PORT PLACEMENT - Detailed description of process
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Hi njmom3,
Most people, even those with wimpy veins, have no problem with port placement. I am a needle phobic myself, so I understand. The cream your doctor gave you may be EMLA (lidocaine/prilocaine). Yes, if you follow the directions it works very well. When I first used my port, I slathered it on and had the nurses apply a numbing spray. They were laughing because I'm such a chicken. During my third infusion, I forgot to put the cream on and only had the spray. Guess what? Didn't feel a thing! Now I only use the spray. A port is a wonderful thing. Mine will stay in forever because I'm stage IV and I use it for blood draws, nuclear injections before scans etc. I don't know if your docs would be willing to leave it in indefinitely if you are not in active tx. Blood draws can only be done through a port by a trained nurse, not a lab tech and it has to be maintained by flushing every 4 weeks or so, which means a trip to the infusion center. Good luck with your chemo.
Caryn
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NJ Hi it's sassy from Insomniacs thread. I've mentored this thread for along time. Tb57 left along time ago. I felt what she wrote in the topic box and the posts here were too important to be lost in the oblivion . AAOAO has helped recently to keep it bumped:)
Let's go from easy question to the more complex:
The cream is known as EMLA. Yes it works! Put it on the prescribed time before a stick. If you're that scared , put it on a little sooner, then put a bit more on a little later.
Ativan------hopefully you have a driver, if you do take about 45 minutes before you know the stick will occur. ---most places have an intake routine, then the wait, then the stick--------time varies, but is generally the same in each facility. You want the drug to peak just at insertion time frame.
Port placement: Your experience with arm/hand insertion will not compare to the chest insertion of a port. Port placement is done by a physician in the operating room, or by a radiologist physician in the Interventional Radiology suite of the Diagnostic Imaging Department. Commonly known as the "X-ray " department.
Tbird 57's description--she refused to have IV sedation in the OR. That may allow for skipping an IV in the hand going into the OR. BUT some facilities may have a rule that Local cases must have an IV access site in case of emergencies.
If you HAVE to have an IV access site due to hospital rules.
1.Ask for the best IV sticker in the group----describing how hard of a stick you are------those words WILL get you the best sticker. Be pushy about this. Being a drama queen if you have too.---------NO wannbees, that say I will give it two tries and then turn it over to someone else.
2. Ask that subcutaneous Lidocaine be used to numb the IV insertion site in your hand or forearm. Usual rule in most facilities that are in this century and decade. If a nurse refuses, ask for someone that will do it.
If you have an IV , please, do your self a favor and agree to the IV sedation-----VERSED is wonderful----YOU WON'T REMEMBER ANYTHING.-------Versed 's key to usage is it's ability to cause short term amnesia. sassy
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Hey Caryn, I was writing while you were posting.
NJ----what Caryn said and I said----cool we didn't overlap too much---so it covers all that you asked
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Thanks guys you were both very helpful! I will suffer the IV to be put out, I'm no hero, and I certainly am not brave enough to chit chat while they are cutting my neck open! I always warn the nurses about my lack of veins, and of course they are like oh no problem. Then they poke away and finally get someone else. It hurts like hell in my hand! They can put something on that?? Well that's a first, aside from hot packs, which do nothing for me, I've never had numbing cream for an IV! I had something applied for the radiological dye that was injected for the nodes prior to my mx, but my God that was the worst of Worst Paine ever!
Interesting how each hospital is different. Where I had my mx they let me take a Valium at home, they gave me some there for that blasted dye injection, then the anesthesia lady gave me something prior to going to the or. Went to the or and that's about all I remember.
For the surgery this week, not allowed to take anything prior, would not give me anything when I arrived and only gave me meds after I got to or, moved to a different table and they strapped me in. That was awful!
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NJmom3, I had my port put in while I had the sedation. I wouldn't have wanted it any other way and that is how the surgeon does it. With all the anxiety, fear and trauma that a breast cancer diagnosis brings, why add incredible stress. I have a low pain threshold. This way it was a piece of cake. They also put me out when they removed the port too.
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njmom,
Sorry you had pain during the injection for your SNB. Chicken that I am, I slathered my nipple in EMLA before that procedure.
Sas-schatzi,
Are there different ways a port is inserted? I've read posts mentioning two incisions, a cut in the neck etc. I appear to just have the one tiny incision where my very small, petite Bard Power Port is.
Caryn
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bump
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Caryn I'd have tp research it, Duh---I forget.......I only remember one, but I've been gone long enough I'm sure there's something new.
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Caryn I have a regular port, some have the power port maybe that's why---the reg port can't take some of the dyes for scan and tests, but it can take most---so it helps. but I always had bad veins so I'd ask for a baby needle and if they did have a baby nurse available It was great u don't feel a thing. I kept my port, cuz neither one of my arms are useable now so I get it flushed, but I see the onc still every 3 months plus other Drs. so it gets used a lot. And I remember going back to work right after (not same day) I got it, cuz I was at that time saving my days for chemo for as long as I could work, and they used the port weekly and I never felt anything but loved the smell of whatever they use for 30 seconds LOL
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Camille,
We are both stage IV, so I don't think our docs mind if we keep the port in, even if we're not actively using it. njmom is stage II and asked about leaving her port in after she completes tx but I'm not sure how the docs would feel about that. At our stage, we probably don't mind the commitment to flushing it, but I might not feel the same way at stage II, especially if I never progressed after tx (everyone should be so lucky!)
Caryn
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Caryn, I'm guessing if someone had known bad viens, it might be a consideration. This was/is my twins scenario. She had hers re-inserted and it's been in for maybe 7 years now. It was re-inserted to help with a different medical problem, not CA. Has been flushed for maybe 5 years and used when her medical problem--liver failure(not mets) becomes an issue. But the liver failure issue ended up with admissions in last 21/4 years. previous just flushed for several years.
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Hi Caryn,
I had one good vein for blood work which was in my left arm. Well that's out and my right arm is awful. For my mx they stuck my hand four times. I had blood work, they did one stick in the inside of my arm and bruised badly. For last weeks surgery, they blew 2 veins in my hand, and one in my arm. Then the expert hi tech came (even though I warned them from the beginning) and she had success after two sticks in my hand. She started lookin in my wrist and I was like no way! The IV was painful, I could not move my hand, but as long as it worked, that's all that mattered. My hand looks like a war zone! I generally go for blood work every 3 months for cholesterol, so that's why I was hoping to keep it.
Also, were you guys put out for placement. At this point I'm so over pain, and really stressed, I just as soon be out! A friend of mine hates her port, she says she can feel it, plus the line in her neck as well and it's irritating. Not what I want to hear. Not that any of this is stuff I want to hear!
Gina
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Gina,
Well, if ever a case could be made for keeping a port in a lower stage patient, it would be you. I cringe in sympathy. I was completely out for my port placement because I was also having one of my nipples removed at the same time. As I mentioned, I have a petite Bard power port. It is located in the little hollow between my shoulder and upper chest. It is barely visible and I only had one incision, nothing on my neck. I rarely feel it and if I do, it's just annoying, not painful. For the sake of full disclosure, I will tell you that I was in the 1% that had a serious complication, a lung puncture. Actually, a tiny nick which resulted in a slow leak that was not detected by the post installation x-Ray. By two weeks post op, I had a complete pneumothorax. This is not to scare you but I feel I have to be honest. Despite that little bump in the road, I love my port and couldn't imagine bc tx without it.
Caryn
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Bump
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BUmp
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I had my port placement yesterday, I went in very optimistic that it was gonna be a piece of cake. Well it was no cake I ever want again! It started off fine except for the darn IV not playing, but when I woke up in Recovery all hell broke loose. I felt terrible, I kept thrashing around, I couldn't stop coughing. My somach hurt then I got sick and had issues with the other end as well. It was awful and very embarrassing! I just hurt all over! They couldn't figure out what was wrong. They did an EKG, chest X-day and an echocardiogram all which were normal. They were going to admit me, they had four different people try to draw blood, after seven failed sticks they gave up. By then I was feeling fine, and begged them to go home. After a while they let me go and I feel fine except for my neck which is killing me! The dr said I was thrashing around through the surgery, so obviously I had some weird reaction to the anesthesia. When I had my last two surgeries under general I was fine, this was just some sedation, apparently it was not for me. I got there at 11 am and didn't leave till 6 pm! This is not the typical experience for port placement but apparently nothing about me is typical. Hope chemo on Tuesday goes better!
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NJ, Obtain anesthesia record through medical records office for all three surgeries. Do this on Monday. Plus, post op record in Pacu, Plus, post surgical operative note of doc on all three
Ask for a consultation with the department chief of anesthesia. OR ask the department chief who in the department would be most likely able to look at the three records and do the detective work to compare all samples. I'd suggest not having the anesthesia doc that gave you anesthesia do the consult.
Ask for the risk Manager to obtain the following on the equipment in the room. 1. maintenance records on the anesthesia machine used on your case. It's supposed to be documented on your paper. Machines can change rooms between cases. That's why the machine number is on your anethsia record.. Ask for maintenance record and check of oxygen lines, pulse oximeter, ekg monitor.
Your case HIGHLY unusual. I worked operating room as a circulator/scrub nurse on all services, specializing in cardiovascular. TRUST me something was highly irregular-----either drugs or equipment that supplied and monitored you. Likely drugs. But malfunction of a machine is suspect until proven otherwise. The odds that the delivery system for oxygen and the monitoring device were both malfunctioning are astronomical.
Get the records first. Once you talk to Risk Manager, the wagons may circle.
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NJ Please, either call or note her, or by pm what is happening with this. Obviously you need to protect yourself from a future occurrence.
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Thanks Sas for the info. It definitely sounds more involved then they were making it out to be, my dr called me from home last night to tell me I was thrashing around on the or table during surgery, which is unusual. She asked me if I had ant memory of it, which I don't. The recovery nurse was ironically the same one I had for my mx in December and she remembered me. I heard telling the doctors repeatedly that I was not like this with my last surgery. I don't know if they thought I was dramatic, but it was scary not being able to get control of myself or my feelings. They kept saying I was dehydrated and that caused it, I don't think so. And I thought just being sedated vs general would be easier! Nothing easy here, but I am nervous about what happens when it's time for the port to comeout...
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one more question, I have a brad port whatever that means, they gave me a card about it. It's like the card for my te, I can use them for poker soon! Anyway, when you use the port can you feel the meds going in, like with an IV sometimes they burn, etc... They also told me yesterday that you can not use the port for IV for surgery, like when I have my implant swap. Well that stinks! Nurse also said chemo ruins veins, how much worse can they get? They blew at 6 yesterday...
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I think you mean Bard, which is simply the brand name. The card should be carried in your wallet so if an emergency occurs, it will be known that you have an implanted medical device, just like your TE. I never felt a thing during any infusion, although I always request that spray be used to numb my skin before the port is accessed. When the port is flushed, I briefly , get a medicinal taste in my mouth but it literally only lasts for a few seconds and is not too awful. I have heard of the port bring accessed for surgery, but I don't know if practices differ from hospital to hospital. Do make sure that you use the port for blood draws and injections before imaging. It is so much better than using the veins in your arm.
Caryn
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AH Hah I have an answer LOL about the port use. I was on a rant eons ago. I transferred the post to here. I even know what page. It was on a rant, so I sound pretty strident. So ignore the grand standing, the info is good LOL.
NJ, your reaction I will say was to a drug----oxygen is a drug......that's why I suggest having the machines checked. If you 'd rather not take it that far I get it
To low of oxygen levels can cause your type of reaction. The body and mind will do amazing things fighting too low of oxygen.
BUT please, follow through on the anesthesia records. They should be compared for what drugs were used. If you find one drug on this new time. It would be the suspect for causing the problem. But looking at all the drugs is important. Even the local injection the surgeon used at the port site s suspect. He may have not used one, but even though you were under anesthesia a local is often used.
With your doc calling, and the discussion you remember between the staff, I guarantee they are trying to figure it out too.
You all need to be Sherlock Holmes and Dr Watson in this. The importance is to prevent a future occurrence.
I'll bring forward that other post, remember I was on a rant.
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Nov 27, 2012 11:55am, edited Dec 31, 2012 08:03am by sas-schatzi
The following RANT was written on a different thread, in response to several members that were told by nurses that ports were for convenience versus medical neccessity. Hope you find it helpful.
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Okay I'll be on a rant. Hit a true nerve and I'm pissed.
Those nurses have their collective heads up their ass. Hmmm was that strong enough. Anyone espousing this garbage was never trained properly regarding IV therapy and the indications, contraindications(not to be used), and complications of there use. I would consider them not only improperly trained , but lazy. Because any true attempt at reading/studying the subject, they wouldn't say something ssssssssssooooooo STUPID. Very scary b/c this is entry level nursing knowledge. So, what else did they not bother to learn !!!
Ports were developed because veins were getting fried by chemo. Tissue that is infiltrated with some chemo's dies and sloughs off. Chemo that doesn't cause tissue death, can discolor the tissue for a very long time. Back to fried veins. You may get through a course of chemo, but the internal vessel damage is being done. Long term affects may NOT be seen for awhile. What it means longterm is that one may NOT have veins available for fututre use, thus putting one at risk in lifethreatening situations for no immediate access. In this situation, those idiot nurses, wouldn't see you dead from a preventable reason had the veins not been fried. This is the worst case scenario. Other non-emergent situations, that are situational dependent, you will end up with a PICC line, Central line, or Port anyway b/c arm veins aren't available.
Reason for PICC's, Centrals, and Ports is they access veins that are larger in diameter, thus the medication administered is diluted in the blood quicker. The faster the dilution takes place, the less internal vessel damage. Less damage to the vessel less likeihood of long term negative consequences.
Anesthesia risk: Docs or CRNA's,prefer arm veins, in administering anesthesia drugs thye will only use Ports, centrals or PICC's as a very, very last resort. They will go to leg veins first if an arm vein not available. Leg vein usage for IV's, puts you at risk for thrombophelbitis or embolism. Not likely while under anesthesia, but can happen. Risk is predominantly after surgery. Even after removal of the IV. Leg veins don't respond well at all to IV therapy.
The peripheral IV access of choice for anesthesia is the arm veins b/c the drugs used are administrered at a slower rate in a smaller diameter vein to prevent the drugs from entering the central circulation too fast. Too fast of arriving at the heart or central nervous system control center in this scenario can cause the heart to NOT work right. HMMM need a further description of what can happen then? Google "speed shock when administering drugs". Plus with the arm veins , the patient is positioned so that anesthesia Docs/CRNA"S can visualize the insertion site. Some drugs administered in this situation that infiltrate can cause serious consequences for the tissues i.e death of the tissue. Besides if they infiltrate, the drug can't accomplish the expected response for administration.
Wasn't too hard was it. Now you know more than the STUPIDS. ERGHHH. Hate it when medical professionals don't learn what they should.
In answer to convenience of use of centrals/ports/piccs ---yes, they are incredibly convenient.
When they are ordered by the Doc, it is b/c of what I have written above. The first consideration for choice of route of administartion of an IV therapy drug is SAFETY of route. NOT CONVENIENCE.
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HMMM maybe I should rewrite and take out the ranting stuff........ I respect your opinions, if you think it will help deliver the message better just let me know. It's even more strident than I remember.
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Sas I loved it! You are so informative and I eat up educational info like nobody's business! I'm so glad to be able to understand the uses and differences between the different IV. I'm also glad I did not allow my mo to convince me to not use a port for my first tx since my port was delayed. Given the poor veins I gave that could have been a disaster! Thanks again for all your support to regarding my situation so I know it wasn't me causing a ruckus in recovery!
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NJ
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Hey Sas one more question, just took off my bandage, I was told two days and then I could shower. I have white strips which dr said to leave on, won't they come off in shower? Also, I anticipated the port bump, but I have a little bump above it in my neck and I can almost see/feel a tube like thing, what is that?
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Nj the bump is the tube, Insertions all are different. But ask doc at next visit. -------Second thought call doc before port used tell him what you said--------rarely caths can double back, better to verify with him before first treatment. -Ask for xary post insertion to be re-looked at-----he may discount what you ask------but a saftey issue-------may explain your reaction during sx. ------But a cath that double backed again should have shown up on post insertion xray.
Strips are just a bit of extra support for the incision. They will peel at edges then finally fall off. Even with showering they will stay up to a couple of weeks. Just don't run shower at high flow directly at them, Gently flow. Once off. use clean wash cloth with antibacterial soap---DIAL and gently wash site. Hugs sassy
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Njmom3, please check into what happened during the surgery. There was excellent advice given and you really should do all you can to find out.
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Thanks Cowgirl sassy0
