PORT PLACEMENT - Detailed description of process
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NJ How's the neck. Kind of blew by that complaint----You should see your PCP and document situation. Talk whether you should see neuro or ortho for consult. If you end up with a long term problem. you want a recource. Not that you were hurt intentionally. But be careful on this.
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Thanks sassy, just read this now had my chemo this morning. The first thighs the nurse did with the port was draw blood to make sure all was well. No problems to speak of, and now I'm searching the boards for the right protocol for Claritin with nuelastra. Getting that tomorrow at three p so not sure if i take It tonight or in the morning and for how many days. So much to learn. I may run down the anesthesia mystery while I'm at the hospital tomorrow wish me luck! And thanks for all your info!
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::) can.t help with clariytng timing sorry hydrate. Talk soon. On kindle typings tough
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Nj, Have an idea on your problem with sedation for port placement. Generally, the type of anesthesia for this procedure would be a face mask without the insertion of an endotracheal (ET)tube. i.e. a tube into the windpipe. If this is true and you had sinus drainage/ buggered nose, it may/could interfere with some oxygen delivery. May sound off the wall. But sitting here worried about my own anesthesia on the 28th b/c my sinus just drops gunk all the time. Much of the time I have to mouth breathe
I will have an ET tube for my sx, but worried about the before and after. Hence it popped in my head about you. Think about your sinuses, could this have been a problem for you? Remember back when i said the body/mind will fight if there is a lack of oxygen.
Added after pm'ing you. If just a mask is used, oral airway isn't used b/c it can stimulate a gag reflex. So, if the nose is stuffy it limits air flow through the nose to the lungs. Usually a trumpet /nasal tube is used in the nose for this reason.
Oh well, just a thought.
Will pm this too you?
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sassy this makes perfect sense! I woke up coughing and when I got home I felt like I had terrible post nasal drip. I have awful sinuses so maybe something was brewing and I didn't realize it since I am so used to it. I still have a little cough which makes the port and I guess the tube up my neck hurt when I cough. I hope that goes away! I almost feel like my lung hurts when I breathe in, but I am also starting to feel like a hypochondriac, googling pneumothorax. I had an X-ray after surgery and I know all was well...
So if having bad sinuses does not agree with sedation without the tube, what is the alternative? I'm already stressed about the surgery to have it removed! Thanks so much for giving me an answer to this baffling question!
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Well it could be an answer. Sometimes when my head is back this flood just drops from the sinuses. Like a water balloon plopping then breaking open---does that create enough of a visual? right onto the larynx area and causes coughing and choking. BUT if you had an ET in then you shouldn't have caough etc. The question is eay enough answered ---whether a tube or mask was used is on the anestesia record.
For removal they could use an ET tube and give you meds perop to dry up the sinuses. That ned would last for hours past the removal of the port .
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Hi reposting this on some threads, may be old news to some, but to good of info not to pass this on,Sassy
Bluebird144…NJJoined: Apr 2013Posts: 39313 hours agoBluebird144 wrote:
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Surgery 09/09/2009 Prophylactic Ovary Removal (Both)Chemotherapy 02/06/2013 Adriamycin, Cytoxan, TaxolSurgery 07/19/2013 Mastectomy (Both); Lymph Node Removal: Sentinel Lymph Node Dissection, Axillary Lymph Node Dissection (Left); Reconstruction: DIEP flap (Both)Surgery 08/20/2013 Reconstruction (Right)Surgery 08/28/2013 Mastectomy (Right)Radiation Therapy 10/14/2013 3-D conformal external beam radiationSurgery 01/24/2014 Reconstruction: Tissue expander placement (Right)
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Hi
Is there more than one method of placement of the port? Is one better than another. Very anxious about the catheter being threading through my neck.
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There are chest and brachial (upper arm) placements. When is your surgery. Please, skim the 22 pages for port placement questions and responses. Probably more brachial ports discussed in last ten pages. Plus, many members have expressed concerns as yours re: the anxiety over the procedure. There's allot of things shared in these pages so reviewing from the beginning will help, :)sassy
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sas,
Hope you're stil trolling this site. Your previos information was excellent. Yesterday I went to the OR for a 30-45 min port placement for chemo on the 13th, After 2 hrs it was a no go. This surgeon I have known and worked with for 7 years and his patients do extremely well. He said I was one in a hundred that the port catheter could not be thread. I really don't want chemo peripherally but really don't want to delay it. Because of extensive LVI of the original tumor and a 1cm tumor in my sentinel node the surgeon did not want to go back to surgery until after chemo was started. It's already day 35 since my surgery. If I am stage 3 chemo needs to be stsrted asap. Do you think adriamycin is safe peripherelly for ond dose? Thanks.
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GEN--HI where in Oregon. Chemo drugs are my major weakness. it's a sub specialty I didn't do. You likely read my opinion on ports on pg 15 and then recently brought forward.
For the short term ask for a PICC line done in the interventioal radiology suite by an interventional radiologist. High degree of skill. High maintenance of sterile technique.
The regional trauma center for my county has an IV team that inserts PICC's and a special transportable machine to indentify the vessel. ULTRASOUND type machine I guess(?) . NOT impressed at all. DID i say I wasn't impressed. I was aghast at the lack of sterile technique.
If a picc works for the short term to get you started on the adriamycin. Then it allows you time to work on the problem of getting the port done. Sometimes docs have one of those wierd days that nothing works. Talk with him. Ask around. At the Big regional centers they have docs whose whole careers consist of doing nothing but ports.
You might try a NCCN approved center, approved by your insurance, and schedule with the port specialist. Get your primary surgeon to get the insurance approvals working. He'll likely be glad too. He won't want to try you twice.
The picc allows you to get started. or get a brachial port. But like other sx's find out how many they've done them, infection rate, complications etc.
I believe if you get a port keep for as long as you can, forever if possible. Some though see/feel the taking out of the port demonstrates that all with cancer is over. Like the bell ceasing after a storm. So, it very personal.
Does this answer your question? Will cut and paste BY PM in case you don't see this
Good luck post back how you do L&H&P's sassy
Edit 3/28/2014:
Some ports aren't comfortable b/c they never were from the beginning. So, comfort i.e lack of pain or comfort is a choice for getting a port removed
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dutchie - I hope that you are at home, snuggled under soft blankets. sound asleep and dreaming of nothing but breezes through the trees.
tangerine- your MO is right, it's one thing to be a working mom - that's a pretty big load. To be the mom to a four-year-old and try to work 40 hours a week and to do that while on chemo after going through what you have with mastectomy and infection etc.? And to do that the way that you have - with little complaint, few tears & the idea that you should be 'able' to do whatever life throws at at you with heels on? You wouldn't expect that of someone else would you? We're just human. Tell the husband that he's in charge of everything for awhile & you are just in charge of you. Does that seem like a lot to put on him? Maybe, but it's just for a couple months and it doesn't matter if he does a 'perfect' job. Just scraping by's okay. Your little one needs you to just rest - so that you will be better sooner. So many hugs.
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Just thought I'd drop a note here. I was going to finally have my port removed at my exchange to implant sx. As this was 2 years and a bit more past my BMX I felt like it was a good time. Well. I realized I was still getting magnesium IV infusions every 4 to 6 weeks. For some reason even though I take 4-6 pills a day I still run low enough they keep giving me the IV. So i kept it. It is still almost 2 years PFC and I will be keeping it for the foreseeable future. I am stage 1 but had a lot of "Scenic Detours" on my cancer "journey"! LOL so since I go and get my mag level checked every 6 weeks (or less) keeping it flushed is no problem. I keep thinking I need to get tattoos. One under the port saying PORT and one under my Pacemaker saying Pacer! So they don't mix them up. LOL of course since my port is on my RIGHT side putting Port on that would make it backwards! LOL
Much love.
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Hello! Good morning! I have been reading, y'all are bunch of toolips, love that I found this board...it's a secret GNO!
Tang, what's the radiologists' address I will go punch them in the face before my chemo today! Breathe in annnnnnd breathe all the way out and blow every ounce of stress as far away as possible. Big hugs and lots of sundaes!
Dutch I am a bit familiar with the mets scare...sorta been going through that this week. I read up on spine hemangiomas and possible mets, it's a bit confusing but for me at this point my treatment is still the same regardless...I will find out CT results today. I do NOT trust that c witch one second, in fact I got her number and I'm making phone calls! "Hello Heaven, I may have been messed up in my earlier years but I'm thriving now and wanna stay, we good?"
Monica my hubs had the same inquiry although I'm still about a year out with herceptin. He assumes I will get it out, I am hesitant but will cross that bridge when I get to it. At this point it seems like my blanket that I rely on to make this difficult experience a little easier. I realized mine is a true port as its on the left...planned it that way.
How's bluebird feeling? Where's bb? Are you healing well?
Hiiiiii Sassy!! You are a wealth of pic and port knowledge! And aaaalways on the ball thanks for that!
NJmom, for my first neulasta shots I did not take claratin but I had it available. I did not have a lot of pain but I used as needed, took an afternoon to help. Now I've developed allergies after 2nths of chemo so I take it daily to prevent the drop from irritating my throat and developing a cough.
Hi to all, have a wonderful day see ya tonight with those crazy steriods!!
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Myra remember that list of a dozen or so threads that I sent you that didn't work. One of them would have been this thread. Glad you got good news today YAY. I'm here to find my description of port removal for Spookie. I usually watch this thread, but been busy the last few days. OOOHHH falling down on my jobbbb.
Moon
funny lady, great sense of humor:)--------YAY for PORTS, saved many a vien0 -
OK, I'm here, read most of this. My PCP is the one pushing me to get it out. My original MO (thanks Humana) said if I made it 2-3 years with no reoccurrence, I'd have a pretty good chance. So far I'm 18 months.
My ? Are: if it does come out, can it go back on the same side? The other side couldn't be used because of tissue damage from rads. Is it out PT at hospital to get it out? Not an in office procedure?
It doesn't bother me, it's a "security blanket" I guess
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Spookie, I believe choices on PORTS should be made by the individual. AS you caught from reading these pages, that is really the overall belief. You can weigh the pro and con. I will write some thoughts.
1. Why is your PCP pushing you? Ask what his rationale is? He may not realize that people successfully keep PORTs for years. Please, post back when he tells you his concerns. I can surmise some, but will wait to see what his thoughts are.
2. If you have good arm veins without threat of LE. This would be a pro for removal. You have left sided SNLD, forget if you have LE(sorry). Can you develop LE on the non-lymph node removal side.Yes. It would take some research to find stats.
On this one, go to the LE threads and ask the question. Particularly, seek out KIRA or Binney4. AS Whippetmom is to Sizing 101. KiRA and Binney4 are to LE knowledge. The answer to this may influence your decision.
3. Humana MO, looked into his crystal ball and said "If you made it 2-3 years you had a pretty good chance". He was basing his statement on statistics. You aren't a statistic you are a person. Looking good---go girl. But we all know, we are one scan away from something new and different. That's why we are here. We are like the meerkats that hold onto each other to ward off those thoughts. So, from the proside for keeping it---If the PORT isn't bothering you physically why remove it. The question is totally different if it's causing pain and or discomfort. Some do have this problem. This would lend toward deciding to remove it.
4. "If it does come out, can it go back on the same side? Yes. There may be some scar tissue in the area, but the doc would be prepared for that and the dissection would be done a bit slower to handle the scar tissue.
Is there a possibility that they try the same side, and can't reinsert it b/c of scar tissue? Yes.
Ports are now being put in the brachial vein. There are some postings here of gals that have had it done and their comments. This would be a proside for removal b/c you would have an alternative to the same chest site. I would suggest googling about brachial vein sites and look at the pros and cons. "Back to the books to learn what you can
"5.Is it out PT at hospital to get it out? Not an in office procedure? I referenced on the Insomnia thread that I have responses to that on Pge 16 & 20. Page 10 and 15 (recopied) have my rant about Why PORTS are so important. As and old OR nurse and many other subspecialties. The highest degree of safety for removal of a port is either in the Operating Department or Interventional Radiology department. Doing it in an office setting doesn't allow for emergencies that may occur as a result of removal. Doc's offices are a clean setting, but how does the office cleaning procedures compare to the operating and interventional radiology departments procedures.
In the hospital, it would be done as in and out, same day, 23 hour observation. Different hospitals call the in and out procedures different names. What insurance is looking at is "not greater than 23 hours and 59 minutes"
Admission for greater than 23 hours is the unexpected.
6."It doesn't bother me, it's a "security blanket". Hey we need all the security we can get.:)
Spookie did this help? sassy
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Spookie, I a shocked that your PCP would say anything about your port. PCP's don't deal with cancer--an oncologist does. I'd get another PCP but that's just me.
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Yes Sas, that did help.
I think PCP is looking at it from a cost savings. I'm in a Medicare Advantage plan. He is arranging to have my port flush and ca blood draw done in his office. I'm ok with that for now. I really don't know why I should keep going to MO if I'm stable. And fork out the co pays. If my markers go up, or something goes wonky, then back to MO.
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I do have LE. I pretty much ignore it.
I'm still with Humana, different plan, for a non ca reason.
Humana, in their efforts to save $$, or maybe because Cigna bought their Advantage plans, dumped my original MOs entire practice. All the Florida an North Carolina offices, dumped. No reason given, no negotiation.
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Spookie, caution red flag waving. Before the office person is allowed to flush determine how she was trained. An old phrase that should remain old "See one, do one, teach one". does not apply. Why can't you go to the chemo center? Try and dig your heels in on this one. Better to have someone that does this as a daily skill, than once every 4 weeks. Use these words safety,and infection risk reduction An alternative is a near hospital. Our IV therapy RN's did it all the time.
I see said the blind man.......You'll make the best decision for you
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it will be a RN doing the flush, his vampire doing the draw.
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Spookie within the hospital only RN's are allowed to touch a port. Accessing, Drawing, Flushing. I'll see if I can locate the guidlines.
As and aside not mentioned before, when a port is accessed and the catheter stays in, usually a hospital scenario, but can occur at home. If a blood draw is done and the cath is left in the procedure after the draw is to flush with saline(get the blood out of the line ASAP), then change the cap---then flush again per protocol. Rational. If the cap isn't changed then b/c of the small crevices in the cap the blood captured there could be a breeding ground for bacteria. Often told by phlebotomists that I was the only RN they saw do that.
One phlebotomist who was very protocol/procedure oriented, challenged what I was doing. I said it was the accepted national standard recommendation and practice, and was in the hospitals policy and procedure manual. She reported it---low and behold she found it was LOL. She wasn't happy with everyone else once she found this out (even herself for not knowing), but thought I was great. Not sure if it went through channels after that and got everyone doing what was in the manual cuz I left the hospital.
This link is from an approved nursing continuing education outline: under port section it does say a technician can perform access: so, a trained non RN can do the port care.
http://dynamicnursingeducation.com/class.php?class...
Perry and Potter, 2006: Clinical Nursing Skills and Techniques, pages 930-962 is the resource guide for most hospitals, but I can't access the pages referenced b/c i"d have to by the book. Aurora Health Care Systems has their guidelines completely on line. Very well and completely written. LOL everything you may not want to know about IV therapy, but a nurses bible.
http://www.aurorahealthcare.org/portals/nurses/stu...
still searching
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sas-schatzi,
At my tx facility, located within a large medical complex including a hospital, not just any RN can access ports. They have to have specific training in doing do. At the infusion center, they are, of course, all trained for port access but when I go for a scan, I need to let them know in advance that I'll be using my port so that a qualified RN will be available. I get my draws at the infusion center so my port can be used.
Caryn
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Hello Caryn, I did leave that part out . You are correct any nurse in the hospital had to be trained by taking a class. A certification was required for PICC line insertion and discontinuing. No idea what status is now it's been 5 years(time flies)
I was surprised to find that reference that a technician could work with a port.
There was a journal on IV therapy that I was trying to locate, but I'm not pulling it up with the keywords I'm using.
Appreciate you are looking too. Please, keep looking. I feel real uncomfortable with anyone but an RN accessing a Central or port a cath. Routine in radiology centers to have techs insert peripheral caths for IV contrast . AN RN is used when available, but if unavailable the techs do it.
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Caryn--nursing consultation, please, any suggestions. I think spookie's doc is cutting corners. The nurse accessing her cath should be able to follow the procedure through till completion. Not sure why the Vampire(phelbotimist) would step in and do the draw.
SO QUESTION:
1. Do you agree that spookie should insist on knowing the nurses training and experience level before touching her port as I suggest several posts ago
2. That the nurse complete the whole procedure.
If you agree, I'm going to terminate my search. Rationale: two qualified nurses agree that accepted practice is that only trained RN's access ports for the purposes of infusing a drug, flushing for maintenance, drawing blood, and discontinuation with appropriate flush protocol.
I'm comfortable if you agree. You know me, search for the exact evidence based answer, but it's not making it self easy with this. Hey--krips someone made a simple statement on the Constipation thread that senna wasn't habit forming. Krips I did 8 or more hours on that one.
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I am not in the medical profession, so can only give an opinion based on my experience.
The procedure for accessing my port, be it for infusion, blood draw or just a flush seems to follow a very specific protocol. Clearly, it is the result of training and experience on the part of the RN's. Although I don't view my part as a fragile thing, I have no desire to have it compromised by someone who may lack the proper training. As I said, at my tx center there is no question of anyone else touching it except those who have been trained. I am very glad that they maintain this standard and agree that anyone who accesses a port should have that same training.
Caryn
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