PORT PLACEMENT - Detailed description of process
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Hi Carms, One thing I have learned through the BCO boards is you have to do what's right for you.
Dislike saying this, but sometimes insurance dictates where procedures are done. With that being said.
Interventional Radiology uses real time fluoroscopy for placement of devices. Usually standard OR's don't have a fluoroscopy machine. They usually have a portable one b/c there are other surgeries that use fluoroscopy. Bigger hospitals may have a permanent on dedicated to a particular room.
The fact that you had a negative experience with the Interventional radiologist can be used to your advantage. Piss and moan about till you get your way.
Generally, Versed or Diprivan are used for anesthesia. Both have amnesic qualities and should be administered by an anesthesiologist or CRNA.
Each unit in the hospital has a crash cart. All personnel interacting with patients has to be certified in CPR. ACLS Advanced Cardiac Life Support requirements vary by facility. But many these days do require it.
The interventional Radiology suite is set up like an OR, but you are right there are some differences. Too long to explain here. In general the IT suite is reserved for clean cases only. That could be a question? Are infected cases done in this room, that my procedure is to be done in? Are the terminal cleaning procedures to the same high standards as the OR?
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Thanks "sas" for your reply. I definitely took a hardline about refusing to let the IR guy do it. My Oncologist does not agree with my concerns but he said he understands my lack of confidence in him. He really thinks I should let him do it anyways, but I won't. I had a surgeon scheduled for the following week, but my oncologist nixed it. He doesn't want me to delay the chemo for a week to get the port and the OR is not available before my next chemo so if I don't want IR doing it, it must be another pic line in the same arm. I will do another pic, but I am very worried about lymphodema, my arm is already swelled slightly and there's even a painful lump just below the last 3 pic-line scars on the inside of my arm near my elbow. I had it checked at the local hospital and it is not a blood clot, they expect it is an infection of some sort and a swollen lymph node. They put me on antibiotics for a week. I go Tuesday the 18th for my next chemo with the pic. They rescheduled the port with a surgeon on August 9th, then getting chemo within an hour of the port placement. I sure hope this next pic on Tuesday the 18th doesn't have any issues and my lump clears up before then. It is still quite painful when I bump it or press on it. I will see my lymphodema physical therapist before I go, so she can give me input on how to best handle this. I just do not know enough about pic lines and lymphodema and my oncologist is not concerned at all, it seems. I will post when I know more.
I wonder if I will be able to drive home about 12 hours after the port is placed? I must drive about an hour home from the airport, 12 hours after the port is inserted and about 6 hours after my chemo infusion. I guess I might be able to get someone to drive me, but it is so late when I get in, (about midnight) I just hate to ask anyone. The port will be in my left chest area.
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Carm, my upfront disclaimer--my son just started his fellowship in IR, so I'll admit I'm biased. But I brought your concerns to him. Here's what he said:
He operates in a "hybrid" operating room that's set up like a regular OR, but has a variety of screens and fluoroscopy. The room has all the resuscitation equipment you'd find in any other operating room. He said IR makes smaller, neater incisions because, depending depending on the setting, they generally place ports with greater frequency than surgeons.
To place a port, he uses fluoroscopy to guide placement of the line into the correct space. It's a bread-and-butter procedure for IR.
If the port placement would be done by the interventional radiologist you don't like, ask for another one. They typically work in group practices.
As to your question about driving about your port placement and chemo administration, it's a very individual decision. I would have been totally fine to drive for an hour, 12 hours after port placement and 6 hours after chemo.
I hope this helps. Gentle hugs.
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Thanks for your info "sbelizibeth" and thanks for asking your son, that is helpful. I do believe a surgeon is still better equipt to handle any emergencies that might come up. The operating room is much colder than the IR room where they put in the pic line at the hospital where I go. I assume to inhibit bacteria growing. That was one of my concerns. Why not the IR procedure room as well? The other concern is the training the IR Dr.s have is pretty much on the job training, a surgeon actually does 4 years of residency in surgery, unless I am mistaken. I did research the training for IR and most of it is not surgical. That was a big concern. Also, I want the port much lower on my chest than the collar bone, I don't want any visible scars, or the port showing when I wear a low cut shirt, bathing suit, or blouse to remind me of my surgery and cancer. The port is usually placed a few inches below the collarbone with the incision above the port. I want the incision below the port, if they can do it. Maybe even use the mastectomy incision that is already healed. I did not have any reconstruction, so I am very flat, not much on my chest but bumpy ribs with very little muscle, The surgeon took all the breast tissue. I also want to be premedicated with ketorolac to lessen the chance of the inflammation from the incision spreading my cancer. I assume the surgeon would be better equipped to handle any serious bleeding issues that might arise from such medication. I also plan to have no meds except the lidocain. I don't want to be sedated. I want to be awake and fully aware of this procedure. Thanks for info on being able to drive 12-14 hours later. I am pretty resilient and believe I will be fine to drive too. Just asking and I was very happy to see you could, so thanks for that info as well. The gentle hug is very welcome too
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This is a great post and was so helpful. The one thing that surprised me was that no one really talked about the post procedure pain that ran up the side of my neck where the port was placed and the difficulty turning my head for a few days. Also, the tenderness of the site during healing when being rubbed by the car seatbelt. It all resolved and Tylenol helped but was a bit difficult and concerning.
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sbelizabeth & carmstr835 Lizaeth so happy for your respose, carms so happy for your respose...Sorry my keypad is roke. The b and n wo't work uless I switch to screen mode. It will make me uts. So, go ack a read a isert the b&n. Makes for some iterestig reading.
Carms, Lisaeth is very right...........ut you must e happy.
Chit(shit sustituio ).............postig is ot goig to e easy
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Hello, don't think Ive posted here yet but have been following for the great advice! I start chemo tomorrow and had a port placed yesterday. I had it done by an IR but at the local hospital in a cath lab for sterility purposes. It was a long day (close to 6 hours), with a lot of waiting. You can read about my whole ordeal in the Starting chemo July 2017 thread, page 9.
The worst (and ironic) part of my procedure was getting the IV placed during the surgery prep. It took 2 nurses and 4 pokes in the same arm to finally get one. I had lymph nodes removed in my left arm so can't do anything on the left arm. Not only was it a poke, but they had to search for a vein to catch the catheter each time. So I'm SOOOO glad to finally have this port put in!
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I know nothing about an IR implanting ports so can't make any comment. I think though, that there is no way I would allow someone who had had issues with establishing PICC lines several times to be cutting into me and trying to go into a vein internally. That would,be true no matter what the individual's Speciality.
My port was implanted by my Surgeon in the OR at the local hospital. He did a great 'job'. The scar line is barely visiable. There were no extermal sutures - just surgical glue and 2 butterflies'.
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Here's a question for those who have had ports with a healed incision--
I bet we all have scars that are horizontal, parallel to the floor, right?
As I get steadily older, the natural wrinkles in my chest seem to have developed in a sort of "scoop neckline" pattern, a curve that mirrors the wrinkles in my neck. Do you think the port incision would have made a less noticeable scar if the incision was NOT horizontal, but curved, to follow the naturally-occurring wrinkles of the chest?
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Hi, E some docs do that, but difficult to predict lower wrinkles. The neck has pretty predictable wrinkling prediction. But even then they may not predict right, Also, dependent on what structure underneath. But can be something to discuss with a doc.
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It is all set. I have the surgical consult on Aug 8th and the placement on Aug 9 and my 5th chemo infusion on aug 10. I drive home August 10. I will be in the operating room with the head of surgery. I heard he is a very good surgeon and everyone likes him. I wanted my own surgeon, but he can't do it
Iwill still present this surgeon with my request for ketorolac pre incision and placing the port low so it won't show on my neck line. I was trying to find out if they can place the port with the incision on the bottom, or under the port, does anyone know? I do believe they can honor my other request for no sedation.This pic line leaked again (July 16), arm is again swelling and painful. Last time, it got infected formed a big lump under the pic scar and needed an emergency hospital visit to rule out a blood clot. They gave me antibiotics. Also the blood draw poke bruised. I think I will be happy for the port when I finally get it.
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Thank you so much for posting! I get my port on the 31st and was wondering how they did it.
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Carmie, Ask the surgeon, if he can request a review of complications & infection s by that IR guy. they can do an internal review.
YAY you got the doc you wanted!
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I see that this original post was made in 2008.. but thank you! I got my port put in today, nine years after this original post. I read it last week and it brought me comfort before going in today.
Thank you.
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Tina marie, YAY for getting the port today! I know this is a scary experience. You'll start chemo soon and be on the other side of this enormous speed bump before you know it. Gentle hugs.
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Thanks sbelizabeth! Can't wait to be on the other side of this! Gentle hugs back!
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audrey1414 Thanks for your post above (July) about post insertion pain. Sounds like yours got better - that's good. I am having (very bad) pain, too, and trying to figure out whether this is just post insertion inflammation/adjustment or if something is wrong.
I have read a number of concerns about having interventional radiology do the port insertions. From the information I have gathered, interventional radiologists who are doing these insertions are (usually) well training and experienced. Regardless of the title of their specialty, where you get the best "outcomes" is with a doctor who does port placements all the time. Ask about their training and their volume (number of placements) is going to be a better indicator than their title.
I acknowledge that may people love their ports, but if you don't want one, I would encourage you to stand up for yourself. I did not get one for my first "round" of BC. I had a PICC line. (My physicians refused to administer chemo without a central line of some sort.) I was very happy with my decision. The medical profession is awful about bullying people. If you don't agree - resist!
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No port or picc will fry your viens.
Short , not sweet, but true
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Others report that they have done it (port free). Kinda surprises me but, some seem to manage. It's not typical and probably depends a lot on your veins and your chemo regimen.
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I wrote that last post while still fatigued from hurricaine. I have a post pages back about my only experience with a chemo gone wrong. There were so many errors made, it's a wonder I survived. Since no one would take responsibility to determine errors origins, I chose not to do another chemo. I will attempt to find the post. Actually two posts and bring them forward.
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OKAY YAY found one, what's terribly odd is I would have sworn this happened this year. OH VEY. Didn't edit today , but it says edited a few minutes ago. Go figure.
May 14, 2016 09:30AM - edited May 14, 2016 09:34AM by sas-schatzi
A minute ago - edited a few seconds ago by sas-schatzi
NEWS FLASH. This may be old news to some. Yesterday I saw for the first time the infrared vein finder. It's on a tripod with a long adjustable arm. It has about a 3by3 field exposure. It's light is directed over an area of skin. You can see ALL the blood vessels. Because you can see them a tourniquet doesn't need to be used. Vein scarring and valves can be seen and avoided.
I had my lovely nurse Marilyn do a whole tutorial. I so would have loved to of had it when I was practicing.
A biggy for me is to be able to take this to the port thread I mentor. Discussion periodically occurs about whether to have a port when only one round(4) of adjuvant chemo is the plan. I was refused a port, but not without a strong discussion.
I only had one single chemo b/c of complications. In that one chemo it took 3 nurses 5 sticks to get a vein. Some chemo extravasated (leaked). That vein where the extravasation occurred has always looked dark even though it's been 7years. The infrared showed that vein and the smaller veins extending from it as shriveled and almost hairy. I'm not describing it well, but the area was very visibly different. Also, unusable.
Wouldn't of happened had I had a port.
(Repost from Insomniacs thread)
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This link is to page 10. There are several posts that are sequential that have value. Too many to repost so I've linked to that page
https://community.breastcancer.org/forum/69/topics/721889?page=10
Page 11 had some good stuff too.
https://community.breastcancer.org/forum/69/topics/721889?page=11
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Originally, I posted an old post. But it was a rant along with the message. I didn't like it. I revised the whole thing. Rant was on pg 15.
Oncologic appilication of ports and piccs: 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 or several, 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.
Other later 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: 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.
Peripheral Veins and Anesthesia risk: Docs or CRNA's, prefer arm veins, in administering anesthesia drugs. They 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. 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. This scenario can cause the heart to NOT work right. HMMM need a further description of what can happen? 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 during anesthesia.
The ports and Piccs are not just for convenience. They protect the patient from preventable short term and long term injury.
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.
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Revised the whole post from pg 15 on ports and piccs.
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Lumpie, missed your concern. Are you still having problems?
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sas-schatzi: Those vein finders are great aren't they! I had seen them before but never had one used on me. I have great veins but asked recently if the nurse would use one in my arm vs hand since it just hurts a lot less. She had a little hand-held version. I held it for her while she "stabbed" me. Lit the vein right up - worked like a charm. So cool.
That makes sense about the port and anesthesia. I always wondered why they make the meds so concentrated... My vitals tend to be really low/slow ... I am always setting off the RR alarm cause I just breathe so slowly even when fully conscious... and at one of my procedures, evidently the anesthesiologist gave me just a smidge too much. All of my vitals got so low, they were standing by to start resuscitating me. Makes a good story.
Update on my port saga here:
https://community.breastcancer.org/forum/8/topics/...
Long story short: They have decided that I sustained a neck injury in the course of the port installation. We hope that it will resolve with time, drugs and TLC. Arg! One more bump in a rocky road!
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Lumpie, such a cluster fuck. I'm an old operating room (dept. ) nurse. The circulating nurse in the operating room along with the physician has the primary responsibility for positioning. Ultimately, it's truly the doc's, but in a case of injury be assured the doc is going to displace or attempt to displace responsibility.
Create a diary, Record by date. Record all before today under today's date. It's a matter of legal record. From this date forward record daily. Pain level and how it's affected your life. You may never use this record, but it will be your best tool to a settlement if that's where it goes. None of like to think suit. But an injury that could have been avoided, is an injury. The doc's accept responsibility of your care. They are schooled in care. If negligence occurred and care wasn't right. Then we do what we have too. I will link to Pain and Other things. The first page has much on pain and recording.
Thanks for posting your experience on the PORT thread. I will cut and paste this response back there too. It will take a number of minutes to bring the other link back.
YES, a diary is the biggest PITA, but it can make a difference
https://community.breastcancer.org/forum/136/topics/839123?page=1
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I insisted the anesthesiologist use my port for the mastectomy. I was simply NOT going to get stabbed and bruised...AGAIN...when I had a perfectly fine central line parked in my shoulder, just waiting to be accessed. I brought documentation that my Power Port could handle the uber-fast IV rates required during a resuscitation.
He was a nice old guy and humored me.
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Beth had to shorten it because you know couldn't remember it and wouldn't let C&P do it.
Ports and centrals can be used for surgery. Generally, they prefer not b/c of reasons described. BUT just as you state in your case modifications can be used. Depending on the surgical site. i.e breast makes it difficult for draping if same side. Port opposite side , no difficulty. Abdominal site or extremity site, no problem.
Most OR's are equipped with machines that can control all or most injections now and the anesthesia folks are pushing buttons with programmed info for meds. It's a technology world. But they still like line of site on injection site.
I agree. If I had a port, I'd be saying the same thing as you. My poor veins after 8 years now on one arm. The antecubital(crook of arm) is cratered and hand many are destroyed.
When I had my crani in 2012, they lied on the anesthesia record. They said two attempts were made on the right for an arterial line. They then did an arterial line on the SNL left side. They said before surgery when doing the consent that there was a 10% chance of lymphedema if they had to stick the left side. I refused all sticks on the left. They still did it. I was aware as soon as I woke up in ICU and saw the art line in my left wrist. I was pissed. I looked at my right wrist and there were no puncture marks. Now, I may have been flying on post -op dugs, particularly, Dexamethasone--decadron, but I know what I saw.
I did okay, I was pissed about the lieing.
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Sas, I'm with you. I would be furious. Speaking to the head of the department and writing a letter furious.
I woke up from a surgery with a bandaid on my LE arm. It was an IM toradol shot, I discovered. Why do we bother with the no needles no BP instructions when they're just ignored? If I'm awake I can defend my arm, but under anesthesia, not so much.
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