PORT PLACEMENT - Detailed description of process
Comments
-
I based my decision on getting a port on the length and frequency of my chemo treatment which is weekly for 12 weeks and bi-weekly for another 12 weeks. Also on the fact that chemo is hard on the veins, I have enough damage, at least my veins will be ok. I also did an IVF cycle before chemo which required blood work every few days. But I knew I made the right decision when the nurse blew a vein trying to put in an IV line during my port surgery. It hurt so bad that I came very close to passing out. It was placed on Friday and I used in on Monday for the first time and didn't have to worry about not moving my arm, the worst part was the spray that stings before it numbs it. I am still getting use to it and at times it feels weird and I just try to distract myself. But its only been a few days and I'm told it gets better.0 -
Does anyone have the experience of developing skin rash as a result of port placement? I just had the Powerport installed last Monday (May 11th) and have not begun the chemo. I'm still on antibiotics from the mastectomy. The port is above my inner elbow and makes my skin very taut there. A couple of days later, the area below the port (closer to the elbow) began to develop itchy rash about the size of 1' x 2'. It gets more itchy and red over time but seems to be localized. There is no trace of bandage or anything adhesive I can see. (The Steristrips are sitting "above" the port.) Am I allergic to the port? Is it some kinda infection? Any input would be appreciated!
0 -
Treelilac, what your describing has to have an "eyes on" by your doc. You gave a great description, but a trained eye is better than any words in this particular instance.
But do track progress over time. Not at all do I suggest you have the same thing I do. But my vigilance identified that I have an allergy to polyurethane IV catheters. Teflon catheters are okay. Whether this is rare or a beginning thing like latex was 20 some years ago is unknown. My allergy was reported to the FDA as a devise problem. The point being is be vigilant.
Two statements cause concern, I will bold words or segments that are clues to my concern.
"The port is above my inner elbow and makes my skin very taut there. A couple of days later, the area below the port (closer to the elbow) began to develop itchy rash about the size of 1' x 2'. It gets more itchy and red over time but seems to be localized.
Skin being taut can be b/c of inflammation which is normal at a surgical site. The question since a vessel is involved is---does the inflammation of the area impede return flow of the vein below the point of insertion. If that were true, what you would observe is swelling below and even down into the hand. You aren't describing that as a problem. The itchiness and redness increasing below the insertion site could indicated that there is a problem in flow and a phlebitis---inflammation of the vein---occurring at that spot.
You use the word rash. That's a word that---may seem right b/c it's within your past experience, but may not apply. Itchiness is associated with a histamine release--either directly(allergic response) or indirectly(scratching). It's a chicken and egg thing---which came first. When they're is an inflammatory response mast cells and histamine get very involved.
Treelilac---girl can you see by my response the docs eyes have to see this. I'm happy for you it's not Friday afternoon at 5 O'clock. But I'm guessing since your post was written 18 hours ago, you've already been seen?
0 -
I wrote this a long time ago----------perhaps I should revise it so it isn't ranting. LOL Maybe I did and forgot. The IV info is still valid. This post is moved here from page 15 of this thread.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.
--------------------------------------------------------------------------------------------------------------------------
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.
0 -
Sas-Schatzi: Thank you for a wealth of information!! I think you're right!
I had an appointment with the PS yesterday so I asked him. At this point, any doctor's advice is welcome. He thought it was an infection but also briefly mentioned internal bleeding. He switched the antibiotics in case it's an infection and wanted me to call the BS.
My BS asked for a picture and the nurse then suggested heat compression, which made it worse. Switching the antibiotic didn't make any difference either (at least 12 hours later until bedtime). In desperation, I took Benedryl, which the nurse approved during our conversation. I also took regular Tylenol instead of the ibuprofen they gave me in case it's the bleeding. For good measure, I bound the read area of my arm with athletic wrap.
This morning the redness has largely subsided except being somewhat still itchy.The nurse called back today and said the BS didn't think it's allergy (I told her your insight). She wants me to continue on the new antibiotics. Sigh.
0 -
Treelilac how you doing. I've been sleeping most of day b/c I stayed up all night.
Did they have an IV in the elbow area while they were putting the port in? Sometimes they're is b/c they can't get one anywhere else.
It takes generally 24 hours before you see if an antibiotic is working. It starts working earlier on a cellular level. We just aren't privy to that.
Heat compresses making it worse--can go both ways. So not much help.
When the PS said about internal bleeding. What he's really saying is that there was bleeding at the time of the insertion. If they're was active bleeding even from a small capillary for as long as it had been since your first to your last post, the area would have been very distended. But not unreasonable to think of the bleeding that occurred during insertion. That bruising should be starting to turn colors if that's it.
Simple inflammation should be starting to reduce.---Sheesh girl SORRY. I should have told you to elevate, minimum above heart level. Better if you can get it higher. Pump the hand---open and closes hand. This will help reduce swelling.
Put a dry cloth over the upper arm and elbow. Use an ice bag 20 minutes on 20 minutes off. Will help with itching and swelling
Check in when you can
0 -
It has been five days since I had my port placed on my left side, my recovery went fairly well, apart from normal stiffness and pain when moving, getting up, etc. Now it is finally hitting me that this thing will be inside of me for quite a while, I have six months of chemo. I am experiencing freak outs and panic attacks. I'm fine most of the time, then I get reminded of it, or get a weird feeling, like a change in blood flow, weird breathing feeling, not sure. The problem is worse in the morning when I just wake up and the first hour or so at work, so I'm wondering if it has to do with going from a laying position to a standing position. Its placed on the left side, which means it goes into the heart, is that right? I really wanted them to place it on the right side, because the thought of it being near the heart kind of freaks me out. And I was told that being on the left means the chemo has a longer way to go before it gets pumped out into the body. I noticed when I had my first infusion with the port that the fluid coming down out of the IV pumps up and down as it goes in. Is it really safe for chemo to go that close to the heart. I'm doing Taxol right now, but I'm more concerned about AC.0 -
sas-schatzi, you pretty much covered the whole understanding and most questions about ports. Thank you for that.
Crs003, the tubing that comes from the port does not go directly into your heart. It goes into the artery next to your heart. Either way chemo is tough no matter how it is administered. And Adriamiacin is very hard on the heart. When I was on AC my heart rate and my blood pressure went up. my MO requested 2 EEG'S for me and I only had 4 rounds (every 2 weeks) of the AC cocktail. Then 12 rounds (every week) of Taxol. I am still on Taxol but I am dealing with neurapothy in my hands and feet because of the taxol. I have had to delay 2 treatments because of it. I just got measured today for my radiation therapy which won't start until I finish chemo. Then at some point my MO will put me on Tamoxifen for the next 10 years.
Have a good night ladies
0 -
I think even Benedryl now is not enough anymore. Red dots begin to show on my neck, abdominal area, shoulders, and the opposite elbow. The elbow where the port is is still red and redness has expanded. It is definitely allergy. This sucks if I need to repeat the port surgery again for a different port.
0 -
Tree, call your doc. Please, you are now having systemic symptoms versus localized at the elbow. Situation is now more serious . I can't see what you are describing, but doesn't matter. You are having a condition change that you shouldn't ignore. Call your doc.If throat tickiling, tightness, chest tightness , or difficulty breathing-----call 911. Do not drive yourself to the hospital.
Tree , I c&p and sent you a PM
0 -
Tree, watching and waiting for a response. Don't assume allergic response, it could be a bacteria. If it is a systemic bacteria you need to move fast---real fast
0 -
Okay Tree contacted me by PM. She's on her way to see her doc.
In Tree's case. She had localized symptom----itching & redness below insertion site. Swelling at insertion site. The swelling at insertion site can be normal tissue response. It also can be abnormal. The redness and itching below insertion site is unusual. The docs responded by changing the initial antibiotic.
What is now happening is she has systemic symptoms/signs as manifested by raised red spots over the torso, neck and opposite arm. This signals a condition change from local to systemic. Systemic means that the whole body is now involved in responding to whatever is happening. Plus, she identified that the area of redness around the catheter is expanding. Her description tips more to a bacterial problem versus an allergic problem. This can only be diagnosed by a doc.
BUT------the KEY is they're is a significant condition change. When there is a significant change in condition having the docs eyes on the problem is the safest approach. If the doc isn't available. Then a trip to ER is the next best and safest approach.
Tree's nurse said she would try to fit her in sometime today. In her scenario you can see from her posts that her symptoms are escalating. This becomes the time that a decision needs to be made. What do you do? If you ask yourself a few questions, it may help make the decision. First can this be life threatening? A "Yes" or "I don't know" flips your action towards telling the office you are on your way to be seen or going directly to ER. Can this wait six-eight hours to be seen? When the signs are changing almost hourly--no. >>>>doc or ER.
Hope this helps. Let me know if something's not clear. sassy
0 -
Thanks Momma---I really should take out the rant stuff---It's distracting from the rest of the post. What's your opinion---take the rant statements out or leave in?
CRS---The catheter tip is in the Superior Vena Cava. It is not in the heart. Read my pervious post above about ports and peripheral IV's
0 -
crs - mine is on the left also. It's been in for 8 weeks now and I do notice some pressure in my throat at times (I think where the tubing passes nearby) but for the most part I don't even notice it anymore. I remember reading people say that right after I had mine in and didn't see how that could ever be possible but it's true, you will adjust to it both physically and emotionally. And the benefits are so great that it's worth the occasional small discomfort - I see nurses struggling to get IVs into at least one person every time I am at chemo and I'm so glad I'm not having to go through that anymore.
0 -
sas-schatzi -- Keep the rant in. It's very informative!
Great job with treelilac. Sometimes there's a reticence to calling 911 or going to the ER--but that can be more dangerous than people realize. Better to be safe than sorry. I hope treelilac is doing OK.
Thanks for the diagram, too. Very informative!
molly1976 -- My port is on my left, too. I used to be more aware of it, but now it's been in since November and I'm almost used to it! I mean--almost attached! My BS asked me if he should take it out, now that I'm done with 18 weeks of chemo, and I said, NO, since I have a year of Herceptin every 3 weeks. I mean, it's not as bad as chemo, but I am still recovering from chemo and get dehydrated, so that shrinks my veins... I've had an SNB now so they don't want to access my right arm... I just would like to spare my left arm as much as possible. And even if it's not the reason to get a port-- it is SO much nicer to have my arms free while sitting around for 4 hours or for 3 hours... Or for all that long time I had continuous IV drips (24 hrs, 14 days at a time) !!!
0 -
I can't believe the damn doc's nurse said she would 'try' to fit her in. I think she should be at emergency or just go straight to the doc's office. This could go anywhere fast. Sorrry to rant but it is so careless of the doc.
Keep us posted sas.
0 -
Thank you for the support!!
So I went to see her and my BS said my port area had cellulitis and the rash was from allergy to the second antibiotic my PS gave me. I sure hope she's right!0 -
Hi folks, Treelilac and I Pm'd several times. She saw the doc in AM He diagnosed cellulitis at the port site and the red bumps as an allergic reaction to the antibiotic. The BS actually had a ultrasound in the office--impressive----she looked for pus pockets >>found none>>dx cellulitis.In PM I explained the two types of cellulitis. Linked to a thread that I did allot of work on wound /incision care. Requested she outline the cellulitis area. Requested she monitor temp q 4-6 hours for the next few days. Elevation with hand pumps as describe in above posts. If it was a closed wound which it is not----warm moist compresses would be great, but not good here.
She was thankful for the help and I was happy she so quickly went to the doc. i.e. didn't wait for an appointment just went and said she was coming to be seen. Yes, my suggestion, but she got the concern and acted on it. ER was discussed.
Relief, I was nervous about her presentation........Worst case scenario I'll keep to myself. I'm confident based on our exchanges she knows what to report and look for(evaluate). I'll link the wound/incision thread, it wasn't my thread, but they're is allot of info that I added.
You all apparently have been following. Continue to follow. I told her I'd be watching , but I think it may be another sleepless night. Which means tomorrow is a bed day. She may need someone to bounce thoughts around with.
I'll bring back the wound/incision link and you can store it away.
https://community.breastcancer.org/forum/44/topic/754935?page=1
0 -
Awhh there she is,
Tree questions? I was typing------Your question was she right. The hard answer is only time will tell. Watching site closely is important. Believe it or not the elevation and hand pumps could turn the situation around
0 -
Think of cellulitis as a logjam. More logs keep piling on the water can't flow. The water becomes stagnant. Stagnant water is a breeding ground for critters(bacteria). By elevating and pumping the hand that promotes flow by gravity and minimal but effective force. Clears away the logjam and the river flows well.
When I said they're are two types of cellulitis----it's really several stages--- early stage is inflammation of area with no redness --normal response to tissue disruption or manipulation. Next phase starts to get pink, can be itchy--the body is trying to fix it. Congestion around cells starts to interfere with lymph pick up of the debri thrown out of the cells. the area needs help--elevation, pumps, and ideally warm moist compresses when allowed.( Not Allowed here). Increasing lymph congestion can start to get really red, to deep red, to purplish.--not good. At this point when it gets into the red phase the concern starts to be whether bacterias starting to grow.Early intervention is the best---Elevate, Elevate---Pump to the Music
0 -
Tree, you've learned allot today. you read the w/&I thread stuff. Everything we talked about in PM's. Do you feel you have a good sense of what to do and look for? If you see a worsening call her with your concern.
Did anything get worse since you got Home? I'll check back in a few minutes. Then need to try and sleep---not likely, but need to try0 -
sas-schatzi, leave the rant in. It think it makes your point a lot more important and meaningful to all of us other ladies here on this post. Besides, it shows us your personality and that is a good thing. Thank you for all of your wonderful knowledge and personal touch....lol
0 -
Tree I will check in in the morning You got the know how to deal with this now-----it's better than not having some tools. Do what you can control elevation and pumping---keep hydrated------- Night Hugs sassy
0 -
The cellulitis does get better throughout the day before I even have a chance to switch to yet another new antibiotic. I guess the antibiotic from the PS works (except for causing allergy). The rash is treated with hydroxyzine. The strange thing is that I've been prescribed amoxicillin before; now I suddenly develop allergy.
0 -
Momma and April---okay two votes the rant stays---I'm easy LOL. Truly I looked at it too. Doesn't carry the same message without the rant. I reacted to the posts where the message was" it's for convenience". They're were several posts over a short period of time. Ta da rant. I did offend one person with it----she never has forgiven me. Momma Thanks ---good
Night
0 -
tree, I agree with sas-schatzi, you need to see a medical professional for your rash right away. I am no nurse or anything but I have dealt with the medical professionals enough when taking care of my mom for many years before she passed. She once got cellulitis in her legs (she was wheelchair bound) to the point where her legs had to be wrapped in bandages multiple times a day because they were actually leaking the infected fluids through the skin. It was nasty but I had to change the bandages and her legs hurt so bad.
Anyway, please get checked out. You go through enough with everything cancer has to dish out to us. There is no need to suffer from anything.
0 -
tree, maybe the antibiotic is interacting with another medication you might be taking. Are you going through chemo? Maybe it's interfering with that.
0 -
Momma--Tree did see her doc yesterday morning0 -
sas-schatzi, oh, sorry I must have missed that in the conversation. Thank you for updating me.
0 -
Okay donkey noproblemo0
