Hickman Port Risks

markatger · July 2005

Hello all,

I have a pretty technical question that I of course am going to be asking the doctors mainly. I posted something about this a few months ago, but am still unsure. I am interested in getting a Hickman port instead of the PICC line. My oncologist is not a fan of Hickman Ports because of risk of infection and blood clots.

I haven't had problems with my white blood cell counts, so I am somewhat unconcerned about the risk of infection. However a question about clotting has arisen in my noggin. My blood tests have shown that my clotting time is really fast...like almost too fast - it is on the very quick end of the normal range of how long it take your blood to clot.

My question is - does that put me at more risk for developing a blood clot?

Thanks for any information ... I know most of you are not health professionals ... but any layman's hearsay on the matter would be great : )

Maria

nanuk · July 2005

I'm not sure what a PICC is, but I've had the Hickman and the Groshong implanted port, and there is no contest. With the Hickman, everything hangs out, and there is more risk of infection, and difficulty bathing, swimming, etc. The Implanted port is on the other hand a dream from the patient's perspective. If you have a tendency to clot, there is probably a way of controlling that..

steved · July 2005

Mark, the decision between the two types is based mainly on issues around infections and clots by clinicians but do think also about your own convenience and wishes (which doctors are less good at considering).
As for the clotting issue- your clotting profile is in the 'normal' range but towards the higher end. As far as I know this does not significantly increase your risk of a clot (beeen a while since I worked in haematology but the the 'normal' range as far as I remember was figured out by looking at what level did you give you a significant chance of increased clotting disorders). So not a major factor to consider.

As you say- best to talk it over with your doc but also get advise from others here abot how inconvenient, uncomfortable etc each option is. I had a PICC and found it annoying but not a major hassle- did wake up one night with it wrapped around my neck!
Best of luck and let us know how you get on,
Steve

HisJoy · July 2005

Maria - I have a port and there are pros and cons with it. Overall, I am very pleased and would do it again. I DID have a problem with a blood clot which ended up causing damage to my spleen (thankfully not heart or brain!). Not sure if that was from the chemo or from the colectomy or from the port. I am on 2.5 mg of coumadin for the clotting and they check that before each treatment at the onc office.

My aunt (stage 4 recurring breast cancer) got an infection from her port and ended up having to go off of chemo to treat the infection and she passed away earlier this month. Again, I'm not sure how much of that was because of the port or if her cancer would have progressed anyway. This was her second round of chemo within one year and I don't believe the chemo was shrinking the tumour even before they had to stop treatment.

Even though my white count has been VERY low, I haven't had any trouble with infection, and now I'm getting Newlasta shots to bring up white count, so should be no trouble there.

The other trouble with the port is that the surgeon had a HECK of a time getting mine in and there was a lot of tissue damage and swelling around the site for a couple weeks, which was quite painful. I still have a great deal of pain in my port-side shoulder when I move it certain ways which is making certain daily activities very difficult - like making a bed, getting dressed, reaching up to hang up clothing.

As bad as all this sounds, getting chemo with a port is a piece of cake. Once the port is in, there is very little concern with infection, since the skin completely covers it. You can go swimming, shower, do anything. I have TERRIBLE veins, and having the port has been a godsend for drawing blood and getting chemo.

Definitely go over the risks and benefits with your dr, but again, as I say, I had a PICC line while in the hospital and I am happy that I chose the port, even with the disadvantages. Please let me know what you decide! I care!

jsabol · July 2005

Hi Maria,
I did my first weekly -6 weeks of chemo through my viens, which started out good and then gave out on me. For the next 3 rounds, I had a Bard port inserted, which is totally contained under the skin below the collar bone. What a difference! The infusions went quicker, they could draw bloods from it, my veins weren't inflamed. My insert proceedure went very smoothly, and the discomfort quickly faded.
I did, however, develop a problem with blood clots. I had one clot develop in my neck, NOT in the vein with the port, which is apparantly not typical. My docs also suspect I had another one that broke up into "buckshot" into my lung, causing some really weird discomfort, but no long term consequences. If the other clot dislodged, it also would have gone to my lung; a bit scary, but the docs weren't too alarmed due to the small size of the clot. The heparin successfully dissolved it, and I remained on Heparin until my port was removed after treatment.
So, another one of those weighing the benefits vs the risks. For me, I would do another port, even with the potential for complications.
Good luck in your decision. Judy

markatger · July 2005

Thank you all for the information and personal experience. I had a PICC line. Ugh...I hated it. Oh let me count the ways... It took me over 2 months to figure out a dressing change that would work without giving me dermatitis. The dressing over it itched like crazy. If I got a little sweaty at all, it would itch more. It made me very self-conscious it was very visible if I wore short sleeves. I had to have weekly dressing changes and flushes. Everytime they did a dressing change, the line pulled out of my arm more. I had to wrap it up to take a shower...and you can forget any swimming.

I have a 3 month break from chemo (am having rectal surgery at the end of August) So I asked to have the PICC line pulled, and a port put it. I am still a little nervous about my decision. Hassle vs. Hazards
It sounds like everyone that responded think it is worth the risk though.

I'm trying to figure out who will put it in and ask them my questions. I think I would have the port put in at the same time of my rectal surgeon. does the rectal surgeon put it in? Or is there a specialist who does it?

Thanks again for your advice,
Maria

JKendall · July 2005

markatger said:
Thank you all for the information and personal experience. I had a PICC line. Ugh...I hated it. Oh let me count the ways... It took me over 2 months to figure out a dressing change that would work without giving me dermatitis. The dressing over it itched like crazy. If I got a little sweaty at all, it would itch more. It made me very self-conscious it was very visible if I wore short sleeves. I had to have weekly dressing changes and flushes. Everytime they did a dressing change, the line pulled out of my arm more. I had to wrap it up to take a shower...and you can forget any swimming.

I have a 3 month break from chemo (am having rectal surgery at the end of August) So I asked to have the PICC line pulled, and a port put it. I am still a little nervous about my decision. Hassle vs. Hazards
It sounds like everyone that responded think it is worth the risk though.

I'm trying to figure out who will put it in and ask them my questions. I think I would have the port put in at the same time of my rectal surgeon. does the rectal surgeon put it in? Or is there a specialist who does it?

Thanks again for your advice,
Maria

Hey Maria... I don't know the differences between all the different ports and lines that everyone is talkng about, but I can give you this much for what it's worth.

My wife had a small port implanted on her chest just below the collar bone. It's completely under the skin, and only a small bump can be seen. The incision is only 1-2 inches long. It's a little irritating and sensitive at times, but much better than getting stuck in the arm every time. Her colon surgeon put it in while he was doing another procedure, so I don't think it requires a specialist.

Good luck! Jimmy

taraHK · July 2005

I just had a Hickman installed 3 weeks ago. Had to have a central line as I'm on chemo and my veins were screaming. My doctors discussed the advantages and disadvantages of Hickman vs. portocath (under the skin). In many ways I think I would have preferred the portocath but I went with the Hickman because it is the procedure/system they are most used to in the hospital system I am in, and they prefer it for various reasons. I do not like having the tubes hanging out of me (aesthetics, psychologically weird, clothing hard, can't swim or have a bath). But, I am now getting used to it -- sorting out clothing options, etc. And of course my chemo is now dreamy in comparison (as dreamy as chemo can be!). My Hickman is flushed out at least once a week with heparin to prevent blood clots. I still have a dressing over the exit wound. Like you, my body doesn't like tape so that has been challenging (and I live in a hot humid climate) but I'm sorting that out too (I know a lot of different tapes now!). Anyway -- that's my experience. Good luck with your decisions.
Tara
ps mine was installed by a vascular surgeon, under local anesthetic -- but it's probably worth exploring the options

steved · July 2005

markatger said:
Thank you all for the information and personal experience. I had a PICC line. Ugh...I hated it. Oh let me count the ways... It took me over 2 months to figure out a dressing change that would work without giving me dermatitis. The dressing over it itched like crazy. If I got a little sweaty at all, it would itch more. It made me very self-conscious it was very visible if I wore short sleeves. I had to have weekly dressing changes and flushes. Everytime they did a dressing change, the line pulled out of my arm more. I had to wrap it up to take a shower...and you can forget any swimming.

I have a 3 month break from chemo (am having rectal surgery at the end of August) So I asked to have the PICC line pulled, and a port put it. I am still a little nervous about my decision. Hassle vs. Hazards
It sounds like everyone that responded think it is worth the risk though.

I'm trying to figure out who will put it in and ask them my questions. I think I would have the port put in at the same time of my rectal surgeon. does the rectal surgeon put it in? Or is there a specialist who does it?

Thanks again for your advice,
Maria

Maria- first to apologise for calling you mark in may last entry. Just something I did reflexively as I well know you are maria. Sorry.

As to who does ports- differs in different hospitals. The best at them are often the vascular surgeons who do them regularly. oncologists and surgeons also can do them and do in some hospitals. The main thing is to get someone who does them regularly and is expereinced.
Let us know how it goes and sorry again for the misnomer.
Steve

HisJoy · July 2005

markatger said:
Thank you all for the information and personal experience. I had a PICC line. Ugh...I hated it. Oh let me count the ways... It took me over 2 months to figure out a dressing change that would work without giving me dermatitis. The dressing over it itched like crazy. If I got a little sweaty at all, it would itch more. It made me very self-conscious it was very visible if I wore short sleeves. I had to have weekly dressing changes and flushes. Everytime they did a dressing change, the line pulled out of my arm more. I had to wrap it up to take a shower...and you can forget any swimming.

I have a 3 month break from chemo (am having rectal surgery at the end of August) So I asked to have the PICC line pulled, and a port put it. I am still a little nervous about my decision. Hassle vs. Hazards
It sounds like everyone that responded think it is worth the risk though.

I'm trying to figure out who will put it in and ask them my questions. I think I would have the port put in at the same time of my rectal surgeon. does the rectal surgeon put it in? Or is there a specialist who does it?

Thanks again for your advice,
Maria

Maria - My port was installed 2 weeks after my abdominal surgery as an outpatient by the same surgeon who did my colectomy. (he is wonderful) They started chemo about 2 wks after that, although I've known of people who get their port in and have chemo within a day or two. *ouch* Can't imagine that.

Best wishes.

Hickman Port Risks

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