March 12, 2001
An Oncology Nurse's Perspective on Ports
Kathleen Allen, RN
My career spans back to the pre-port era. It could be hell. Impossible veins (give this teensy one in the finger a try? as patient and nurse sweat bullets)... vesicant infiltration, chemo burns... The subject was everywhere in the literature: how to avoid burns, how to treat burns. Now you almost never see such an article! I haven't burned a patient with a vesicant since 1986. We put in our first port in late 1984. Before that, it was external catheters. People didn't especially like those tubes hanging outside their chest, and in fact it did limit their activities. The first ports had to be maintained with constant flushes and dressings.Nowadays, vesicant infiltrations should be rare, if people are paying attention to the patient's venous status, and thinking ahead to how many treatments are planned...
Our department treats some patients for the neurology service and the infectious disease service. In 1985, I began giving immune globulin to a teenager with an inborn immune deficiency...AIDS-like, but not the result of infection. After a year of monthly treatments, he had NO veins. Each month was unpleasant for both of us, so a port was placed. It's 2001 now. He's grown up, but he still gets his immune globulin every 3 weeks... and that same port is going strong! Talk about a lifeline!
Implanting such a device is a balancing act. You are having something foreign put inside you, but without it, the necessary treatment just becomes more and more difficult. It's true, the correct answer isn't always to lie down and accept what is suggested...but we've all gotta do what we've gotta do!
- Ask for the most experienced surgeon to implant yours... the one who has put in the most and done it best. Ask the treatment room nurses who does the best job. This is the single most important item in your list of things to think about.
- Consider cosmetics, certainly, but don't get too hung up on how the port will look or where it is placed. Think of this item as your lifeline. It has a job...to give blood and to accept fluids. Your job is to learn to live with the port.
- Ask for a prescription for Emla cream and use as directed over your port reservoir prior to its being accessed.
- If you are fortunate enough to reach a point when you do not need your port any longer, think hard before you have it removed. Wait and be reasonably certain that you have a durable remission. The second port rarely works as well as the first (Murphy's Law on Ports).