PORT PLACEMENT - Detailed description of process
Comments
-
Thanks, all for the info.
I don't think the doctors were going to take the port out in their office... But maybe were wondering if I wanted it out asap... But so far, I don't want it out. I've got the year of Herceptin to do. So maybe next spring/summer I will get it out...???
My veins aren't great, so I'm glad to keep my port in for a while. It definitely makes things easier.
Interesting that the ports can be kept in for many years...
0 -
April, I wrote a bit of a ranty thing awhile back. about nurses saying to their patients they haven't got good veins and in my last post I'm doing it to myself. UGH.
Some folks are physically uncomfortable (i.e. pain) with the port b/c of the positioning in the body. In that circumstance getting it out asap after treatment is no question the best thing to do for them.
Some folks it's a direct connection to cancer. Getting it out asap after treatment is effectively them asserting control over this connection to cancer. Port out, cancer gone, on with my life sort of thingy.
Some folks know that even under normal circumstances access isn't easy. I fall in this group
From a reinsertion standpoint in a future time. Can be difficult. Can be impossible. Can be easy. So many variables. Each of us, after knowing the facts, makes a decision and hope it's right.
0 -
is it really sometimes very hard to put it back in? That s an interesting thing to consider. I was so afraid of the port, but now love it so much I have no plans to give it up until at least I'm done with my year of herceptin
0 -
Scar tissue forms whenever skin and tissue is disrupted. If the tissue is scarred, it can hinder insertion. Absolute, no. Potential, yes.
We've all seen external scars. When tissue is cut internally scarring occurs too, but the term used to describe it is 'adhesion(s)'. The body is fine tuned to protect from injury. When membranes are breached a whole chain of events occur to protect the body. Scar/adhesion development is different in each person. Some bodies overproduce in a response to a breach. Scarring /adhesions can be trouble for them. An example of a body overproducing when they're is a breach is a Keloid. Very often surgeons will ask if they're is a history of keloiding when they are doing a surgical work up. PS's are real careful to get this kind of history. Some people develop an overabundance of internal adhesions, so that their tissues are all glued down together.
Scars have no blood supply. Scars are not elastic like normal skin tissue. The tissue matrix is destroyed. When surgery is being done, a surgeon will never choose an incision site that is scarred. If they want the incision to be in that location, what they do is cut the scar out. A cut on either side of the scar, then underneath. Total removal. Undermine the tissue a bit. Pull the two edges together. LOL did you really want to know that?
Sutures or staples in scar tissue will rip out with movement, or simply fall out. The matrix doesn't support them
Internal scars 'adhesions' may never be known as a problem UNTIL the area is re-entered. This is encountered by the surgeon after cutting in. Then they have to make do with what's presented. Can it cause a surgeon to back of a surgical site b/c to much scar tissue/adhesions have formed? YES. If they are presented with so many adhesions, it can change the surgical plan.
I'll link to Wiki. It gives a detailed description.
https://en.wikipedia.org/wiki/Adhesion_(medicine)
Trej--let me know if you want more..........
0 -
Hi ladies,
I'm kind of a basket case here. My MO scheduled me to get my port out only 6 days PFC. I am very concerned about possible complications, such as the hole in my vein where the catheter went in not closing or the clot blowing off, and having an open wound on my chest, or getting an infection. He said my blood work looks great, so nothing to worry about, but I am very scared of bleeding to death. This is because it almost happened to me after my MX...they nicked a vein and the clot blew off almost a we later and I lost 3 units of blood. At that time, I was taking way too much ibuprophen, on bad advice from my discharge nures, so I know that's what caused it, but I'm still scared. Any advice would be much appreciated!
0 -
Little blue working on an answer. Hang in there.
First. Little blue read back a few pages or even further and scan for removal posts. I am seriously biased for keeping them awhile. But I accept not everyone has the same thought. I'm working on the rest of the response. So, check back.
0 -
no I'm good. That was very helpful and something I hadn't thought about.
0 -
Littleblue, sorry you had a bad experience. Tell me what the nurses instructions were? Did it correspond to the docs written instructions that you were given at discharge? Did you read the docs written instructions? I have a specific reason for asking.
Where is the removal planned for? Operating room, procedure room in a surgical facility, office. If you've read anything here, you know I'm not an office fan.
Being a basket case can work for you in this case. How to make it work for you? Voice your concerns to the doc. Statements that may sway him to get you into an OR setting. "My anxiety is very high b/c of the complications that I experienced after surgery."(You said this , I cleaned it up. Keyword is anxiety) State any symptoms--examples--loss of sleep, crying, nervousness, emotionally flying off the handle. Your anxiety is a reason to have minimum versed (Benzodiazepine). Sometimes referred to as a twilight sleep
"I'm scared of an infection". Tell him you want the highest level of protection from an infection. My bias as an old OR nurse is an operating room. Hospital procedure rooms are acceptable. Specifically, b/c hospital cleaning people are trained to decontaminate OR's and patient care areas to standards that are determined by external sources like the American Hospital Association and JACHO. Doctors offices, they do what they like. Smart docs have professionally trained personnel to clean their offices with the proper decontamination products. The local mom and pop second job night workers with Walmart cleaning supplies, doesn't cut it with today's superbugs.
"A hole in my vein where the catheter went in not closing or the clot blowing off, and having an open wound on my chest". Several issues here, but talk it through with him. Shoot for the OR.
Now, wherever it's done you have to have prior authorization from insurance. Because this is an elective procedure definitely don't jump the gun. If you and your doc decide the OR is the right place and insurance won't approve it. Appeal. The doc will have to write a justification. Work the problem until you are satisfied.
Post procedure. Follow his written instructions. The nurse shouldn't vary from his written instructions. But until I hear what was said and what his written instructions were, I can't advise. The doc may have blamed it on the nurse. She may have done nothing wrong.
Pre-op discussion as to what meds and supplements to stop or not take is important. It's fairly uniform through out the USA.
Hope you did your review of the thread.
0 -
Tresj What part?
Littleblue---I'll check back. When is your removal scheduled? Girl, it's your body. If you are not ready to have it removed, and it's scheduled for this week. Call the MO and say "I have concerns, not all my questions have been answered. This is an elective procedure. I would like it rescheduled". That's all you have to do chickie. If they scheduled you for tomorrow, same thing ---cancel it.
0 -
Thanks for the detailed reply, sas-shatzi,
Regarding my first bleeding experience, the discharge nurse said that there was no tramadol or tordol (can't remember which) available, and for post bmx pain I was to take 800 MG of motrin every 4 hrs. This was witnessed by 3 family members upon my discharge. The surgeons written instructions were for the tramadol or tordol.
The port removal is planned for the office, not OR. It will be done by my MO, not surgeon. He says he has done almost 1000 removals, but I am still scared. I do trust him though, as an MO.
I didn't realize this is an elective surgery. Thanks for the info. I will call my insurance company tomorrow.
It sounds like I need to call the MO and talk this through tomorrow. When he scheduled me I was loaded with pre-meds, and so wasn't tracking very well. I am curtly reading thru this thread for further info. Thanks so much for your help!
0 -
Where were you Hospital, surgi center?
0 -
Hmmm. problems, I'll dissect it.
"the discharge nurse said that there was no tramadol or tordol (can't remember which) available, and for post bmx pain I was to take 800 MG of motrin every 4 hrs. This was witnessed by 3 family members upon my discharge. The surgeons written instructions were for the tramadol or tordol." Can't answer till I have more info. Which doc wrote the discharge. Where were you? Whose employee was the nurse? Did you read the written orders? Was Ibuprofen checked off as a drug of choice?
" The port removal is planned for the office, not OR. It will be done by my MO, not surgeon. He says he has done almost 1000 removals, but I am still scared. I do trust him though, as an MO" Ask him what his infection and complication rate is? Hey, a thousand procedures are good. Not a first timer for sure. He probably started doing it for his patients as a necessity or a way to help pay the rent. Either way if infections haven't been a problem , and complications aren't a problem, then you have to decide. BUT don't second guess yourself if something happens. We can't predict the future. We can make a judgment of how to proceed with safety when given correct information.
"I didn't realize this is an elective surgery." Surgery or procedure. Long ago it was learned that the use of the word 'procedure' reduced anxiety. On the insurance end: it's given a procedure code for billing to the insurance company. Insurance doesn't care what it's called as long as the code is right.
"When he scheduled me I was loaded with pre-meds, and so wasn't tracking very well" Why was he there?
0 -
Blue, I have a whole bunch to say about the drug thing. . Go back to previous post. The little that I've gotten about the nurse. The doc was wrong. His screw up, not hers. If I'm wrong I'll tell you. But please, I need details. Go back to that previous post and answer all my questions. I'll bold them so you can find them.
Going to move on. Can't guarantee a visit back here to night. But will check into tomorrow. I spend hours answering questions. Please, don't leave the drug thing hanging out there. As a nurse(retired), I want to determine if the nurse gave bad info and if the doc laid his screw up off on the nurse. You may think you have it figured out. I don't think so.
sassy
0 -
Blue YOOOOOOOOOOOOOHHHHHHHHHhhhhhh waiting. Also, more questions? Were you given scripts at discharge? Did you have a follow up visit with the surgeon or Mo before the bleed? List all meds within week of bleed? What was your activity restriction? Did you do any lifting over 5 Lbs the day of the bleed? Any new activity---like housecleaning, laundry, swimming within 24 hours of the bleed? Did you have any evidence of a hematoma or seroma after surgery? Did you take the Ibuprofen every 4 hours from the time of surgery till the bleed occurred? What strength? Post all the discharge instructions as the appear on the instruction sheet, please.
0 -
Hi Sas-Shatzi,
Thank you so much for your help! I will look up all of the information you request when I get off work. I did talk to my MO's nurse about my concerns- the primary ones being:
1) Bleeding out after port removal from the catheter hole in my vein,
2) Infection, since I am only 6 days PFC.
She said they often remove ports so soon after chemo, and have never had a problem, and somehow the vein which had the catheter in it closes itself. I guess I will just have to accept that answer, because my insurance will not pay for an operating room procedure for this.
As far as the post surgical bleed which lead to my fear of all surgeries, again, I need to find the paperwork. At the time, I didn't want to get the nurse who provided the instruction in trouble, so when my surgeon asked for her name and said she would be reprimanded, I said I didn't remember it. I'm sure she was doing the best she could.
I was not given scripts at discharge, except for hydrocodone.
I did have a followup with the surgeon before the bleed, and in fact went in as soon as I noticed the hematoma growing. He aspirated it and put a pressure dressing on it, but it didn't help. I went home, and a few hours later, felt blood running down my back and out the drain holes. Then I passed out from blood loss.
My Surgeon wrote the initial discharge. Not sure who employed the nurse- as far as I know she was just employed on the Oncology floor.
I did read the written orders. Nothing on the written orders said Ibuprofen. The instructions from my discharging nurse were verbal. Luckily I had 3 witnesses to her instructions to take 800 mg of ibuprofen every 4 hours.
I had activity restrictions in in place and written down before the bleed. No lifting over 5 lbs, limited range of motion exercises. I followed these to the letter.
No new activities pre- bleed.
When the surgeon went in to fix the bleed the next day, he said I had a hematoma, and also that the vein had been nicked during the original BMX surgery going the length of the vein rather than across it, which lead to it not closing up? I am very grateful he was able to find it and fix it. I'm not interested in causing anyone any trouble, at all. When I mentioned it, I was just trying to explain why I was so scared of having my port removed this time- that being having a hole in my vein. Can you explain to me how veins close up after injury? Thanks so much for your response!!!!! I am trying to remember answeres to your questions, as I am at work, and not near my files. Thanks again!
0 -
Well, Blue. They're doc errors and nurse errors. But I will give you my analysis after review of all the answers rather than piecemeal. Glad you are feeling like you are getting some answers. Chickie, you are in this for the long haul. We've all been where you are. It is near impossible to not worry. Try incorporating the deep breath when something is wrong. If you feel like things are out of control. Think--Is this a real emergency or a MMC(make me crazy) problem. The minute you can say that it's a MMC problem, you've asserted control over the problem. Then problem solve. They're is an answer somewhere.
Litlleblue. What kind of scan plan does your doc have for the next year. Labs you'll be minimum every 3 months for the next year. Removing the port may be premature. Again your choice. I'm amazed 6 years out that I have any veins left.
Not to make light of your bleed incident, but I am looking forward to the detective work with each tidbit. They're have been a few Ah-Hah moments.
0 -
Sas-Shatzi, I am so grateful for your insight! I will gladly share the information surrounding my bleeding incident when I have it. As for the next year, my MO will see me in 2 weeks for blood work, then appointments every 3 months which will include bloodwork and a manual exam. Other than that, nothing unless I have symptoms. He said call if I have symptoms that last a week, because there is no reason to stress by waiting 2 weeks. His stated oppinion of ports is that "its not if they get infected, its when". Since mine is painful, I believe he wants to take it out sooner than later. I will be glad to have it gone, I'm just scared for the reasons I described. I guess if my number is up, its up, though, so no use worrying about it. One more question, since you have been so helpful- can you tell me how large the catheter into my vein from my port is? Under my skin, it feels giant! Would you compare it to an IV needle? Or something larger or smaller? I don't have a medical background for comparison, unfortunatly. Thank you so much!
0 -
This is my* BardPort Implantable Port with Grosheng Catheter. The port is a hair larger in circumference than a quarter. The catheter's diameter is a tiny bit wider than the eagle's neck.
*"My" is literal--I was given my removed port as a souvenir.
0 -
Thanks for the comparison! I know I'm being an obsessive dork about this, buT for some reason I can't let it go.
0 -
littleblue, some of us triple positives are asked to keep our port in for an extra 2 years. I don't see what the problem is if you keep it in a little longer.
Re; the nurse that told you to take the ibuprofen....I would definitely let your facility know who it was. This could happen to other patients. Everyone knows you don't take ibuprofen when you've had surgery. The nurse needs more training.
0 -
Such great info here. I had no idea port removal was "elective." Also had no idea it could be removed in the office! I got it put in in an operating room in a hospital and just assumed it would be removed in the same way. Also interesting to see the port and hear about worries and complications.
I'll be keeping mine until next year at least, but it's still good to know all this!
0 -
Gals, Please, not the office. I suppose you could ask what kind of terminal disinfection is done and is it to the same standards as surgical areas. I've seen too many infections traced to docs offices.
Now be patient if you can. I have a book to write about Blue's bleed situation. I don't want to piecemeal it. I need the final answers.
BLUE, you really must find that discharge sheet. You could get a copy from medical records. It's that important.
0 -
April from an medicolegal and insurance stand point there are three levels of need. Emergent, urgent, and non urgent. How they are managed and covered is different. With surgical or procedures they are either emergent or elective.
0 -
Sas, i would never have my port out in a medical office. I had it put in in a surgery center and had it removed at the center. How anyone could be awake for it being taken out is beyond me. Comments?
0 -
Being awake in the surgeon's office wasn't bad, though I had my doubts beforehand. All is healing well.
0 -
Glad to hear, ksusan.
0 -
KSusan
Cowgirl on the ibuprofen thing for Littleblue. I can address that without messing up the sequential analysis I want to do for Littleblue. The NSAIDS are a in most protocols limited before surgery. In the post op period, it depends on the surgery. The association with operative site bleeding is not an absolute. For example, ibuprofen is commonly used in non-joint orthopedic surgery postop. Conversely, it isn't used in eye surgery. Is it a problem with eye surgery. Never proved, but with eye surgery a small bleed can lead to a disaster.. So, even a hint of a bleed potential causes the docs not to use it. NSAIDS risk in heart surgery is now well documented and is contraindicated for use with heart surgery patients.
Overall, though b/c of undefined association with surgical site bleeding the use of Ibuprofen and other NSAIDS have been used less. BTW not all NSAIDS are used in hospital settings. Motrin (Ibuprofen) is the most common and naproxyn is less commonly used(Aleve-trade name). Not sure why Naproxyn wasn't as commonly used. Motrin was right up there from first introduction. It could be something like the drug company has always discounted the drug to hospitals. This is a common situation with drugs. People think quality is the driving force. It's money.
The bigger aspect with NSAIDS are their association with stroke and cardiac events. I'll try and bring the black box warning her. Another limitation for their use is the direct well documented association for gastrointestinal bleeding. With bigger surgeries like breast, Gi resections, stress ulcers are a consideration. A stress ulcer is an stomach ulcer that occurs b/c of the release of too much acid. Limiting NSAIDS and using H2 blockers(Tagamet, zantac, Pepcid) standard practice for years.
I have a mantra I started in the 70's " Just when you think you know something look again". I google to see what the current Evidence Based Research(EBR) is in re: to NSAIDS. Their have been many completed well done studies on the use of NSAIDS in tonsillectomies /adenoectomy(sic) in children. The research is very active in the last 12-13 years. The reason is if they're is surgical site bleeding in a child with a T&A can be very hard to stop. Conclusion: The risk for bleeding is inconclusive, the benefit in reduce vomiting is well documented. How will this information be applied to adults? Probably, we will continue with limiting use pre-op that won't change. Postop use will continue to be based on type of surgery.
http://www.ncbi.nlm.nih.gov/pubmed/23881651
0 -
0
-
"Probably, we will continue with limiting use pre-op that won't change. Postop use will continue to be based on type of surgery". When I finished writing that statement. I decided to continuing looking. My mantra" Just when you think you know something look again" was chanting in my head. "You don't know enough, look again, you don't know enough look again".
There has been ungoing research that is looking at the specific use of Torodal(ketorolac) in the perioperative phase of breast surgery. The initial study was from Belgium. A particular isolated group of patient that had unusually low rate of breast cancer recurrence. All had the same breast surgeon and one of two anesthesiologist. The anesthesiologists had a common approach to drugs used for surgery. Toradol was common the common drug given intraoperative.(in surgery---common practice worldwide)
This link is to an article about the Forget et al study. For some reason Medscape is locking up. It's likely a short term thing. I had to do ctrl+alt+delete to get out. ITA when gathering info.
http://www.medscape.com/viewarticle/723293
Forget et all study----this will be/ is a landmark study
http://www.ncbi.nlm.nih.gov/pubmed/20435950
This is a link to Retsky et all study also will be/is a landmark study
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3831877/
Attempted to get a Medscape article(most trusted) which are done to simplify understanding of a study. Medscape routinely does this. They take out all the gooblygook that us lesser minds can't deal with. But Medscape is locking up If I haven't brought back an article. Google "Retsky and Medscape and NSAID"
---------------------------------------------------------------------------------
What's this mean to Blue? Again I'm not addressing the errors specifically or the bleed. The use of NSAIDS in the initial post op period up to 7 days is associated with a decreased risk of recurrence that is currently being investigated. My placing this here is not to suggest that anyone take NSAIDS. But discussing this with your doc is important. Plus, Torodal is a common drug given by anesthesia for surgery. The Forget study and the Retsky metanalysis study have shown a reduction in BC recurrence. In order to say if this is a direct causal relationship a clinical trial, albeit more than one, needs to be completed.
This is important area of study that needs to be followed.
Okay done
0 -
Amazing. Today's news. I Googled NSAIDS, and before I could add another word this popped up. More warnings about NSAIDS. I"m not going to go get the direct FDA warning. You can if you like. The warning will be all over the news for the next few days
Black box warning of NSAIDS group FDA required to put in NSAIDS monograph. I said earlier that I would bring it here. Here it is
The definition of a BBW is " The strongest warning that the FDA requires is that of the Black Box Warning. This warning is reserved for prescription drugs that pose a significant risk of serious or life-threatening adverse effects, based on medical studies."http://www.ncbi.nlm.nih.gov/books/NBK53952/
0
