August 13, 2001
How I Got an Arm Port
December 19, 2003
Women who receive infusions of chemotherapy combinations over time are often advised like I was that a port be implanted. They may also be offered like I was one choice for the port which would be placed in the chest. The following is my own research in which I discovered an array of options that ultimately lead to the choice of an arm port.
The arm port I selected in order to take weekly Navelbine and Herceptin was the plastic Bard Slimport NRI Ultra Low Profile. The surgery was performed in June of 2000. This arm port is about the size of a quarter and approximately 1/4 inch high. The port rests just above the crease on the inside of my arm and is attached to a catheter which is fed into the Basilic Vein up to the chest (you can see it in chest x-rays). An ultrasound was done on my arm to select a vein that was moving the day before the surgery. The surgeon used silk sutures to attach it. There is a one inch scar which is a thin red line just above the port. It was put in by a vascular surgeon, Dr. Sharon Beth Drager at Doctors Medical Building in San Pablo, California. Dr. Drager was very experienced, clear in her communication and skilled in her work. I recommend her to anyone who wants an arm or chest port. Her office number is 510-237-7728.
The onc nurses access the arm port by placing the forefinger and index fingers around the edges of the port to find the center. This also keeps the port from moving around. The needle goes in perpendicular to the port until it stops at the back of the port. Tape is placed over the butterfly needle which has this little rubber butterfly top on it, so the needle does not move around. Once the needle is in, I don't feel anything. I explain the finger placement to each nurse the first time they use the arm port, but this is also in the booklet. The patient can put prescription Emla cream on the skin over the port one hour before the poke to numb the skin. Another alternative is Hurricane spray which works to numb the area in about three minutes. A third alternative is to get a shot to numb the area. I always use the Emla cream which works just fine. I asked the surgeon for a prescription of Emla cream, so that I could have it the fist time the port was accessed. The area around the port was bruised and swollen right after the surgery. They usually give your arm about a week to heal before the first access. It took about a month for all of the swelling to go down.
This arm port is used for blood tests, for drugs and for blood transfusions. Another nurse e-mailed me that some arm ports cannot be used for blood transfusions, so I asked the surgeon for a port that had this feature.
Another onc nurse who had just returned from a manufacturers of drugs and devices show on June 15, 2000 e-mailed me that plastic allows for no interf erence with MRI and is lighter, but titanium ports are not much heavier... She said if you are overweight, and especially if you carry weight on your chest where the reservoir will be implanted, the small ones can be too deep in tissue for easy access. They no longer put low profile chest ports in people where she works "unless they are really skinny."
A few people e-mailed me that they had had both chest and arm ports and they preferred the arm port over the chest port. Not all surgeons do arm ports, so it is beneficial to ask the secretary if the surgeon does arm ports before you actually go to the appointment.
Before I got the arm port, the vascular surgeon recommended I ask the staff at the oncologist's office if the staff would use the arm port since they had originally recommended a chest port. I faxed the oncologist the instruction booklet that BARD faxed me along with my request and the surgeon's phone number. The oncologist called back the same day and agreed after speaking with the surgeon over the phone.
The nurses at my oncologist's office love my arm port. It is much easier and faster to access and takes less skill than accessing a vein the "old way." With a mastectomy on one side and an arm port on the other side, blood pressure must be taken on the ankle or the thigh with the leg raised.
I carry a Medical Alert ID card in my purse filled out by the surgeon which describes what type of port I have, the location, and a caution to use only non-coring needles. It is important that the needle size is written on the card, so that an emergency room nurse would know what size needle to use.
While I was deciding between an arm port and a chest port, I received arm port recommendations from women around the country. Nancy T. in Texas had this slim port BARD arm port and she liked it because it was so small and it was just a slight bump in her arm. Ginny in Philadelphia said arm ports are routinely done at Templar University Hospital in Philadelphia (which owns Fox Chase Cancer Center) by a Dr. David Bull, an interventional radiologist, 215-707-2000. At Templar, the port placement is halfway between the crease in the arm and the shoulder on the inside of the arm. Vera of Gilroy, California wrote me that her Stanford Hospital surgeon put the arm port just below the crease in her arm.
Cindy in Akron, Ohio said that the arm port does not restrict her partner, Nancy's movement at all. Nancy even "bowls port side and that just about everyone who has a port at the Akron General treatment center has arm ports. The nurses there are very comfortable with them. Yes, there is the occasional blockage, but the enzyme (abokinase or some others also) has never failed to clear the line for us. In two over years of often weekly treatments, we've only had trouble with the port about 4 or 5 times, and the enzyme has always worked to unclog it for us."
Lee, the nurse practitioner at BARD's customer service dept. in Atlanta answered questions about low profile chest and arm ports. She recommended I go to a vascular surgeon because I could not get a small and plastic port from a general surgeon. He had recommended a large titanium chest port that they had on hand which would be attached with metal clamps with two incisions on my chest. You can call BARD at 1-800-443-3385, option 3 and ask for a nurse practitioner who will be happy to answer questions regarding all kinds of ports and how they work.
A nurse informed me over e-mail that most hospitals order ports through purchasing departments and that most brands of venous access devices have plastic regular and small models in their lines. She said that most hospitals probably belong to a form of buying club where they have contracts with certain manufactures for most medical supplies which they buy in bulk for the best price. She let me know they could also order a port from a single source at a higher price.
Since my oncologists office used BARD ports, I called BARD and asked for their smallest, newest, plastic arm port, got the name and presented my request to the surgeon along with the BARD ordering information phone number 1-800-545-0890. The vascular surgeon called BARD directly while I was in her office and asked them to FED EX this plastic ultra slim arm port. When I asked about a plastic port, she said there was nothing wrong with titanium ports, in fact, she used them all the time. She also pointed out that there were ultra thin chest ports available after I said I'd heard that chest ports could be uncomfortable with seat belts. She said that not many people get arm ports even though they have been around for years but at my request, she ordered the plastic slim arm port. She also said there was less risk in putting in an arm port than a chest port, but each have risks. The risks for the arm port are that there is a longer catheter feed and therefore it has more length that could potentially block. If this happens, it can be flushed, but if this doesn't work then she's got to take it out and replace it surgically. Chest ports also block and are cleared in the same manner.
I think patients would benefit greatly if they could see a few ports and have a few choice. Judy in Arizona wrote that her oncologist's office has samples of four different ports on hand with fake skin, so you can simulate what the port would feel like once implanted.
The only thing I would have done differently was to have the placement of the arm port slightly higher, that is, halfway between the crease in the arm and the shoulder at the bicep (the way they do them at Templar), essentially hiding the one inch scar. Six months after surgery, the faded scar and slight bump from the port are hardly visible at all.
Rita Riley, Oakland, CA
August 13, 2001
The only difficulty we've had is that some hospitals have never seen them before. They require shorter needles for infusion so we got a few spare and keep it with them.
John Fetto, Husband