Port/Central line/ Pic line & questions

Port

In medicine, a port (or portacath) is a small medical appliance that is installed beneath the skin. A catheter connects the port to a vein. Under the skin, the port has a septum through which drugs can be injected and blood samples can be drawn many times, usually with less discomfort for the patient than a more typical "needle stick".

Ports are used mostly to treat hematology and oncology patients, but recently ports have been adapted also for hemodialysis patients.

The port is usually inserted in the upper chest, just below the clavicle or collar bone, leaving the patient's hands free.

How it works

The catheter runs from the portal and is surgically inserted into a vein (usually the jugular vein, subclavian vein, or superior vena cava). Ideally, the catheter terminates in the superior vena cava, just upstream of the right atrium. This position allows infused agents to be spread throughout the body quickly and efficiently.

A port consists of a reservoir compartment (the portal) that has a silicone bubble for needle insertion (the septum), with an attached plastic tube (the catheter). The device is surgically inserted under the skin in the upper chest or in the arm and appears as a bump under the skin. It requires no special maintenance and is completely internal so swimming and bathing are not a problem. The catheter runs from the portal and is surgically inserted into a vein (usually the jugular vein, subclavian vein, or superior vena cava). Ideally, the catheter terminates in the superior vena cava, just upstream of the right atrium. This position allows infused agents to be spread throughout the body quickly and efficiently.

The septum is made of a special self-sealing silicone rubber; it can be punctured hundreds of times before it weakens significantly. To administer treatment or to withdraw blood, a health professional will first locate the port and disinfect the area. Then he or she will access the port by puncturing the overlying skin with a 90° Huber point needle although a winged needle may also be used. (Due to its design, there is a very low infection risk, as the breach of skin integrity is never larger than the caliber of the needle. This gives it an advantage over indwelling lines such as the Hickman line.) Negative pressure is created to withdraw blood into the vacuumized needle, to check for blood return and see if the port is functioning normally. Next, the port will be flushed with a saline solution. Then, treatment will begin. After each use, a heparin lock is made by injecting a small amount of heparinized saline (an anticoagulant) into the device. This prevents development of clots within the port or catheter. In some catheter designs where there is a self-sealing valve at the far end, the system is locked with just saline. The port can be left accessed for as long as required. The port is covered in a dressing to protect the site from infection and to secure the needle in position.

If a port is used infrequently, it may be necessary to access the port, flush it with saline, and inject a new heparin lock every month to prevent clotting between uses.

The surgery itself is considered minor, and is typically performed under both local anaesthesia and conscious sedation. Patients sometimes have a little discomfort after the procedure, and can be managed with a narcotic, such as demerol for 24–48 hours.

A port is most commonly inserted as a day surgery procedure in a hospital or clinic by a surgeon or an interventional radiologist, under conscious sedation. When no longer needed, the port can be removed in the operating room.

Picc Line

What is a PICC Line and Why Do I Need It?

A PICC line is, by definition and per its acronym, a peripherally inserted central catheter. It is long, slender, small, flexible tube that is inserted into a peripheral vein, typically in the upper arm, and advanced until the catheter tip terminates in a large vein in the chest near the heart to obtain intravenous access. It is similar to other central lines as it terminates into a large vessel near the heart. However, unlike other central lines, its point of entry is from the periphery of the body � the extremities. And typically the upper arm is the area of choice.

A PICC line provides the best of both worlds concerning venous access. Similar to a standard IV, it is inserted in the arm, and usually in the upper arm under the benefits of ultrasound visualization. Also, PICCs differ from peripheral IV access but similar to central lines in that a PICCs termination point is centrally located in the body allowing for treatment that could not be obtained from standard periphery IV access. In addition, PICC insertions are less invasive, have decreased complication risk associated with them, and remain for a much longer duration than other central or periphery access devices.

Using ultrasound technology to visualize a deep, large vessel in the upper arm, the PICC catheter is inserted by a specially trained and certified PICC nurse specialist. Post insertion at the bedside, a chest x-ray is obtained to confirm ideal placement. The entire procedure is done in the patient�s room decreasing discomfort, transportation, and loss of nursing care.

A PICC line may requested for a variety of treatment options which include some of the following:

-Prolonged IV antibiotic treatment;

-IV access obtainable by less invasive and longer lasting methods;

-Multiple accesses obtainable with one access line;

-TPN Nutrition;

-Chemotherapy;;

-IV access related to physiological factors; and

-Home or sub-acute discharge for extended treatment.

PICCs are frequently used to obtain central venous access for patients in acute care, home care and skilled nursing care. Since complication risks are less with PICC lines, it is preferred over other forms of central venous catheters. A PICC is not appropriate for all patients. Proper selection to determine the appropriateness of this device is required.

The PICC may have single or multiple lumens. This depends on how many intravenous therapies are needed. A PICC line can be used for antibiotics, pain medicine, chemotherapy, nutrition, or for the drawing of blood samples. PICCs can be inserted by radiologists, physician assistants or certified registered nurses. They are inserted using ultrasound technology at the bedside or ultrasound wit fluoroscopy. Chest radiographs are also used to confirm placement of the PICC tip if it was not inserted using fluoroscopy.

I am stage iv, idc triple positive (or on herceptin because I was borderline her2 positive),  I have a power port.  I was scared, but knew that from my first round with chemo, my veins were shot.  Putting the port in was not anything I expected.  It was much easier.  I went in the morning, they gave me an IV with antibiotics, numbed the area, put me in a twilight sleep, didn't hurt, was in recovery for about an hour, they gave me some crackers and a drink and I came home. 

It has been a God-send.  No more digging, veins not collapsing.  It is used for almost all of my tests.  It is just a little prick, and they asked me if I wanted cream to numb it before, but it has never hurt so I have not needed any creme.  The chemo is very hard on the veins, and after a while they break down.  I had a right side mastectomy with the nodes removed, so my left arm was overused. 

I love my port and only wish I would have had one the first time around.  When it comes to a port, it does not matter if you are negative or positive.  I have friends who were stage 1 and 2 who opted for a port, my doctor offered it the first time, but I said no.  Your doctor is correct, stage iv is not curable, however, for many it becomes a chronic condition where they go into a remission or the cancer stableizes (does not actively grow), and chemo is put on hold.  We have many here who are in that position.  Cypress Cynthia, Sirod has gone a really long time with stage iv. 

When I was diagnosed with stage iv, it was already through my bones and skin and I have not hit a remission, but there is no way I could have had chemo weekly for almost 2 years without the port. 

I am so sorry that you are stage iv, but there is no time limit on how long you will be here.  I was told 3 months without chemo, maybe 6 with...  that was 2 1/2 years ago.  It continues to grow, but I am still alive and living.  When I pressed him for a prognosis, he told me this, he also stated it was based on statistics and I could be different. 

Hugs,

Carol

Rague said:

I'm not TN or have mets (as

I'm not TN or have mets (as far as I know) - I'm IBC (Inflammatory Breasst Cancer), Stage III and ER+.

Do not be afraid of a port (or even a PICC) as the possible problems caused by the chemo materials can do horrendous things to your veins wheninfused by 'needle sticks'.  Especially when you have veins that are already not easy to hit.  I have great veins and knew that once surgery was over there would be only one arm left to use so wanted to protect it as much a possible.  (The guy who does most of my draws always laughs that while men are supposed to have better veins than women I have better veins than most men.)

My decision to do a port to start with as I had done my research and wanted to protect my veins and did not want a PICC.  When I was in High School one of my friend's little brothers had leukemia and they used a PICC with him and I did not want to deal with that.  I am a very active outdoor person/horsewoman and the potential for problems with a PICC were just too high for me.  A port is enclosed within the body and only when it is medically accessed, is it 'open' to the outside 'world'.

My port wass put in in Aug 2009 and is still in.  My choice (with my Drs approval).  The 'odds' for IBC is that only 1 in 4 will make it to 5 yrs post DX without at least moving to Stage IV so to me it makes sense to keep it in and ready just in case needed (I have a vivid imaginatino - so I visualize my port as my little soldier standing guard so that the IC Monster will not try to attack again as it knows that there is already an 'armed force' ready to do battle.)  IF it's needed - then it's already there and ready - so one less surgery in the future.  Because I'm not on any chemo now, I have to go in monthly and have it flushed (blood drawn back, saline injected, heparin injected to prevent clots) and off I go for another month.  For me, I like going in monthly for the flush as I see my PA's RN and I can ask her about any questions I have and if needed she will go directly to PA and I'll see her if needed if not get answers from her..  So to me it is pro-active.

Sorry gor rambling on - I tend to do that sometimes.

Winyan - The Power Within

Susan

Hi 

i am stage IV  while it is Er+ it behaves as TNBC and has been treated as such

No Marker uptake on PET means no active cancer. Please ask your doctor to explain your PET scan results to you. While I am not a doctor it is my understanding that you are in remission and should feel good about your future.

Please walk away from those people around you who are giving you an expiration date. Keep your chin up while enjoying your family and daily life.

I'm TN inflammatory BC with mets to the lymph nodes between my lungs.  I've also had mets to the brain (treated with rads, no evidence of brain mets now).

Yes, I was told I will be in treatment for the rest of my life.  I was also told I might be able to have a few short breaks here and there.  Honestly, I'm not sure if I want breaks. I feel like the chemo protects me.

I hear people compare stage IV chronic diseases like diabities.  I prefer to think of it like HIV/aids.  You can live with it for a long time with proper treatment, and yes, this disease could kill me.  But so could a car accident, or a heart attack.

I have a husband and two kids, so it's really important to me to live each and every day.   I want to be around for a long time!

hugs,

Linda

Gabe N Abby Mom said:

I forgot to say I have a port

I forgot to say I have a port which I'm really happy with.  I have lymphedema in my left arm, chest and back.  That means no needles in my left arm.  My right arm was orginally used for chemo infusions, those veins are shot.  I had a bilateral so the right is also at risk for lymphedema, so again no needles.

Finally, I currently have chemo two weeks on and one week off.  Plus regular CT scans and MRI's.  So my port gets lots of use.  The chemo nurses also really like the port.  I do use the cream, when I remember, or the nurses offer a cold spray.  The port has also been accessed without anything, it really doesn't hurt any more than a standard IV prick.

Hugs,

Linda

For me, accessing my port REALLY hurts without numbing spray or cream!  Mine's only been accessed once without numbing and it was much worse than any neeedle èever has.  Mine only gets flushed each  month now as I have great veins in left arm so it's quicker and easier to just stick.

NewOne39 said:

CONCERNS

I think what concerns me most with a port or any line are clots.

I had a lung clot (I am currently on coumadin) and now have frequent sinus clots. 

I am really concerned that a port may cause more clots and especially since it is near the heart.

Please communicate your concerns to your doctors. Tell them about blood clots and your reservations