PORT PLACEMENT - Detailed description of process
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Thanks, Sas! Wow, that is a lot to keep track of. It would be interesting to watch a tutorial video so I could be like your patients and follow the steps. I'm glad to know that gloves aren't required for that first part. I think it's cool how they open and dump the things out of their packages onto the sterile mat without touching them. Here is something strange: I was getting a red spot that would last three weeks after port access. One of the nurses thought maybe my skin was reacting to the cleaner in the sponge thingy. So she used alcohol wipes instead and I didn't get the redness. But then another nurse said alcohol wasn't good enough, so we used iodine and then wiped off the color with saline.
Yes, VAD=venous access device, so that can be port or picc line I think.
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Shetland, Nothing worse than flipping things on a sterile field and having them flip off. ugh
Important for you to find out what the cleanser was that made you red. Very important.
What your describing as the second one is Betadine. You might check have the nurses check with infection control and or the Infectious disease doc to see if betadine is still as good as it once was. Just to be safe.
VAD LOL. Sounds good. Every few years or decades names have to change. Like Xray begat radiology, radiology begat diagnostic imaging.
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DistrictGirl. bruising. BUT you are doing a great job watching it. Look at it every few hours in the same light.
Bruising you will see discoloration but not any more swelling that say after the first hour.
Hematoma is a collection of blood underneath the skin. It often has a slight bluish caste early on. It usually is mounded. If a hematoma is getting worse the mound will get bigger over time. Generally, with a surgery like a port, a self contained hematoma would have coagulated within the first hour. If the area appears to be getting bigger then call your doc.
One thing in the exam of a hematoma, if hubby can get down at beside and look at how far it projects from the chest. Look at the other side in the same fashion. Then do this comparison over a few hours. If there's no change then it's good
Rather than reinventing the wheel. I have a thread that I did oodles of wound care stuff on. I'll go get it BBL.
Here's the link
https://community.breastcancer.org/forum/44/topics/754935?page=1
If at anytime you are concerned and you feel like something is going on call. Better to call and let the doc ask the questions than wait too long.
Think of a spectrum of when you should call the doc
concern(watch) .......more concern(maybe call doc)........not right(call doc)............frightened/out of control (ER/ EMS)
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Shetland. I took your cue and looked at youtube. There are several. I'm putting them here.
Example of terrible technique:This one is by George in India. He contaminated his gloves like oodles of times just putting them on. WHICH makes everything else contaminated that he's touched after that. GAWD. Then when he's cleaning the site he touches areas that are considered contaminated in the sense that once cleaned you shouldn't be moving drapes with the fingers that are palpating the site. AND he does it several times. Plus using liquids from a large bottle like that has been not acceptable for years and years(decades). In the USA the kits come with a prefilled disposable unit for cleaning. AND the patient is breathing all over it. He should of had the patient turn away, but even then a mask is better. Cuz one ouchy and the patient looks back and says "OUCH". (micro)Spit all over the site. Also, the bracelet over the gloves was a unique touch
https://www.youtube.com/watch?v=xWL4sVsqQOw
I'll look to find a good one.
This is a very decent example of port insertion and deaccessing
https://www.youtube.com/watch?v=z_wCv2kCoyY
Excellent presentation of how to apply sterile gloves
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sas-schatzi - thank you so much for your thoughtful and knowledgeable response - you are truly wonderful!
I think you're right about the hematoma part - and it hasn't really changed at all since I first posted. I did get a smaller scale hematoma from my biopsy that took about a month to go away.
thanks!!
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DG Yay
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Thank you! Think I'll take the happy juice!
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Thanks, Sas. I asked what the cleanser was, and have made a note that my skin seems sensitive to chlorhexadine. I will ask my nurse to put a note in my records. Thanks also for the video. One complication--I'm not sure I can watch needle insertion! All these years of bc tests and treatment and I still can't look.
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bump
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Shetland I hope you see this. I reread your last post as I was bumping this. I used to educate Paramedics. In the interview I had a set standard of questions. One was do you have a problem with needles, the next was blood on you or on someone else. Reasonable questions for a Paramedic right?
Asked the question to one interviewee. Silence. I looked up. He was as white as a sheet and perspiring. I went around the desk and he was as cold as ice. After recovering him. We chatted. He said he was solid on wanting to do it, but I grilled him about his reaction. He had a serious bad experience as a kid.
I accepted him provisionally, if he couldn't insert needles, deal with blood, or draw blood, he would have to accept that it wasn't for him.
First blood draw in ER he feel flat on his face. He convinced everyone not to tell me. He got by it and went on to become a great medic.
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What a courageous guy.
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So glad I kept my port. Don't really know why I did. My first 2 BC diagnoses where Stage 2A, little did I know that I would be Stage 4 less than 5 years from the last time. Statistically this happens to 1 0ut of every 3 early diagnosed. Something to consider if you are thinking of having yours removed
Now I am glad I got it flushed every 4-6 weeks.
Cat
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thank you for explaining in detail.. I'm having my port placement on Tuesday 2/28/17 with chemo to follow on the same day..I'm such a wreck and scared.. yes I'm a big baby and having anxiety just thinking about it.. hopefully it's as smooth as u say!
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Robin-
Good luck on your port placement! We hope it's smooth sailing
The Mods
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yes, good luck. It is a scary time. But we all settle in and it becomes bearable, we eventually meet friends and then there comes a familiarity to the whole thing. You'll do great
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I had no choice about the "happy juice" I didn't even know they were going to do it. I was under having my mastectomy when they did it. it was quite painful if bumped for quite a while after for some reason. that limited one of my hobbies, competitive rifle and shotgun shooting, \especially when protecting the mastectomy site on my left side. (I am left handed). I am on tamoxifan now and its still there, getting a flush every month and a half.
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Thank you for this information; it's very generous of you. I am having my port put in tomorrow and starting my first chemo right after.
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Welcome, pmburro, and good luck tomorrow! Please, come back and let us know how it goes.
The Mods
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I am currently trying to decide what to do. Either a port or weekly injection treatments. Taxol for 3 months/weekly along with Herceptin. After the 3 months herceptin every 3 weeks for a total of 9 months. Yes I would do the sleepy drugs. Thank you for posting this procedure.
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SRosenbeck: I suggest that you go with the port. Cancer can be a long process. You will want to save your veins. Not only will you be doing the infusions that you mentioned, but there will be plenty of blood draws as well. And don't forget about the occasional scan that requires dye or radiated sugar to be injected. That's a lot of sticks into some small and sensitive veins. If you have had or will have surgery and are at risk for LE, you may be limited to only using one arm. That puts more pressure on just a handful of available veins.
Admittedly, I don't have a good relationship with my port. I hate it! I find it irritating and uncomfortable. However, I'm still glad that I have it. It made chemo easier. I will be using it going forward for the numerous blood draws that I need along with my Zometa infusions to support my bone health.
In the end, you need to do what feels right for you. That's what really matters. But do consider the number of pokes that will be needed over the long haul.
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Hi srosenbeck. tbird57 the thread starter hasn't been here for along time. But her description of port insertion will always be current until the next invention. There may be several that pop in to give you their opinions and be a resource for you.
I have a personal bias towards ports 1. as an old nurse having used them for delivery of drugs and obtaining bloodwork 2, personal experience of only one problem chemo which lead to a vein section being destroyed. This was due to difficult vein access,.5 sticks by 3 chemo nurses, resulted in leakage of chemo into the tissue. 3. I'm now 8 years post that time. My R arm has taken a beating with all the lab draws over the years. Left arm can't be used b/c of the SNL biopsy.
I will look for an old post. I was on a rant when I wrote it. It defines the advantages of having a port. I did revise it once to make it less ranty. I'll either link it or move a copy forward. After reading come back with your questions
My twin has her port since around 2006(7). She had her first port placed in 1996. It was in for around five years and then had it removed. She came up with a noncancerous condition that she chose to have the port reinserted in 2006.
The question always arises whether to keep or not keep after treatment is completed. Again, I am biased. But what I've learned here over the years, is it's a very personal decision. It's a weigh the information situation and decide what's right for you.
Be back with the previous post !
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srosenbeck, I decided to link to page 10. The post is a in the middle of the page. Look for my peace dove. Pg 10 and 11 have several posts more you may want to read.
I started possibly on pg 10. I know I read all the pages that were here when I first came. Throughout the whole 36 pages there are pearls offered by many.
https://community.breastcancer.org/forum/69/topics/721889?page=10#post_2478423
I'll watch for your questions. sassy
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srosenbeck, definitely recommend a port! 6 1/2 years ago when my doctor told me the treatment will be chemo 6 rounds first, I asked for a port. It was done by a surgeon very much like what described in the opening post. Except the port was supposed to be on the opposite side of cancer breast, and it wasn't. I have three punch spots on right side, and port on left (cancer side). Surgeon explained that he tried 3 times could not find the vein on right. I used the port without any problem through chemo treatments and the surgeon took it out during mastectomy.
For 6 years on horemonal treatments, for every blood test and scan my poor right arm veins are poked and bruised. Last month doctor told me that she is putting me back on chemo treatment, the first thing I asked is to have a port back. My surgeon is still practing at 74, but with last port experience, I won't go back to him. I also learned now interventional radiologist can do the port procedure. I chose to have IR doctor do it. Radiologists always have imagine machines guiding their procedures. Of course I took the happy juice and wake up in an hour with the port properly placed on the right side!
With my new knowledge now (than 6 1/2 years ago when just diagnosed), I specifically asked for a power port vs what was prescribed for a regular port. Because I will go thru lots CT scans in the future, the contrast can be injected thru power port instead my vein. I have used the port twice for chemo now, using the port certainly releases the anxiety for looking for a usable vein each time. I intend to keep my port as long as I can possibly do so.
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Personally - there is no way I would have not gotten my port. I have great veins and knew that once I had UMX, I would only have on arm vein to use for draws/ect. I did neoadjuvant (4 DD A/C) and adjuvant (12 weekly Taxol). If I hadn't had my port for infusions, arm vein may have been compromised and I did not want to have to go to using foot/ankle veins for blood draws or doing BP on leg - so port prevented that from happening.
I still have my 'Little Soldier' (port) 7+ yrs since it was implanted. It's just there standing guard with rifle at ready to keep the Monster from coming back - BUT if Monster does try to attack again, Soldier is there and ready for the reinforcement (Chemo) to join the battle. Yeah - that's a bit of a juvenile way to look at it but is how I do. Do have it flushes d every 8 weeks.
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You crack me up, Kicks.
I enjoyed having a port because it prevented painful digging for veins during chemo and lab draws, and it eliminated the possibility of chemo drugs leaking into the skin around an "iffy" IV. As Sas-Schatzi said, the powerful chemicals in these drugs can really damage any skin and tissue they accidentally touch. I was also happy for the opportunity to say good-bye to my port it when I had recon.
If you decide to go with the port, here are a couple of tips.
- Put on your favorite, go-to bra, and use a thin sharpie marker to outline where your bra straps lie. Ask your surgeon or interventional radiologist (IR) to place your port just toward the inside of your bra strap line. That way you won't have your port right under the strap, which is no bueno.
- Ask your surgeon or IR to make the incision in a small curve that follows the natural wrinkles of your chest. When the port comes out (or even if it doesn't) the scar will look more natural than the standard horizontal slice.
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Something I haven't seen written for a while from those getting ports - a second incision on neck. Back when I had my 'Little Soldier' put in - I had one incision. BUT I remember others saying they had had 2 incisions and were a bit surprised I can nly had 1.I like the idea for marking the area that most bra straps gp. I didn't think about that. My port is not a problem where it is.
My scar is barely visible - about 1 1/2" ( or a bit less), just a 'hairline'. I had no external sutures as Surgeon used surgical glue to close it - did have 2 butterflies over it. When he did my UMX (10 weeks post port implant) he used surgical glue - no external sutures but internal ones. My UMX scar is just a narrow line.
'Digging for veins' is not something I've experienced in my life except for 3 times. The first was a Nun who had just graduated with her RN and was sent to the local hospital's blood bank. She 'royally' goofed. Her 'supervising' Nun was called in and I did get to donate (it was needed quick til more could be flown in). The next time was an Anethesia Inturrn when heading into UMX. The 3rd time was an RN who was supposed to be injecting contrast for a Scan - he succeeded in 'squirting' the contrast all over the room and a lot of blood.
So yes - I do keep my port (Little Soldier) in case it's ever needed. As easy as my vein is to hit - I never use my port for blood draws as it takes an RN (NP/PA/ Dr), not a Tech., to access it as the heparin block has to be removed before a draw and then the heperan block re-established after. This is just SOP while doing Chemo/infusions.
My port is a Bard Power Port so basically, it can be used for 'anything'.
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I wasn't a big fan of the port insertion but I have to say I loved having it. I have terrible veins to find so it was a huge plus. I had Herceptin for a year and couldn't imagine life without it! Just had it removed last month. No drugs at all, just freezing. Once again ended up with the stitches poking through at each end but one has finally fallen off and the second one will soon. I would highly recommend the port!
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I second the advice to ask for a power port that can be used for scan injections as well as infusions and blood draws. The IVs I had for scan injections pre-port were more painful than blood draws. You do need access to a nurse trained for ports in order to use it for everything. Also it will need periodic flushing when not in use. Another thing -- if you are an athlete or are a performing artist, think about whether it is ok with you if the port shows when you wear a bathing suit, costume, etc. I wish I had talked to the radiologist and asked if it was possible to have mine placed 1/2" lower. I hated the way it looked especially at first, but I have made peace with it. I am thankful to have it every time I need a stick for something.
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Shetland brings back a memory. My TE port was visible through a typical florida light weight shirt. I didn't know how visible till I read my cardiologist report of my thallium stress test. He put in the physical exam that I had an infusaport. Nope it was the TE port.
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I am getting a port soon, I think. They planned for a radiologist to do it. I asked for a surgeon. I don't feel comfortable having this done in the radiology department rather than in an operating room. How can they be prepared for emergencies in the radiology department? Do they have anesthesiologists in radiology for this? I just think I will refuse my port if a real surgeon with an anesthesiologist can't do it in a real operating room. I don't feel comfortable about this at all. I have had this radiologist do 2 of my pic lines already, he is not friendly and seems to be in a hurry. My last pic line ended up leaking blood down my arm and was very painful for days even after it was removed and it left a big bruise. The choice to do a port was my oncologists because of my risk of lymphodema, and with 17 more infusions to go, I doubt they can do 17 more pic lines in my left arm. That arm now gets all the blood draws (weekly) , ct scan IV's as well as the new pic lines every 3 weeks. I used to have great veins but they have missed twice the last 2 times. They can't use my right at all.
Anyone else refuse to let the radiology department do their port placement? Please share your concerns regarding who does your port placements. If you had a radiologist do yours, were you happy with the outcome?
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