May 31, 2010 - 6:17 am
OK, I just want to vent here. My local cancer center is implementing some new cost cutting measures, and IMO, it's affecting patient comfort and care.
I have a port, and since my primary chemo treatment is done, I currently use it for my monthly blood draw. I intend to keep it until my year of treatment if done, then have it removed (I'm superstitious if I have it removed before then, my melanoma will recur and I'll regret having it removed!).
When I had the port implanted, experienced friends of friends recommended I ask for the Emla cream to numb the skin around the port. When I asked for it at the cancer center, I was told they don't use it! It has to be applied an hour before port access, and apparently patients regularly forget, potentially delaying access. Instead, they use a "freeze spray", which immediately numbs the area, with only minor discomfort. (As I found out later, the freeze sprays causes about the same level of discomfort as the Huber needle, AT LEAST FOR ME, so I can actually do without the freeze spray.)
Awesome! The freeze spray isn't necessarily comfortable, but it worked, kinda. For someone who doesn't like needles of any sort, it provided some measure of comfort. Then I discovered that sticking that Huber needle in is also a matter of some skill, and that some of the nurses were far, far better than others!
Honestly, I loved my chemo nurse, and she took excellent care of me. But, when it came to accessing my port, she was NOT one of the better ones. She actually HURT me, even WITH the freeze spray - unintentionally, and I know she didn't realize she was doing it. The first time someone else accessed my port, it was night and day. I think maybe Leslie just pushed too hard to get the needle in - it always felt like she was going to come thru the other side! And it always hurt for several minutes afterward. When the other nurse did it, there was NO pain. What a difference!
Anyway, back to cost cutting measures. Last month, I went into the cancer center, and OMG, NO FREEZE SPRAY! The nurse in the injection room said they weren't using it anymore. I asked why, and she had some lame excuse about it not really being effective, and the amount of discomfort from the freeze spray being about equivalent to the discomfort of the needle going in when they accessed the port (true). What they were missing out on was the mental comfort of their patients. And there are probably patients for whom the freeze spray actually provided needed numbing qualities (especially if they are just post-implant surgery!) I once sat across from a young woman who cussed, cried, and moaned the entire time her port was accessed (including when they finally REMOVED the needle). And that was WITH the freeze spray! I dread what she'll be like without it, and feel sorry for the nurses who have to deal with her.
I also noticed they have changed their sterile procedures used to access the port. Gone is the betadine solution and four cleansings of the area with: Swab one with alcohol (I think) and then with swabs 2 thru 4 with betadine. Now they they use only two swabs of some chlorhexadine (or something like that).
Also gone - the 2nd set of obviously STERILE gloves, opened and donned just before they actually access the port. Now they don non-sterile gloves out of a box, and they use those gloves throughout the procedure. (Even after they've touched other things in the procedure room! I watched my nurse don the gloves, then open several cabinets and drawers looking for things she should already have had out before starting. I didn't realize at the time these were the same gloves she would use when accessing my port!)
Truthfully, I'm not really comfortable with the changes in their procedures. I've already had one infection in the area of my port. I don't look forward to the possibility of another due to changes in sterile procedure. IV antibiotics are NOT fun. My last experience with them resulted in unnecessary medical tests when one of them caused bloody diarrhea (I tried to tell them it was the invanz, they wouldn't listen.)
I also feel with the change in sterile procedures, they're more relaxed in their approach. With the old set of procedures, they were so very careful to maintain those sterile procedures. You even had to keep your head turned away in case you breathed germs on the area they had just prepped! With the new procedures, they just seem too relaxed and maybe a little careless to me.
I'm afraid it's going to take someone getting a serious port infection for them to take it seriously again. And that really scares me. These ports connect to a vein that goes directly to our heart. An infection there is serious and can have dire consequences, including potentially the need for a heart transplant (worst case scenario). This is one area they absolutely should not be cutting costs in!
As to the lack of freeze spray? Well, the first time wasn't too terrible. The nurse who did mine was one who spends all day, every day, accesing ports. She was really good, and the pain level was practically non-existant. I would have had more discomfort if the freeze spray had been used. Last time? There was more discomfort. It was a different nurse, and I would guess she had less experience accessing ports.
So, based on my experience, must of the level of pain associated with port access can be attributed to the skill level of the nurse performing the procedure.
OK, I've ranted, and now I feel a little bit better, at least about the freeze spray. I don't think I'll ever feel better about the change in sterile procedures.