has been accessed 30 times in the past 14 months, used EMLA everytime but the first. There is no change in the thickness of my skin. I wouldn't want to use the port without EMLA first.
Sep 14, 2011 01:17 AM sas-schatzi wrote:
Hillck ----------thanks for your individual report------it was the same as my DH's .......... The thinning of the skin has value b/c if it's true could make a difference. BUT if NOT BASED ON EVIDIDENCE BASED STUDIES--------------it holds no value. So, whomever gave you that piece of info -------------please , ask them for there resource