PORT PLACEMENT - Detailed description of process
Comments
-
thank you so much for that. I get mine tomorrow morning. Lynn
0 -
Ly5, hope you check and to let us know how you did
0 -
Thanks for the great info!
I am scheduled to have my echo done on the 20th and if all goes well, my port placement is the 21st.
0 -
bump
0 -
Thank you so much for the description. I am scheduled for Monday and feel much better now that I know what will go on. Blessings
0 -
Good Luck MRSR--pop in if you need help
0 -
Has anyone had a port put in after starting ac? I have had my first round and veins aren't too good. Should I be worried about infection? Help.
0 -
Teena, thank you so much for this detailed description. I am supposed to get a port in the next 1-2 days and had no clue what to expect. I think I may opt for just the local anesthetic too. It helps me enormously to know what to expect!!
0 -
I'm scheduled to get a port on Monday. My MO didn't think I needed one, but sometimes the IVs go in OK, but other times I've got tiny, rolling veins so that several techs had to try for various hands and arms and were thinking of neck before someone finally got an IV into my hand! SO one time out of 2, IV was not easy. (Of course, I was probably freaking and dehydrated that first time, which didn't help.)
I'm going to be getting my first Chemo 2 days after! I'm doing neoadjuvent chemo, TCHP for 6 cycles... so I think getting a port will be best.
BUT... they told me "Oh, radiology can get a port put in!" -- no surgeon?? That made it seem like a simple thing, but after reading about the whole process and possible things that go wrong, I'm not worried!
If it's my RIGHT breast that has the cancer, will they put in my right side or my left? Or does it matter???
0 -
April,
We meet again! The vast, vast majority of port placements go off very smoothly. Any time you have any type of surgical procedure, there are risks, but with ports, it's pretty minimal. Also, keep in mind that more people post about things when they don't go well as opposed to when they do. Please don't worry. Even the worst possible complication, lung puncture, happens only 1% of the time. I know, because it happened to me but I still love my port and think they make bc tx so much easier.
I forgot to add, is it and interventional radiologist putting the port in? I think they do that.
0 -
April, I have found that one of the best canula/needle inserters is a young woman in a particular radiology practice. Before that it was an older guy in another one. I don't know how they teach them at the radiology schools, but they seem to do it better than a lot of Drs and nurses. I have a port now and wouldn't be without it after all the failures beforehand.
Sheila.
0 -
Hi, April Your choice of a port is an excellent choice. In hospitals that have Interventional Radiologist, they are an excellent source. The whole focus of interventional radiology is they are 'sticking' something all day long. Ports, stent, lasers, various caths for different procedures. It's their daily job.
But before that subspecialty was available surgeons did the procedure. Could be the breast surgeon. A general surgeon. A chest surgeon. The key is the training. A medical doctor or a nurse would NOT be putting in a PORT because in is a central procedure that requires a higher skill level.
A medical doc and certified nurse can put in PICC lines. A PICC line is placed in an arm. The skill level is less than a PORT. The reference that Aussie made re: a young woman doing the stick was better than they others. 1. It had to fall under her licencesure . 2. she had to receive special training to perform the skill, usually evidenced by a certificate of completion of a program of training. 3. She would not be doing Ports or central lines at least in the USA.4. Each country establishes the rules covering their licensed workers.
The days of OJT -On The Job training have passed.
PORTS are the best thing in oncology care since, oncology chemo care started. ONE reason they prevent the destruction of veins.
BBL going to find something---found it. April this next post was a rant when several people in a short space of time had been told that PORTTS were for the convenience of the staff. It's a bit strident. I have thought about making it less strident.
I have left it as is b/c a person that runs into someone espousing misinformation may actually convince someone of the wrong reasons ports are used..
Each section describes the accurate surgical/medical reason ports are so important.
If you read my posts from about pg 8 on there are other suggestions re: the total pre, during, post insertion activities and expectations
April I'm a retired nurse. I don't know everything, but have been involved first hand in many areas of nursing over 40 years
Exb has given you great advice. If you go back and read she has many posts with lots of good advice. TB57 hasn't posted since 2009, but her topic box is as good today as when she wrote it. The only difference might me the IV antibiotic
We will watch for questions and post insertion report----------sassy
Naw going to clean it up some---it even irritates me
0 -
Nov 27, 2012 11:55AM , edited Dec 31, 2012 08:03AM by sas-schatziThe 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. EDIT12/12/2014 I decided it was time to take out all the ranting stuff :)sassy.
--------------------------------------------------------------------------------------------------------------------------
Anyone espousing that a port was for convenience was never trained properly regarding IV therapy and the indications, contraindications(not to be used), and complications of there use.
Ports were developed because veins were getting fried by chemo. Fried is a slang term. The medical term can be phlebitis, hardening of the vein, collapse of the vein, withering of the vein.
When I say fried, chemo can cause the smaller veins to react as if they have been burned. They become hard, close up, and are not useful anymore for the flow of blood or insertion of catheters.
Chemo or other drugs can leak out of a vein into the surrounding tissue. This leak into surrounding tissue is called infiltration. Chemo's that can cause tissue death are called dessicant chemo's. Chemo's that don't cause tissue death if they infiltrate, can discolor the tissue for a very long time. I had Taxotere and Cytoxan infiltrate. I have an area that is still discolored 5 3/4 years later and the veins in that area are useless. I was refused a port even though I told them my veins were difficult to find and small.
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 you may NOT have veins available for future use, thus putting you at risk in lifethreatening situation b/c of no immediate access. In an emergency, the first IV site try is in the arms. If they can't be cannulated the doc/medics go for the external jugular or femoral. This problem solving eats up minutes in a critical situation. 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 from the previous chemo damage.
Reason for PICC's, Centrals, and Ports are 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 vessel loss.
For completeness, I will describe why Anesthesia doesn't use ports/centrasl etc. Anesthesia Docs or CRNA's, prefer arm veins, in administering anesthesia drugs. They will only use Ports, centrals or PICC's as a very last resort. The reason is hospital protocols require that Ports and Central lines be on IV pumps. 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 patient should be watched for several weeks post- op for phlebitis after having a leg vein used for an IV.
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. Drugs arriving too fast at the heart or central nervous system(CNS) control center can cause the heart or CNS to NOT work right. Plus with the arm veins, the patient is positioned so that anesthesia Docs/CRNA"S can visualize the insertion site to assure that infiltration hasn't occurred.
Equipment has now been developed to allow Anesthesia docs to use the ports and central lines during surgery. Over time all Operating Rooms will have this equipment.
In answer to convenience of use of centrals/ports/piccs ---yes, they are incredibly convenient for the safety of the patient.
When an IV site is ordered by the Doc, it is b/c of what I have written above. Right route for the right reason.
If your doc refuse a port for chemo and you want one, stand your ground.
The first consideration for choice of route of administartion of an IV therapy drug is SAFETY. NOT CONVENIENCE.
0 -
Wow. Thanks for all the info on Ports, sas-shatzi. exbrnxgrl has been fabulous about talking me through all this, too.
It was odd that my MO wasn't for a port... but I think it's all part of the game KP and other health-care providers are playing. Once my MO had the outside 2nd Opinion in his hand he immediately approved EVERYTHING! Port, more scans (although timing is bad because chemo coming up), even the Perjeta for the TCH he had already suggested. I think he NEEDED a reason to justify things that weren't normally recommended by KP (which is healthcare provider and hospital in one--so interesting dynamic).
I need the veins I have. they aren't big or easy to access! That was the main reason why Ports sounded like a good idea. And all the other considerations just cement it! Thanks SO much for the great information!!!
0 -
April,
I am so glad you're feeling more settled about things. The port surgery is very easy for most folks, so don't stress. As far as KP, might I suggest it was your particular mo who was resistant to some things and just used KP "policy" as an excuse. The reason I say this is because both my original and current mo's ordered whatever was medically necessary and there was no quibble over anything. The same goes for my plastic surgeon and every bit of care I've received. I do like that they don't do lots of unneeded tests and save the big guns for when they're needed as this parallels my feelings on health care. I know some people are not comfortable with this and I know a woman (not with bc) who said they were awful because they wouldn't give her antibiotics for a common cold. Ironically, I did not want a PET because of unneeded radiation exposure. About 6 weeks after my bmx, I had a PET for reasons unrelated to bc. That reason turned out to be nothing, but my very unlikely bone met was found. Go figure that an indolent grade 1 bc would have metastasized. Everyone was quite surprised and my whole txplan changed. In my fourth year now and things are pretty normal. What a trip!
0 -
I'm so glad you'/re hanging in there exbrnxgrl, and taking your time to help newbies out, like me.
I didn't think I needed the PET, but 2nd Opinion guy says it's important because of no SNB or other tests like MRI for both breasts and brain MRI and Bone scan before the chemo. I'm getting some of those AFTER, but chemo might have messed with things a bit.
My MO says, now, OK to PET, but KP might not be able to fit it in before Chemo. I might have to pay for it myself... have port done down here, go an hour up to LA, for PET on Tuesdays. Come back down here for Chemo... and Radiologist appt after.
I feel like one over-booked person at the moment!
If MO had been open to all from the start, all this last-minute business or after chemo business wouldn't be happening... I was thinking things were going OK at KP, but now I'm back to wanting out! This is all too much on top of getting used to the idea of having cancer.
0 -
PORT placement -- I missed the call from the person who was going to go over what I am supposed to do before the Port Placement early this Monday, and now it's late and the weekend has started, so I think I'm out of luck as far as getting another call.
Does anyone remember what the instructions are before going to get port put in? When I made the appointment for the procedure, they told me: No EATING from midnight the night before. Certain meds I could take but only with a sip of water. And check in early. Anything else?
----------------
Also... I may need to drive somewhere that night, after the port placement, in order to make an appointment for the next day! Do you think I should get someone to drive me that night, or if I feel able, just go for it? I guess it really depends on the reaction to the procedure and the anesthetic... I last had twilight sleep for a colonoscopy, but I can't remember how able I was to do things later that night! I was OK... but I just pretty much slept the rest of the day!
0 -
April Hi, yes you need a driver... you may seem right, but with the twilight or anesthesia you are given VERSED. It is a benzodiazepine. It's beautiful characteristic is amnesia and a luscious relaxation. Bottom line you shouldn't drive for 24 hours after versed. You are considred to be--- Driving under the influence of a drug.
What's this -------why a PET before? Don't do anything that you have to pay for. This isn't going to be solved in a day. Wait on the PET. Learn the ropes. Always get pre-approvals. Something's not right. Don't let the second opinion chase you into costs that don't have to be. Re -ask second opinion for clarification. Look, never heard of chemo messing with all the MRI, CT's Nuclear Scans-----------get clarification.
Unless someone comes along and says I'm off base and why. Settle down. Get your port. Go through APPROVED scans with confirmation number. Always the confirmation number-------------don't set yourself up for financial failure by not following the rules. I know you are panicked by this, we all were. Slow down, lovey. One thing at a time
Two threads to put in your favorites
https://community.breastcancer.org/forum/5/topic/748296?page=1
https://community.breastcancer.org/forum/69/topic/706846?page=1
0 -
sas-schatzi -- Thanks for the links! I've added them both to Favorites!
PET scan craziness... My 2nd Opinion Oncologist recommended it. My MO approved, but said radiation is too high in PETs, so I let him take it off the table. THEN 2nd Opinion Oncologist said that since I wasn't getting an SNB or any MRIs or Brain Scan BEFORE Chemo (which were all things he recommended, and MO approved, but there was no time before my scheduled Chemo!!! So 2nd. OP really insisted that I at least get the PET. But port placement was scheduled Monday and Chemo Wednesday--and I could get a PET through my provider, but only AFTER 1st Chemo... UNLESS I delayed Chemo and port. Paying for PET, I could do it before Chemo... but after Port. My provider said just after Port would not work. I'm not sure what 2nd Op thinks about this because I didn't know about the "not after Port" deal!!! SO.. STILL up in the air with unsettled business!!!
0 -
April,
I tend to agree with sas and still don't understand the urgency of a PET scan. She is a very knowledgeable woman with a professional medical background. Why expose yourself to unneeded radiation and perhaps, great personal expense, when you don't have to? My understanding is that PET scans can cost upward of $3,000, depending on how much of your body is scanned. You mentioned that your second opinion doc was "fancy", but ordering every test in the world doesn't make one a superior doctor. Part of treating bc, or any disease Iimagine, is not over treating or over testing. I do think you need to slow down and get yourself out of the "more is better mode". This is just my opinion and ultimately you need to go with what you feel best about. Take good care.
0 -
I think I wouldn't go for the PET if I actually had some other tests done before chemo. Not having a SNB, or Breast and Brain MRI first was making me feel nervous. I only had a abdomen/hips CT and MUGU (which I haven't seen results from yet), so quite a lot of me wasn't checked. If there's lymph spread, I want to know.
I think because the mammograms didn't find my cancer, and I had to find a lump myself, I'm just feeling under-scanned, if you know what I mean? If basic scans had actually worked for me to begin with, I might feel OK with fewer. But now I want to be double-sure. I do feel the 2nd guy is being ultra-thorough, but I kind of wish someone had been a bit more thorough with me to begin with, and maybe my cancer would have been found at an earlier stage...
But I do agree that tons of tests aren't called for, usually. It's just--what if there's more things that haven't been caught?
I know it's my paranoia, but I'm getting conflicting opinions, from doctors and friends and people with bc.
I just talked to someone who the American Cancer Soc. matched me up with, who said she's been talking to others with bc and is a 7 year survivor, and she said to go get the PET.
I'm still trying to figure stuff out. I guess, down the road, I'll figure out whether it is a good idea or not, or whether it doesn't matter... I really don't know...
0 -
April,
You can't compare various tests, whether screening or diagnostic. A screening mammo is a very different thing than an MRI and that is different than a PET. Screening mammos are ok, but not a perfect tool. Many women were diagnosed with bc after clear screening mammos. Could other tests have been done? Well yes, I suppose, but realistically you cannot administer every test to every patient on the off chance that something might be found. It is just not economically unfeasible , but the tests themselves often present risks to the patients.
Opinions and advice, whether from friends or doctors not only seems conflicting but is! Treating bc comes with no absolutes, no clear cut treatments and certainly no guarantees. Look at me, an unexpected stage IV, never had chemo, rads to bone met only and an AI only. I'm in my 4th year since dx and lead a virtually normal life (family, work, travel etc). Others who were lower stage, may have had more aggressive tx, better prognosis etc., have been far more impacted by this disease. Why? We simply don't know. I wish I could supply the answer, but this is a good illustration of why advice and opinions can differ so much. There is no one "right" way to go. You do your research and then go with what feels right to you. In doing that, you've done your best and that's all you can do.
0 -
Exbr that should be the opening statement to all newbies. Then we tie them done give then a massage, a new doo, mani&pedi, aroma therapy, tickle their feet with a feather, biscuits an cocoa. Finally chocolate, that should get them on the right path.
0 -
You do need a bone density if it hasn't'been done in the last two years. Lots of the drugs affect bone density.
Did your docs get your immunizations up to date?
0 -
Bone density... is that different from a Bone scan? I've never had either, but I really should, to establish a base-line and see if any osteoporosis is happening...!
0 -
YES - a Bone Density Test is different than a Bone Scan. The Bone Scan is to look for any possible mets to bones; a Bone Density Test is get a baseline as to where you are in relation to Osteopenia or Osteoporosis or to keep up progress of it. I've been having them annually since I was 50 because I have a huge family history of osteoporosis and went through natural menopause at 44. I was Osteopenia for years and did become Osteoporosis after TX but it would have happened anyway with time. Fosamax is keeping it under control.
I had fulll body Bone, CT, MRI and PET Scans before neoadjuvant chemo so that the Drs had as much info as possible to fight the Monster. The PET lit up on an area along my lower jaw for which I immediately had a biopsy - nothing there of any worry. PET Scans will 'light up' on any area of possible inflamation, no just cancer. In the years since, the only Scans I've had were for limited areas when my PÀ felt it best to be sure that 'nothing' was going on.
Opinions' are just that - what 'someone' thinks. There are no guarantees for what tomorrow will bring for anyone. Don't try to 'over think' things. We each have to do what we believe is the best for us, which is not the same for all.
0 -
Kicks -- Thanks for the explanation. There is so much to learn about with this diagnosis! ...and about all the tests and scans. I'm 58... I guess I should get a Bone density test at some point... Sooner rather than later, I guess? I hadn't really thought about it, although I know that osteoporosis is a big problem as we get older.
0 -
Forgot to add - a Bone Density Test is basically an X ray of the hip area, a Bone Scan (at least all I've had) are nuclear.
0 -
Thanks, Kicks!
Well, I'm heading to the Medical Offices/Hospital for my Port Placement, now. Hopefully it all works out well!
0 -
Morning all. April, Kicks explanation of a Bone density is most accurate. It is a non-nuclear low radiation test to check for osteo. It IS the one universal test that should be done before or near the beginning of chemo. Most of the chemo drugs will lower density. Two in particular,the steroids and then the AI's. Tamox does too, but you won't be getting that.
The bone density is the most often missed test.
Your probably too late to be caught up on your immunizations. But it's worth the question. Pneumovax, flu, shingles, tetanus. Any others that might be a problem in your area. There is a time limit before chemo. Find out when you safely can get them. Your fancy MO and MO should have had them on the top of the list. The reason each should be caught up on immunizations is the chemo will reduce your immunity. In a reduced immunity you are more susceptible to these viruses and bacterias.
The other tests are debatable as to timing. But make sure you get insurance approvals otherwise you will be saddled with allot of bills. Chemo will not cover up a mets. Waiting on a PET isn't going to change things if you get chemo started first.
FYI when a radiology/diagnostic imaging test is ordered always ask what it for and what type and does it expose me to radiation? Is their another test that can be used that will not expose me to radiation. This is very important.
Just even in the last few years there has been a strong movement to move to test that expose us to less radiation.
Please, use those links I posted. They will help you keep organized.
sassy0
