January 16, 2006
Portacath Helpful Advice
Hi, I am a patient in the UK.Some of the terms and no doubt practices I use in the following will be different in USA.
I have breast cancer mets to the bone (since 2001) and because my veins are dreadful on one hand and arm and absolutely ridiculous on the other I was asked by the chemo clinic if I would like a Picc, Hickman line or a Portacath as I needed a bisphosphonate treatment every four weeks?
Inserting a cannula into my hand took well over 40 minutes each time and quite often two or three nurses tried to gain access. And even once access was gained no one could guarantee a blood sample could be taken as the veins collapsed almost immediately. Then I had problems with tissue damage even though a baby needle was used. I have had blood taken from my foot (not to be recommended - so painful.)
Not one to have been needle shy previously I then began to dread the appointment coming round and got very stressed when the day came.
As I swim I chose the portacath, (this is the only real exercise I can get.)
The first port that I had for three years was inserted on the upper chest wall, up near the collar bone but I wasn't told at the time of insertion that there was a risk of lung puncture. Yes, my lung was punctured and a chest drain insertion is not one to be repeated. And I had to forego my flight to Northern Ireland for the Christmas period as it is required by the airline (and probably other airlines too) that a punctured lung must be resolved 14 days before flying.
My major concern with the portacath was that if I could not get to the clinic/hospital due to newly diagnosed bone mets and the pain at that time poorly controlled, what would I do if my port wasn't flushed regularly? I had visions of blood clots forming. When I raised my concerns with the staff at the clinic I was offered the opportunity to learn to access the port myself and have a supply of gripper needles, saline and Healcowipes, etc.
For someone who had become almost terrified at the sight of a needle this was one huge task however, I decided I had to learn. I was given the plastic teaching model to practice on first and had a good look at what and where I was inserting the needle.
The Sister who trained me later told me she didn't think I would go through with it!
Since I have learnt I have assisted with the training of a number of staff first timers who have practiced on the model but never inserted a needle into a patient and it was interesting to note just how nervous the beginners were. I offered to be a learner's first patient as I felt I wanted to give something back to the unit and Hey! everyone has to learn, sometime.
- The following instructions are the ones I found most useful.
- Find a good mirror and good light.
Thoroughly wash hands and arms.
Open packs on sterile trolley top.
Alco wipe hands.
Fill two syringes with saline or use two pre-loaded syringes.
Flush gripper needle with saline and close clamps using positive force. (press on syringe whilst closing clamp)
Put on gloves.
Cleanse port area with a circular motion gradually moving outwards.
Press the edges of the port firmly against the ribs/chest wall and keep hold. Really pin it down.
Imagine a cross, across the port and where the two lines cross is where you are aiming (centre) There is a 5mm tolerance which means you can access anywhere within a 5mm centre. Imagine a tiny circle.
Keep a firm hold on the port all the time.
Remove the needle cover and press the needle in and keep pushing. It's like going through a wine gum sweet or a dense piece of rubber, press until you hit the back plate, sometimes you can hear it click or even feel it. (not pain)
Make sure the needle is firmly in place before letting go of the port. Do not be afraid to keep pressing - remember the needle is in the port not your tissue, so no pain. (I was offered local anaesthetic cream but didn'tbother)
Attach syringe, undo clamp/s and draw off 10ml blood and discard. Nurse takes blood samples now.
Flush back with saline and clamp again using positive force.
After treatment flush with saline, clamp, insert Hepflush, clamp with positive force.
To remove the needle hold down the tissue either side of the needle, press quite firmly (clean hands etc.) If you don't do this it will hurt because the needle is not straight. If you look at the needle it is a bit like a beak, a straight part then an angled part. Needles have a razor edge so as you remove the needle the edge can drag through the tissue and very slightly cut it, hence a little bleed and a bit sore. I found this out this when a learner nurse just pulled the needle out without holding the tissue down either side, the skin appeared to lift off the port momentarily and ooh ouch!
Apply a little pressure pad for a minute or two.
Always examine the needle after removal to ensure the tip has not broken off. This is highly unlikely but it is the way I was taught.
ALWAYS BE AWARE THAT YOU HAVE A NEEDLE THAT HAS YOUR BODY FLUID ON IT AND MAKE SURE YOU DISPOSE OF IT CAREFULLY IN THE SHARPS BIN.
Now this may all seem to be an arduous task and you wouldn't be expected to access the port if you didn't want to, and if you did you would have the appropriate training, slowly and repeated so you are absolutely clear about what you are doing.
It is interesting that no sooner had I been taught and I felt very confident about doing it on my own, but wrote copious notes, in order, that I couldn't get to the clinic for the next treatment because I was admitted into another hospital for a diverticulitis flare and no one in the hospital had even seen a port never mind access one. I taught a doctor how to access it.
Two and half years later and self accessed several times by now, I noticed the skin over the port was different the day before clinic. It was like it had a blue undercoat and the skin almost transparent, plus rather tender to touch. I told the clinic nurse when I went and she looked and sent meoff to see the surgeon. He told me I had a vivid imagination and dismissed me! The Sister suggested I had a hand canulla that day. Two days later I had half an egg sized swelling over the port and red and sore, like you wouldn't believe. I rang the clinic and they asked me come in. By the time I had arrived some three hours later I had a temperature of 41 degrees Celcius and was admitted immediately with an infected port/septicaemia. and spent a night in the intensive care unit.
I was really pleased, even though I didn't feel too well, that the surgeon I had seen two days before came to see me and I said, "I am imagining I have an infected port," - he did not answer me!
I have since had that port removed and another inserted but this one was placed in my cleavage and didn't work anyway. So having had this problem I took great care to let the surgeon know exactly where I would like the next port and he agreed only to find I had a different surgeon on the day and he placed it under the right breast fold. I was horrified! Placed here means I cannot lie on my right side, it is too painful to be accessed and needs to be removed and another one inserted (in fact I will have it done tomorrow.) Always discuss and agree where it will be placed beforehand.
Despite all my problems, without doubt if you have poor venous access, get a port. In the main you can forget them. They don't hurt, I wondered if it would hurt or pull when I bent over but no, the newer ones are flatter and not noticeable, they mean less time at the clinic and ease of treatment. But placement is best, from my experiences on the chest, high up, beneath the collarbone.
I searched the Net for signs of infected ports but alas, I could not find any sites, so if you have a port just look and touch and report any changes.
I hope this article helps someone out there, be safe, be happy, be well,