PORT PLACEMENT - Detailed description of process
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I have a tiny little incision right above my collar-bone... about 1/4" or so. And then the larger incision-- about 1.5", running at an angle (horizontal) pretty much right below the port access. They super-glued things shut. The scar is pretty big and obvious, but is half-under my bra-strap and mostly hidden unless I'm wearing something very low-cut.
I had a light twilight anesthetic, and locals, so I was awake and chatting through the procedure. I asked about a deeper twilight, since I really didn't NEED to be awake for it, but they told me that they use less anesthetic than when I had my colonoscopy--because I mentioned that I was out for that, even if it was a twilight. I'm not sure why they use LESS than during a colonoscopy! Seems like the reverse would be true, but who knows?
I can feel the tube that runs up over my collarbone. Things stick out a little, but so far my skin isn't TOO thin in that area (but my skin is getting thinner all the time post-menopause). So things aren't obvious, but I definitely have a lump where the port is, and I can see the tube running up from the port and over my collar-bone.
My neck was sore for a few days. Not terribly, but I was definitely careful about moving it! It's possible that a nerve might have been irritated during placement, causing a bit more nerve pain, mommacat4. I've had blood draws that somehow irritated a nerve (although they claimed that was impossible when I mentioned it), and I could feel that sharp pinched-nerve feeling in my arm for a few days afterwards--so I bet that can happen whenever the body is fiddled with, even if it's just a needle poke... My neck just felt stiff on that side for a number of days. I only took Tylenol the first day and was OK the rest of the time if I was careful how I moved or positioned myself during sleep.
My port area was sensitive for a good week and more, and I'm still keeping a band-aid on it, just to pad the area, weeks later! My bra strap JUST misses it, so that was OK. But I tried driving and my port is also on my left, and the seat-belt would hit it, which wasn't fun. But I think it'll be less sensitive as time goes on, and I'll just pad the seat belt... It should be OK.
I do hope your neck pain goes away very soon, mommacat4.
Huh. Interesting about the different placement techniques! Who knew? Different kinds of ports, different placement surgeries... And of course, since people differ, even the same ports and placements can have different results depending on the person.
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I actually had my port placed during my BMX by my BS and I have no external incision at all. I had IMF incisions and he placed the port after the breast tissue was removed but before the plastic surgeon placed the TE under the pectoral muscle on that side. That is one of the reasons I still have my port - I will end up with an external incision, high up as my port is subclavian and that area is visible all the time, in everything except a turtleneck.
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let us know what you find out when you Google it because I was not given an option for different ports. When I was told what the port looked like they said it was a little round disc maybe about the circumference of a quarter and the center has a soft cork like substance to inject the chemo through. It will then travel down the catheter to the main vein in my chest.
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After having it in place for almost 3 months, the area around my port has gotten really sore and red/inflamed. I started on an antibiotic tonight, and will (hopefully) will nip this in the bud. I am just about to start my Herceptin-only phase, but with unreliable veins for IV, so feeling apprehensive.
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momma at,
Ports are implanted medical devices and as such, I don't believe we have "options" to choose which one we get. Your surgeon or interventional radiologist makes the determination based on what fits your body best and also what brand their facility keeps in stock. I know I didn't have the medical knowledge to choose a port and I doubt that many patients do
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armamp95 -- Oh, I hope the irritation around your port clears up! I think there is always a bit of a risk of that kind of thing happening. I'm always asked if my port is doing OK or not... And good luck with the iffy veins and the Herceptin. Hopefully you will be able to use your port for that with no problems.
mommacat4 -- That port description seems pretty much like the Bard port they gave me (I think it's a bit bigger than a quarter, but close enough). Apparently there are mini and low-profile versions, but the surgeon who placed mine said that it was best if people could easily find and feel the port so they could access it. He said there are problems where some ports disappear into people and they need to be found by ultra-sound or something like that (might just be a story, but that's what he said).
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I don't know what type/brand mine is but the first one was inserted in Sept '13 less than a week before my first Abraxane chemo txt. It was blocked and didn't work!...so I went the canula route until a new one was placed two weeks later. That one worked once and then I found that it had turned over
, there were no spikes to feel for. As I was on the one week break from the infusions, I would feel it while showering and realised that the thing was flipping over for some odd reason. One day it would be the right way up, the next day it was the dumb side. On the day of my next infusion, it was the wrong way up and, worried that I would be getting the canula routine with consequent bruises etc., I figured, if it was turning over by itself I should be able to turn it manually myself. Guess what? It worked!
Later, at the chemo unit, I blithely told my nurse for the day what was happening but it was alright now.....and she refused to use it!
So I had to have another three txts via canula, before going in for the third surgery to have it stitched in place.
To say I was not amused would be an understatement.
Sheila.
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Aussiesheila,
I am so sorry to hear that you had so many problems with your port. The vast majority of port installations go off without a hitch and the ports are used without a problem
Infections are always a possibility with any surgery and implanted device. It is a known risk and can happen even years after a port is placed. Again, something that does not happen the majority of the time, but not pleasant if it happens to you.
If you are unsure about the brand of your port, check out the info packet you were given when you were discharged after placement. It should include a wallet sized card with the info on your implanted medical device. In the same vein (pun intended), as far as I know, virtually all ports used in the US are power injectable but as I posted earlier, as patients, we don't chose which port we get. That is a medical,decision that we trust our doctors to make. I don't want anyone reading this thread to believe that port brand/size/model is a patient choice.
Finally, everyone with a port needs to understand that accessing the port requires a nurse (in the US) who is certified to do so. Lab techs, imaging techs, ER nurses etc. do not access ports. It's not a matter of them not wanting to or not liking to, they are simply not certified to do so. Outside of an ER situation, you can often make arrangements, in advance, to have your port used for blood draws or scans. If I need a blood draw, I make an appointment at the infusion center and they gladly do it. If I need a PET scan, I let them know several days ahead of time that I need my my port accessed, so that a certified nurse is available
Again, port placement and use go very well the vast majority of the time. Are there risks, do things go wrong at times? Yes, but that's the exception. Before getting a port, know that it's not like choosing which model car to buy and be very aware of the limitations on who will be able to access it once you have it.
I hope all of those having problems get them resolved quickly and that things go smoothly for all
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AussieShiela -- Wow. Sorry to hear that you had such problems with your port!!! I really hope they've finally fixed things and you have a working port that isn't moving around! ... I'm not sure, but I think getting them stitched down is fairly typical. Mine doesn't seem to be moving at all, anyway. I can imagine, since the shoulder joint is fairly flexible and the whole area can be squished and flattened and moved quite a bit just with the arm/shoulder moving around, that it would be easy to flip ports if they aren't anchored down a bit. I was sort of worried about sleeping on that shoulder--I still don't!--because squishing that area seems to be a bad idea (as it's not entirely healed for me--the bruises are just going away now).
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I actually asked my surgeon about the types of ports. I wanted to know what was going into me. I didn't object to his recommendation--I just wanted to see what my options were. He nicely explained that they were Bard PowerPorts, which sounded good to me, since I'd heard of them and others have had them placed, and that there were several models, but that I'd be getting the typical Powerport. I asked about the slim profile one--which was the only other ones they had on hand, and he said he usually only used those for women who were super-thin. There is apparently a mini powerport, but they didn't carry it at that hospital. One of the techs/nurses/assistants said that they had requested some to be ordered, but the front office wasn't in favor. The surgeon said if I really wanted one, they could order one, but it would take time, and I was having my first chemo in 2 days, so there was no time, so I said to go ahead. The assistant guy showed me the port (it was one of the metallic purple-ish kind of heart-shaped things with a circular shape in the center and a clear tube leading out of it). He said the smaller version really wasn't much smaller, just maybe a centimeter or so.
I just like to know as much as I can. The doctors and assistants who have good bedside manners are fine with answering questions--and most people are careful to answer patients' questions and be helpful these days (at least the folk were I was were always friendly and helpful!).
I mean--I was all too awake through the whole procedure, so they just had to deal with me chatting away (I do that when I'm nervous, and getting a procedure done wasn't exactly a calming experience).
I don't think it hurts to ask about things. They can explain why they choose certain ports over others and then you can feel a bit better about getting the right thing for you. Of course there isn't really much choice--the hospitals carry what they carry and the doctors implant what they think is best. But at the very least, as a patient, you deserve to know something about it. And you may have a reason to request something specific. You probably won't get it unless the reason is a good one and it is carried by the hospital and the surgeon thinks it's a good idea, of course--but it can't hurt to ask about it... And maybe BEFORE the actual placement day!!! I didn't have time to ask much before the day, so my choices were pretty much nil... but they said they might have been able to order a different model if the doctors agreed and I'd asked beforehand (or at least that's what it sounded like they said!).
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I still feel a little hitch in my collar-bone/neck area where the tube is going into the vein when I move in certain ways... I think that's just how it works, since the body movements pull and stretch things and the tube doesn't stretch! The surgeon mentioned something about the tube shifting around in the vein and sometimes it can stick up against the vein's wall and stop working...
Infections-- also more likely to happen because of compromised immune systems during chemo... So that's always something to watch for.
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april, interesting what you are saying about the tube can stick up against the vein wall. I think that's what happened with my blood draw on Monday, the nurse could not get a decent tube out of me. I didn't know what to do & neither did she. We should have asked another RN, but didn't & I ended up having to go back the next day. The RN that was there that day said my port seemed to be "stuck" & she flushed it 3 times & it worked. She was there yesterday for my infusion as well & she said just to be safe she would flush it 3 times first & we had no problems.
I was awake for the insertion & I'm very chatty when I'm nervous, so I think I talked their ears off in the OR!!
Here in BC, only a trained RN can access the port, no lab or imaging techs either, though at my last CT scan there was a trained RN in the imaging dept, so I didn't have to run downstairs to get accessed. Cheers, GG
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Absolutely, I agree that it is very useful to know about an implanted device. My point was, for those who are about to get a port,to let folks know that this is not really something that is chosen by the patient. I had a funny conversation in my head:
Me: I'd like one of those cute little purple Bard ports.
Surgeon: What about a Port-a-cath?
Me: Port-a-cath? No, grey doesn't really suit me.
(This was not a real convo. Written in a silly, idle moment)
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hee-heh! Well, I was sort of glad they had the Bards at my hospital. I hate to be shallow, but they are kind of cute being purple and heart/triangle-shaped like that! It's inside me so no one sees it, but I'm still glad it's kind of cute-looking!!!
My surgeon said that sometimes if the tube isn't quite the right length it can push up against a wall and won't work--so he said he was careful about making it long enough. I've only had my port used once and it was fine. Hopefully he will have got it right with me, so that won't be a problem!
I don't know if it's just thinking about it, but I'm feeling a weird little poking feeling around my port today... I keep worrying that it's going to get infected... or something! But hopefully it's just "stuff" that happens with ports and nothing bad...!
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bump
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Some ER s and hospitals DO use the ports for. IVs. .. I just got admitted for dehydration during chemo and unlike the other hospital I was at, this one is using my port and it is SO much nicer!!!
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I am surprised that so many say they don't know what port they have. I was given a card from the manufacturer (Bard) and was told to keep it in my billfold in case it needed to be used in other settings or a problem developed the Drs/RNs dealing with it would have the information readily. There is quite a bit of info on he card - the serial number, the amout of saline to be used and amount of heparin to be put in for the different activities (infusions, blood draws, injection of contrast, non- use monthly flushes) being used for. It also lists the different gauge needles that can be used and the max flow rate and max PSI.
In some ways, there are no 'absolutes' as to rather or not different facilities will/can/are set up to access ports. I have great veins so for blood draws so it's easier to just use my vein. I did have one blood draw done via my port as it was being flushed that day anyway so RN just pulled blood when she flushed. When I've had surgeries, I always tell them I have a port if they want to use it they usually look at my veins and say "No, we'll use your veins" which is fine with me. One time it was used for surgery but only because of major ssues they were having with establishing a line for someone else who needed to get into critical surgery and I was asked if I would mind them going ahead and quickly accessing my port so I'd be ready when my surgeon was. I was having cataract surgery so Sure.
Not all 'techs' can access a port but my Surgeon told me that ParaMedics can also if in serious accidents it would be the quickest/best way to get life sustaining meds in.
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someone told me that LNs can't but qualified RN can access ports. Not sure if that's true or not.
I've had two blood draws NOT from my port during this hospital stay. One was because they needed blood culture from two different sites.. the other was from a tech who said "you can't draw blood from ports" after it had just been done a number of times. I think it meant that SHE couldn't draw it from a port. I don't know why they just don't say that...
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It may vary from state to state, due to licensure, as to who can access a port. The RNs, LPNs, and the medical assistants all access ports at my oncologist's office. I have never had my port used for any surgery, or diagnostic test, including PET scans at the other, much larger, branch of my oncologist's office, even though people who access ports all day long are right there in the same building. I also received a card with the information on my port and I carry it in my wallet as well.
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Some solutions used in diagnostic tests... such as the radioactive stiff can't be administered through ports. .. which makes sense.
Policies may vary by hospital or institution too. Both hospitals I was/am at are in the same state but run by different organizations. .. one immediately accessed my port in the ER and after and one didn't. Both have oncology departments and infusion clinics...
I got the pamphlet and card too, but I need to hunt it down a and put it in my wallet...
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I've had my port used for blood draws, CT scan contrast & bone scan contrast but I usually have to go to Medical Daycare or oncology to get it accessed first. Because I don't have a good arm to use, they will usually be quite good about it, but when I get my appts I always tell them I have a port, just to give them a heads up.
I never go anywhere without my card, there are so many different ports that I wouldn't want my RN to be guessing how it needs to be accessed or flushed. And one time they said wouldn't use it without the card & the wristband, which luckily I had both with me. GG
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I was under the impression that only RN's and dr's can access ports. The only one who has ever accessed my port was the RN giving me my chemo. But I have only had one treatment of chemo so far. I also got a wallet card. I think that is handy to have.
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mommacat, I'm not sure if you were remarking about my post or not, but my port is only accessed by RN's even though I've had blood draws etc, it's not technicians who are doing it. What they do is access it and then any technician can do the injection or blood draw. I don't know if it's any different anywhere else, but where I live this is how it works. GG
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I've never had a tech do Chemo infusions (or anything associated with my port). Fhe one time my port was used for surgery, it was accessed in pre- op by an RN and then flushed and heparin block re-established after surgery by an RN. The anesthesiologist I had then was a PA. The act of sticking a needle in, getting blood flow back and then flushing the heparin out with saline before starting any infusion/draw of any kind is only the first 1/2 of using it. Once it is used/accessed for whatever reason, saline has to be 'run' through it to clear it so the heparin block can be re-established to prevent clotting. For those of us who keep our ports long after Chemo is finished, we have to go in monthly for flushes (some facilities say longer between is OK but my card says monthly and VA agrees), so mine is flushed monthly.
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kicks,
this makes since about flushing the port. Thank you for explaining this.
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Hi Mommacat and all. Please, reread SpecialK's post. It's has the most complete info.Just as with anything. It has to follow the laws and rules. Each person performing the skill has to be certified to preform the skill. This would take maybe a half day --one day of class and skill lab. May seem short, but all those being taught are in a full IV class which would be multiple classes and skill labs. OR adding this to their skill set.
Historically, when ports were introduced. Everything about them and how they could be used was different. Very restricted. Over time things changed. Individual facilities may have chosen to remain in the past for what ever reason.
The key is excellent technique.
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According to an RN (the head RN where my flushes are done) who did my flushes while my PA's RN was on maternity leave a couple of years ago, there have been a lot of changes since the early ones. He had had one of the VERY early ports for his chemo infusions many years before so he had personal experience in addition to his medical education.
Long story somewhat shorter - when I went to my last Taxol, the Rads Dr decided he wanted me,to have a new contrast CT before I started rads the next week so I was sent up to Radiology in the hospital (the CCI is 'attached to' via doors to the Regional Hospital so it was just a walk to get there. They were 'happy' I had a port they could use for 'education' so there were many there for their 'education' - if you're old enough, think of the 'Keystone Kops'. Well, it was definately an 'education'. They had no numbing spray, I had to explain to them (they asked me) what needed to be done to access. Then when done, they had no clue what needed to be done. They did call over to the CCI and were told to just leave the needle in place and they would handle doing what was neededafter infusion. One of the RN's at the infusion center is a friend of many years and apparently all sorts of Hades was brought down with the hospital's radiology.
There are different ports - some are more limited as to what can be used through them - some aren't as limited.
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Kicks CHIT. Just points out how we need to be so educated about what's happening to us. Glad all hell broke lose to correct the situation. Whomever was in charge of that clusterf**k was the wrong teacher. How somebody in that position wouldn't be constantly updating their knowledge.When you have to teach the person doing a procedure, that's the time to call a time out !
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'Cluster****' is a good term. I didn't think of it at the time - just the 'Keystone Kops' came to my old mind. Perhaps it would have been a good idea to just get up off the machine and walk out but I didn't as I wanted the scan done and get down to last Taxol so could start rads the next week.
Actually I like having students come in for procedures (with competent instructors). I learn a lot when hearing the instructor teaching them. In practicals, they have to actually deal with 'humans' - not just books and 'dummies' under supervision.
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Bump0 -
sas-schatzi, what does it mean to bump?
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When a thread has not been active (had a post to it) for a while, sometimes someone will post a "Bump" to it so it comes back to the top of the list of current threads.0
