Port Infection/Rejection

i just completed my course of chemo and go back in 8 weeks for my second go at Rituxan maintenance. Dr. Says keep the port until at least after my next scan. Hmmmm... why would he say that? But I hate the damn thing and would like it out. Don’t want to maintain it. Its a nuisance and I do not need it for Rituxan. Next infusion will be my 31st R infusion so I know I can handle it in the arm with no issues. Does anyone know if having a port installed the second time is any more prone to complications than the first time? Having a stiff stainless steel wire gouged into my chest is not appealing but neither is living with a port. As I said, I hate the damn thing. Any advice or suggestions?

PBL said:

Keep it!

My understanding is that if/when you need a new port, it is placed on the other side - not in the same "pocket" as the first one.

My personal view on the matter is this: It took me over a year to make that port a part of me. I am also prone to thick, ugly scars. I have fragile veins (goes with the ugly scarring: conjunctive tissue anomaly).

Knowing that I have an indolent lymphoma and that it is very likely to start acting up again at some point, I prefer the port to stay right where it is.

In any case, it does seem reasonable to at least leave it in place until NED is confirmed, right?

PBL

Do you flush and how often? Can you flush it yourself?

ShadyGuy said:

Do you flush and how often?

Do you flush and how often? Can you flush it yourself?

I was of PBL's opinion as regards a port. I did not want mine removed. A sort of Linus safety blanket, if you will.  My port never "bothered" me in any discernable way.

At the end of treatment, when my oncologist gave me the NED PET results, he then added, "I have a call in to your surgeon to have the port removed."  I was disappointed to hear that, and wanted the port left in indefinitely, but did not argue with the doctor.

Infection in port incisions is very rare. I would suspect curable with a topical.

I have never heard of self-cleaning a port, but then again, some people wear chemo pumps home to self-administer drugs, so I guess it is possible.

Periodicity of flushing a port varies widely also.  My next-door neighbor, who went to the same cancer center as me, when he finished R-EPOCH for NHL, was required to keep his port in for an additional two years.  After a while, he was only having it flushed every 4 months or thereabout, and never had a problem. I have read posters here who claimed to have gone a year without a flush.

After port removal, when a second port is needed, it can be placed a few inches away from the initial port, or on the other side, and neither is a problem.  I discussed this with my surgeon, due to a huge amount of scar tissue on my right side, and he said placing additional ports for me would be no issue; might take a few minutes longer than if I did not have scar tissue.

Port trivia: 

Some ports will receive CT contrasting fluids, and some will not (at least this was true in 2010; the CT nurses always asked me if my port 'could receive contrasting element or not.')  I was unsure at the first CT, and called the surgeon; my port was NOT suitable for contrast.  What the difference is I do not know.   N.B.: I am not referring to the PET radiological element, but to conventional CT contrasting fluid.....

The port is usually run to the superior vena cava, the largest vein in the body, but there are suitable alternatives.

Ports can occasionally block some portion of CT images (despite 3D); I had this happen. But it is rare and only effects a very small area; I read this on a radiologist's report.

When I first began chemo, the lab pulled my biweekly blood draws for CBCs and metabolic labs from my port. Then, they discontinued this practice, and all blood lab draws had to be from the arm or hand.  My onc said that port draws were shown to alter lab results, especially LDH.   I later read confirmation of this is a hematology journal, but I do not know if universally ports are o longer used for blood draws.

When to remove a port is determined by an assortment of factors, but most oncologists (reportedly) base their recommendations upon liklihood of rapid relapse.  Some cancer centers have formal recommendations for when to remove.  Things considered are how well the diesease was eradicatd by therapy; occurence of relapse; strain of the disease, and others.  Subjective judgement on the part of the doctor is undoubtedly also a factor.  And patient request likely is considered also.

So when to remove or retain is sort of like when to repaint the den; views vary, and there is not universal agreement on 'right' or 'wrong.'

max

I had one. My port became infected at the small incision at the base of the neck where the catheter is inserted into the vein. The area around the incision was very red and inflamed. I had a temperature of 102. This was during regular business hours so I was told to go to the Doctor's office. The Doctor saw me, examined me, and ordered blood drawn for cultures. My WBC was zero and I got my first Neulasta shot. The Doctor said I needed to go to the hospital. I went into the infusion room where I was started on IV antibiotics while the hospital prepared a room for me. 

The cultures were positive for staph and the port had to be removed. I wound up in the hospital for 2 weeks. I was discharged with a home health nurse and was taught to give myself two 90 minute infusions each day for another two weeks. My R-CHOP had to be delayed.

Before my next treatment, I had another port placed on the other side of my chest. I never had any problems with the second port (which I named "Lucky") but I was very protective of it. I only allowed it to be used for chemo and religiously had it flushed every 4 weeks. Once my Rituxan maintenance was finished, I could not wait to get that thing out of me. It was one happy day when I came home with it in my pocket rather than my chest. 

My Doctor's take on it is that it is a foreign object in the body and if not being used, take it out. Don't plan for recurrence.

I hope this never happens to anyone else!

Rocquie

ShadyGuy said:

i just completed my course of chemo and go back in 8 weeks for my second go at Rituxan maintenance. Dr. Says keep the port until at least after my next scan. Hmmmm... why would he say that? But I hate the damn thing and would like it out. Don’t want to maintain it. Its a nuisance and I do not need it for Rituxan. Next infusion will be my 31st R infusion so I know I can handle it in the arm with no issues. Does anyone know if having a port installed the second time is any more prone to complications than the first time? Having a stiff stainless steel wire gouged into my chest is not appealing but neither is living with a port. As I said, I hate the damn thing. Any advice or suggestions?

My nearest and dearest has always adhered strongly to the philosophy that "You do not want to turn up at the ER and have them unable to find a vein!" Yes, your veins will withstand the Rituxan OK, but you do need to remember the possible long-term wall damage that can come from all those sticks.  Since I do not have a port, I am very careful to alternate arms.