Chemotherapy patients should B sure 2 ask 4A medi-port prior 2 start of chemo regimen-Needle sticks

LorettaMarshall

It occurs to me that every patient that will undergo chemotherapy as part of their work-up for Esophageal Cancer may not know that a port is easier on the patient. 

Several points are worth remembering about ports.  As stated in one of these articles, 9 out of 10 patients prefer a port as opposed to multiple “needle sticks.” There are several reasons which I have chosen to put in “bold” just to draw attention to the statement.   

When my husband was diagnosed with “Adenocarcinoma @ the Gastroesophageal Junction (GE), when all the testing was completed, the first thing the oncologist did was to order that a port be placed in my husband’s chest, next to the collar bone on the right hand side.  This was to facilitate the delivery of the chemo treatments that my husband would receive.  In his case, there were two 96-hr. continual infusions of Carboplatin/5-FU.  After the medi-port was implanted, my husband was outfitted with what I call a “fanny pack” device.  My husband’s port was placed on a Friday, and his chemo infusion began the following Monday.  The nurse at the oncologist’s office connected the device to my husband’s medi-port and then we came home.  In 96-hours, he returned to the oncology lab and the fanny pack was disconnected from the medi-port, (also called a portacath or also a BardPort – it depends on the manufacturer of the port as to the name given to the port.)  His chemo side effects were minimal, but I’ve come to realize that side effects will vary both by the type of chemo that is given, as well as the patient’s own bodily response.  In my own experience as a Stage IV Ovarian Cancer patient, my side effects were very debilitating much more so than my husband’s were for him. 

Here is my husband’s treatment schedule after he was diagnosed in November of 2002 at the age of 65. 

William’s treatment schedule was as follows:  (Started Feb. 10 & completed March 17, 2003.)

  ·       Week 1 ~ (02-10-03) Chemo 96-hr. continual infusion of Carboplatin/5-FU (via Fanny pack)

  ·       Weeks 2, 3, and 4 ~ (02-17-03) Five days-a-week radiation treatment.  (No CyberKnife equipment (targeted radiation) in this area in 2003, but now we do have one in our Tidewater area.)

  ·       Week 5  ~ Combination radiation plus SECOND chemo continuous 96-hr. infusion (via Fanny pack)

  ·       Week 6 ~ (03-17-03) Final week of radiation.

   ·       Repeat PET Scan on 04-28-03 ~ results - COMPLETE ERADICATION OF TUMOR in Esophagus and the 2 affected lymph nodes.

           Laparoscopic surgery was scheduled for May 17, 2003 at the University of Pittsburgh Medical Center (UPMC) by the pioneer of the Ivor Lewis Minimally Invasive Esophagectomy (MIE) Dr. James D. Luketich, approximately 3 weeks later after successful pre-op treatment.  Radiation does cause scar tissue, so the sooner the surgery after the pre-op treatments—the better.

At the time of my husband’s Esophageal Cancer diagnosis, we had never heard of such a cancer.  Our immediate reaction after the initial shock was, “Does this mean I am going to die?”  No doubt this is a common reaction to hearing the words, “You have cancer.”  At least it was for both of us.  Well thankfully my husband is still alive and is now 80 years old.  He is in his 15^th year of survival.  We credit my husband’s success first to the Lord and the excellent work-up by our local thoracic surgeon and our oncologist here at home, and the subsequent SECOND OPINION at the University of Pittsburgh Medical Center. 

As I’ve often stated before, at the time of my husband’s diagnosis, our local thoracic surgeon was only trained to perform the oldest open method of Esophagectomy commonly called the Ivor Lewis Esophagectomy.  Ivor Lewis was one of the first doctors to ever attempt to perform surgery on patients who had been diagnosed with Esophageal Cancer.  That was back in the 1940 era.

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http://yba.llgc.org.uk/en/s10-LEWI-IVO-1895.html

“…In the year after his death, following the launch of a fund by the doctors at Glan Clwyd Hospital, an annual lecture, the Ivor Lewis Memorial Lecture, was established and continues to be held at the Postgraduate Education Centre at Glan Clwyd Hospital. In 2011 a new outpatient department was opened at the hospital, with the name the Ivor Lewis Building. Thus are the achievements of a surgeon who pioneered the combined abdominal and thoracic approach to the excision of cancer of the oesophagus, and a man who made a notable contribution to Welsh public life still recognised…”

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Fast forward to today and you will know that esophagectomies have been “refined” today.  They can be done “laparoscopically.”  Dr. James D. Luketich pioneered the “Minimally Invasive Ivor Lewis Esophagectomy” in the mid-1990s.  More and more hospitals are performing the Minimally Invasive Esophagectomy commonly called the MIE.

So a word to the wise—I highly recommend that first you always have a SECOND OPINION. 

Secondly, have it done at a major medical facility that is noted for their expertise in Gastrointestinal Surgeries.   Hospitals differ in rank according to their specialties.  So there is no ONE hospital that is best for all types of cancer.  In regard to Esophageal Cancer patients, they will want to know which hospitals rank highest in GASTROINTESTINAL SURGERIES.  So while I see lots of TV commercials that would lead one to believe that they are the very best, that is a bit misleading.  At what are they best would be a more specific answer?  It seems that if one believed all they see on TV, they would think, “Oh if I can only go there, I can be healed!”  Quite the contrary, you will want to know how much experience the thoracic surgeon has in performing the MIE—where he trained—has he written any relative medical articles that have been published—how many surgeries does he perform on a yearly basis, what is the rate of morbidity, the success rate at that particular medical facility, etc.?  Today the minimally invasive esophagectomy is being taught world wide.  Many surgeons have upgraded their skills in order to perform the laparoscopic method.  However, some have not, and if you don’t know to ask, you may not know that some esophagectomies are more invasive with potentially more problems, than the MIE.  Sure the surgeon is good at what he has been trained to do, but he may only know how to perform the OPEN Ivor Lewis Esophagectomy.  So just know that there are CHOICES and that’s it’s up to us to research the different types before we blindly accept the first thoracic surgeon that says, “Yes I perform Esophagectomies”. 

And to help you make that decision, here is a link that is very helpful.  Note that different hospitals rank differently according to their expertise, and just because that facility ranks #1 in one type of disease, that doesn’t mean that they rank #1 in all categories. 

So first here is the listing for the top 3 leading hospitals in a specific type of care.  But wait—Esophageal Cancer patients will want to know which hospitals excel in the field of “gastrointestinal surgeries.”  And many of us here always say, just because you like your doctor, and there’s a hospital close to your house, doesn’t mean that it is your best choice.  After all Esophagectomies are not as easy as having hip surgeries or knee replacements!

1.      https://health.usnews.com/best-hospitals/rankings 

2.      https://health.usnews.com/best-hospitals/rankings/gastroenterology-and-gi-surgery 

Now when you’re a “newbie” you would not naturally be expected to know there ARE different gastrointestinal surgeries to remove all or part of a diseased Esophagus.  And thank God, my husband had a Stage III diagnosis, (EC T3N1M0) which made him a potentially surgical candidate.  Those are wonderful words to hear even though the surgery is MAJOR!  With a Stage IV diagnosis, it means that the cancer has metastasized to one or more major organs in addition to the Esophagus.  That’s always sad to hear because then only palliative measures such as chemo/radiation can be prescribed and that will not be considered potentially curative.  Still there are long-term survivors even with Stage IV, but it is a difficult journey.

But this particular posting is specifically to inform those that are just being diagnosed that one of the most helpful things your medical team can do for you is to implant a medi-port to avoid being “stuck with a needle” each time you have any kind of treatment. 

And in that regard, I have posted several references, including some “you tube” videos to let you know exactly what a medi-port is and the many advantages of having one.  Both my husband and I have had cancer diagnoses, and we both have had medi-ports.  I still have a medi-port.  I can’t imagine how awful it would be to have to have nurses search for a vein every time I needed some type of blood draw or injection.  In my 42-day stay at the Passavant Hospital in Pittsburgh for my Cytoreductive Surgery back in 2013, I surely would have “run out of veins” had I not had a medi-port. So my advice is don’t settle for “needle sticks” when you can have a medi-port implanted instead!  The many articles referenced below state so many reasons why veins can “wear out” while a medi-port can remain in for as long as necessary.  Medications, hydration, chemo drugs, blood draws, transfusions, etc. can all be done through the medi-port. 

So my advice is that if you are contemplating receiving chemotherapy that you REQUEST a medi-port.  It is so much easier on the patient.  My medi-port has certainly been a "vein saver!"

Loretta (Wife of William who had the Ivor Lewis Minimally Invasive Esophagectomy on May 17, 2003 at the University of Pittsburgh Medical Center, by Dr. James D. Luketich.  My husband is still cancer free and now 80 years old!)

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3.       https://www.curetoday.com/publications/cure/2009/spring2009/The-Ins-and-Outs-of-Ports

“The Ins and Outs of Ports

A port can make intravenous chemotherapy easier on patients. 

BY CURTIS PESMEN - PUBLISHED: FEBRUARY 18, 2009

 Right after my stage 3 colon cancer diagnosis, something seemed odd: I was advised to have an immediate, voluntary surgery in order to get chemotherapy. But my port-a-cath implant surgery—also designed to help me avoid countless needle sticks—doesn’t seem odd today, looking back cancer-free, seven years after treatment. 

Basically, I consented to have a port-a-cath, a small, round (about 1.5 inches in diameter) intravenous drug reservoir and thin catheter tube placed into my chest to streamline both chemotherapy delivery and many blood draws over the course of nine months. Breast cancer patients who have mastectomies and lymph node removal also benefit from ports, as access to the inside of their arms on the operating side(s) may be limited.

The theory was that I’d have less pain and fewer vein-related complications. All proved true. Plus, unlike my planned tumor removal, it was outpatient surgery. The port stayed in me for one year post-treatment—shrouded by my chest hair—just in case of recurrence.

Today, port implants in the chest or along the inside arm seem almost routine following myriad cancer diagnoses. Both surgeons and interventional radiologists are now trained to perform the surgery. Radiologists are newer to the field, but their implants may be guided more precisely by pre-operative imaging.

Yet patients and their caregivers don’t always realize there’s more to the port story than easier access for oncology nurses and treatment efficiency. Older patients and survivors who face multiple rounds of intravenous therapy may over time suffer hardened veins, which complicates or even prevents traditional needle-catheter infusions of anti-cancer drugs, liquid nutrition, or antibiotics.

“Your [port] access is always there; without repeated needles, and without worrying about the nurse or CT tech not being able to ‘find’ a vein,’ ” says John Kaufman, MD, chief of vascular and interventional radiology at Dotter Interventional Institute at the Oregon Health & Science University in Portland.

Kaufman explains that many chemotherapy and targeted drug therapies follow a strict schedule; and if you return home after unsuccessful jabs one day—without a successful needle point-of-entry for treatment—that very schedule is jeopardized. “The port gives you tremendous security,” he says. “It’s meant to make a difficult time of your life easier.” Also, some chemotherapy agents can cause tissue damage if they leak around the vein from a regular I.V. line, so a port avoids that risk as well.

Still, ports aren’t perfect, nor are they maintenance-free. They typically require flushing every four to six weeks with heparin solution, a quick and relatively painless procedure that helps to prevent blood clots. The devices can break on rare occasions, or more often contribute to swelling, excessive pain, or infection. If the device does break, surgery may be needed—never a risk-free proposition for those who have compromised immune systems during chemotherapy— but other methods may be available. One recent European study looked at 30 patients whose ports required corrections, as they had migrated or were incorrectly implanted. One patient’s port corrected itself, while doctors used radiological imaging to help reposition 27 other patients’ ports without surgery.

Though rare, the ports can also “flip” over, rupture, or fracture, leading to risk of chemotherapy leakage. “I’ve been doing these for 17 years, into the thousands,” says Kaufman, “and I’ve only seen two flips.” Fractures and infections are more common. To avoid unnerving port malfunctions, experts say it pays to be vigilant about the device’s limitations and side effects.

Keeping Ports Healthy

So the key question remains: What can you do, if you opt for a port, to minimize your risk of complications? These tricks of the trade can help with maintenance—plus help you avoid port removals:

> To prevent pain, apply prescription EMLA cream (lidocaine-prilocaine) over the port site prior to infusions. Before intravenous therapy, a sturdy needle still needs to be inserted through the skin into the port receptacle, so remember to apply it one hour before your appointment. If you forget the advance prep, ask for numbing spray, such as Hurricane, at the infusion center.

> Ask what the center’s schedule or process is for port flushing for maintenance. If you travel for weeks at a time, can a significant other be trained to perform the flush while away?

> In case of infection, antibiotics may be able to successfully treat and cure the infection without having surgery for port removal. Ask your team what experience they have with both.

> In breast cancer cases, ports are usually not added during lumpectomy or other initial breast surgery. “You wouldn’t know the staging or prognosis until after the pathology report,” says Allen Cohn, MD, medical oncologist at Rocky Mountain Cancer Centers in Denver. It may turn out, he says, that a port isn’t needed after all.”

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4.      http://www.veins4life.com/downloads/pdf/VFLspotlightBrochr7.pdf

“VEINS FOR LIFE - WHAT EVERY CHEMOTHERAPY PATIENT SHOULD KNOW ABOUT PORTS

GETTING YOUR PORT PLACED •

Your doctor will refer you to a physician who specializes in port placement • Insertion of a port is placed during a minor surgical procedure that typically doesn’t require general anesthesia. This can be done as an outpatient procedure3

• The port is placed just below your skin, and is connected to a small flexible tube called a catheter that is inserted directly into a blood vessel3 •

Use of an implanted port carries risks associated with a minor surgical procedure and vascular access. Potential complications include: internal bleeding, nerve damage, collapsed lung, fluid buildup around the lungs, blood clot formation, and accidental cutting or puncturing of blood vessels.

WHEN FIGHTING CANCER, IT HELPS TO KNOW YOU’RE NOT IN IT ALONE.

Cancer is a disease that touches many lives, and learning from each other makes us all stronger. That’s why we created the VEINS FOR LIFE* awareness program. The VEINS FOR LIFE* awareness program is for and about educating chemotherapy patients and their families about implanted port usage and other intravenous (I.V.) chemotherapy delivery options.

With the help of patients who have gone through chemotherapy, as well as input from medical experts, the VEINS FOR LIFE* awareness program will help you take an active role in decisions regarding the way you receive your chemotherapy.  Choosing a method of chemotherapy delivery is an important decision for you and your doctor.  That’s because the decisions you and your doctor or nurse make today go far beyond chemotherapy—it may help to positively impact your lifestyle and comfort during chemotherapy delivery, as well as the long-term health of the peripheral veins in your hands and arms.  Depending on your treatment regimen, you have the option to choose a chemotherapy delivery method that fits your lifestyle.  Ports, compared to other central venous access devices, are more likely to permit you to go about your normal day-to-day activities, like showering, swimming, jogging and playing with your children.  Ask your doctor or nurse about specific activities and the appropriate time to resume them.

YOU CAN IMPACT THE WAY YOU FIGHT CANCER.

Let’s face it, getting chemotherapy isn’t easy – no one likes getting stuck by a needle. The poking, prodding, and potential failed attempts to find a peripheral vein in your arms or hands can be painful. Also, repeated use of peripheral I.V.s for blood work and additional I.V.s may cause damage to your veins in your arm and hand. After meeting with your healthcare provider, you may find an alternative vascular access device (VAD) that may help minimize your discomfort.

9 OUT OF 10 PATIENTS surveyed stated in one study that use of a port improved their quality of life due to decreased pain, need for fewer needle sticks, and quicker blood withdrawals.1

If you are thinking about getting a port, you probably have questions about how it differs from other ways of receiving chemotherapy. For additional information, ask your doctor or nurse and visit www.VEINS4LIFE.com

WHAT ARE THE ADVANTAGES TO HAVING A PORT?

Implanted ports have many advantages over other methods of administering chemotherapy.2 •

LIFESTYLE.   Implanted ports, compared to other centrally placed vascular access devices, are more likely to permit you to go about your normal day-to-day activities, like showering, swimming, jogging, and playing with your children.  Ask your doctor or nurse about specific activities and the appropriate time to resume them. •

COMFORT.   Once placed, a port can remain for as long your doctor determines you need it. While the port itself will still need to be accessed with a special needle, there will be a decreased need for the sometimes painful poking and prodding to find a peripheral vein in the arms or hands with an I.V. every time you receive chemotherapy or have your blood drawn. •

INCREASED PRIVACY AND APPEARANCE.  Implanted ports are small and can be hidden from view. With an implanted port, there is no exposed device and, because ports are typically placed in the chest, there’s no potential for bruised arms. No one needs to know about your treatment unless you want them to. •

LONG-TERM HEALTH.   Since ports are typically placed in the chest, port usage can reduce the likelihood of damage to the peripheral veins in your arm or hand. This may benefit a patient who needs blood work or I.V.s down the road.

A PORT IS NOT FOR EVERYONE—especially patients with a history of forming blood clots, who have had previous vascular access surgery, or who are not emotionally prepared to have an implanted medical device. Like any vascular access procedure, there is always a risk of complications, including venous blood clots, skin erosion, infection, a collapsed lung, or clotting of the port catheter. Talk to your physician or nurse about these and other risks, and whether a port or other treatments are right for you.

WHAT IS A PORT?   An implanted port (or port) is a small vascular access device (about the size of a quarter in diameter) with a hollow space inside that is sealed by a soft top. It is used to carry medications into the bloodstream and is placed in patients who need intermittent to long term I.V. therapy. The implanted port is connected to a small flexible tube called a catheter. A special needle is put in the soft top of the port so that medications and fluids can be given and blood samples withdrawn. In a minor surgical procedure, the port is implanted, which means it is placed completely beneath the skin, and the catheter is inserted inside a blood vessel.

An implanted port allows the doctor or nurse to deliver medications and fluids or withdraw blood samples without having to stick your arm veins directly with a needle. The implanted port allows the medications to be delivered directly into your heart to dilute and deliver the medication more quickly than if the medication was given in the veins in your arms or hands. An infusion or oncology nurse will use a special needle to deliver medication or take blood, and they may use an anesthetic cream to numb the skin to eliminate discomfort. The port may help to make these procedures more comfortable for you, especially if your treatment requires frequent access to the bloodstream for medication delivery or blood withdrawal. Some ports can also be used for CECT or CT scans.3

WHY WOULD I CONSIDER A PORT?

If you are receiving a treatment such as chemotherapy, it may involve frequent injections or infusions of medication and other fluids directly into the bloodstream. The treatment may also require that blood samples be withdrawn. An implanted port may help to decrease the discomfort of these procedures. Frequent needle sticks and certain medication can damage the peripheral veins in your arm or hand, making access more difficult over time.4

WHY WOULD I NOT CONSIDER A PORT?  You should not consider a port if you: • Have or are suspected of having an infection • Have a history of forming blood clots • Have a body size that will not allow for proper port placement or port access • Have had the port insertion site exposed to radiation • Are not emotionally prepared to have an implanted medical device.

A PORT IS NOT FOR EVERYONE. Talk to your doctor or nurse about these and other risks, and whether a port or another vascular access device is right for you. For important patient safety information, please visit www.VEINS4LIFE.com.

References : 1. Chernecky C. Satisfaction versus dissatisfaction with venous access devices in outpatient oncology: a pilot study. Oncology Nursing Forum 2001;28(10):1613-1616. 2. Lamont JP, McCarty TM, Stephens JS, et al. A randomized trial of valved vs nonvalved implantable ports for vascular access. Baylor University Medical Center Proceedings 2003;16(4):384- 387. 3. Bard Access Systems: PowerPort* Implanted Ports: Patient Guide, 2009; 0717710 0903 4. RNAO Nursing Best Practice Guideline: Assessment and device selection for vascular access, 2004, p. 56-59 © 2010 C. R. Bard, Inc. All rights reserved. [MC-0509-01] [1003R] *Bard, BardPort, the leaf shape, and “Veins for Life” are trademarks and/or registered trademarks of C. R. Bard, Inc.”

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5.      https://www.youtube.com/watch?v=drpFrn8UwQE

This is a You tube video telling importance of medi-ports

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6.      https://www.youtube.com/watch?v=FiDQAfF2TKc

“Oncology Associates - Published on Apr 12, 2012

Oncologist Dr. Stephen Lemon from Oncology Associates in Omaha, Nebraska explains how a port-a-cath is used for cancer treatment during chemotherapy. Visit http://oacancer.com/patient-info/reso... to watch more videos on cancer treatment. Medical Minute cancer information videos are produced by Dr. Stephen J. Lemon of Oncology Associates to help provide useful cancer information to cancer patients and survivors.

 Oncology Associates provides a full range of personalized cancer care at two Omaha clinics as well as at cancer treatment clinics throughout Nebraska. The physicians of Oncology Associates include: * Stephen J. Lemon, MD * Irina E. Popa, MD * Susan Constantino, MD To learn more about OA's approach to personalized cancer treatment as well as about the oncologists and staff, please visit http://www.oacancer.com

 Video Transcript: Using a portacath during chemotherapy – Dr. Stephen Lemon Portacaths, or ports, are vascular access devices used for the treatment of chemotherapy that is given intravenously.

 Portacaths sit under the skin and the catheter goes into a large vein. This helps in the chemotherapy administration, and can also be used to draw blood for blood counts and blood tests. This is also a safe way to give chemotherapy, with less chance of the chemotherapy leaking out of the vein and causing damage to skin or other tissues.

 The portacath, shown here, is accessed with a needle that goes through the skin and into the portacath chamber. So blood fills the chamber, and can be withdrawn through the needle to have blood tests done before chemotherapy. And then at the time of chemotherapy treatment the chemo drug is given through the needle into the chamber, and then into the vein through the catheter.

 At the completion of your chemotherapy treatment the needle will be removed from the port and from the skin so that when you go home there isn't any needle or any catheters or anything that requires care. Simply keep the skin clean and dry.

 Once a patient's cancer treatment is completed and they no longer require chemotherapy, the portacath can be removed as a simple outpatient procedure.

 Sometimes your doctor may ask you to keep the portacath in for a little bit longer in case of additional blood draws or possible additional treatment. If a portacath is going to be maintained after the completion of cancer treatment it needs to be flushed once a month to prevent blood clots from forming in the catheter.

  To watch more videos visit http://www.canceris.net and http://www. oacancer.com.”

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7.      https://www.youtube.com/watch?v=hmVGLbSrJU4

 “Sarel Gaur MD - Published on Apr 23, 2014

 Step by step guide on how to place a port catheter ( port a cath ).

 Performed by Ken Ramirez RPA-C. Filmed and edited by Sarel Gaur MD.

 Sections (minutes:seconds) : Getting Access: 00:20 …….

Numbing port pocket: 02:52…..

Creation of port pocket: 05:31 …..

Sizing and then placing port catheter: 07:53

Closing Skin: 12:45 …..

References to Stony Brook Medicine do not imply sponsorship or endorsement, merely the author's academic affiliation at the time of production.

Category Education”

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