My Port-O-Cath History and Review

My Port-O-Cath History and Review

Port-O-Cath

I thought that today I would talk about the decision CF’ers have to face about getting a Port-O-Cath  inserted through my own personal experiences with Ports…

If you have read my previous blogs you would know I have had my fair share of PICC Lines, my first being in 1998 when I was 12 years old..Between 1998 and 2001 I had roughly 20 PICC Lines and hated every second of it.

Ok There were a few reasons why my Doctors started discussing with my parents the option of having a Port placed, however the mains reasons were:
>>I was needing more and more IV treatments as my health was declining.
>>My veins were building up with scar tissue to the point that the surgeons were having difficulty placing the lines.
I also remember how horrible and strenuous the whole PICC line process was on myself, which made me reluctant to attend hospital appointments in case I had to be admitted. So The ease of treatment was another reason why a Port was being discussed.

On and off over a 6 months period my Doctors had been bringing up the idea of me getting a Port and how it would make hospital admissions and treatments much easier, although at the time I was going through my Teen rebellion stage and didn’t give it a second thought. That was until the day my Dad had the day off work and came to my Tuesday morning appointment…

Now as soon as my Mum said Dad was coming to the CF clinic I knew I was in for some not so pleasant news since Dad worked full time so it was usually just me and Mum who attended the Clinic..

My parents went into see the Doctors and I could here some discussion going on. I remember it quite cleanly, back than being a Teen I hated the world and was totally pissed off that I wasn’t in on the discussion….About 5 minutes later I was called in…My Dad looked agitated, which he gets like when things are getting a little heated.. So I was already on the defensive and ready for an argument being the Bitch I was back than.

Now basically what happened is this. I was told by Mum that I was going to be getting a Port placed. The nurse and Doctor than proceeded to show me what a Port looked like but at this stage I was not having a bar of it. I remember going crazy, screaming and yelling all sorts of obscenities about how I was not going to have a Port put in and how my life would be ruined..

Now in hindsight the way my parents and Doctors went about telling me was borderline ludicrous, you don’t just tell a 15 year old he is going to have a Port surgically implanted in his chest and expect for him to sit there all happy and content. What should have been done is the idea discussed in more detail between me and my Doctors allowing me….little Pegson at the time to feel more in control, however I guess everyone was clutching a straws and this was an attempt to make it easier for me to have treatments, make my treatments more flexible and eventually be able to do treatments at home, which was all geared to try and restable my declining health and also give me a better quality of life. However like I said at the time didn’t  quite see it this way.

A week later and after considering to run away and live in my cubby out the back I was in hospital to have my Port placed..

So what is a Port exactly?????? Well a Port-O-Cath 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 routine flushes when not in use to avoid blockages and is completely internal, 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 .

I woke up in recovery which almost seemed like straight away, but In fact the operation had taken around 1 hour and 25 minutes and at the time I didn’t know but I had lost a fair amount of blood , enough for them to call for a unit of blood just in case, however fortunately the bleeding stopped and the Unit of blood was required. It was later discovered that my Liver disease had contributed to the abnormal bleeding so usually this amount of bleeding is not an issue.

About 3 hours later I was fully awake and back on the ward shit stirring like usual, I was sore but everything seemed ok. Coughing was excruciating and made you feel like your neck was going to explode however some morphine was able to keep the pain level under wraps (please sir can I have some more)

The way my Port-O-Cath was inserted, was through two 2 inch incisions. The first being the incision for the Portal itself, which was placed on the right side of my chest and the second incision being on the side of my neck where the tubing (catheter) was threaded and stitched into the vein before being reattached to the Portal.

The first few dressing changes were a bit tedious and uncomfortable but within a few weeks my neck and chest were healed with no more than a bit of a red scar that now is no more than a light pink blemish.

The Access needle from my very first IV treatment using my Port

Now the Port stuck out off my chest by an inch however at the time I was quite skinny (around 45 kilos), so if you looked really hard you could notice it under my shirt however now I’m  30 kilos heavier so you can hardly tell I have a Port even with a shirt off.

After having the Port placed, the most difficult thing to come to terms with Is having the monthly access which I time to coincide with the CF clinic date. A monthly flush with saline, followed by a HEP saline lock helps to prevent blockages thus aiding to the longevity of a Port. The accessing of the Port is done with a small right angle needle, it hurts no more than a blood test however if your like me and hate pain you can use Emla cream which contains local anaesthetic that numbs the Port making accessing completely painless.

Another Issue I came up against was contact sport, luckily for me I had finished Rugby League the year before so the risk of a knock wasn’t a huge issue but I have received the odd knock on the Port from Frisbees, Baseballs etc and It is extremely painful. The pain is similar to being kicked in the shin. However over time you learn to guard your Port.

So my Port had been working great for two years and I was really happy with it alround mainly because the Port was allowing me to be much more productive while on a treatment as I had two arms available unlike having a PICC inserted and I was able to attend school with hardly anyone noticing meaning life was able to go on without any of the annoyances that come with a PICC line.

Sometime around 2003 my CF liaison nurse when accessing my Port Noticed that the pressure required to push saline through my Port was increasing, however she could easily without issue withdraw blood from the Port..

Eventually my Port become increasingly more difficult to flush and not even an IV machine could pump medication through my port any quicker than 5 mls an hour, surprisingly withdrawal from the Port was unaffected, so it was clear that a blockage was not an issue.

To me personally the Port-O-Cath felt fine, it wasn’t red, wasn’t sore or inflamed at all. After discussions with the Doctors it was believe that maybe a kink had occured so I was sent for an X-Ray  which highlighted an issue thats quite rare where  the Tubing (catheter) on the Port had flicked around in the vein and was now facing against the blood flow which meant that any fluids entering the Port were having to compete against my body’s natural blood flow, however this allowed for good return of blood as the blood flow was heading straight up the tubing.

So the decision was made that when my next IV antibiotic course was needed I would go back into surgery and have the Port replaced. A few months later I went in and had the Port replaced. My surgeon was able to insert the new Port into the exact same place as the previous Port so there was no extra scars..

I was 18 at the time and coped much better with the surgery and recovery. So now its 2009 and this port is 5 years old and so far I have yet to run into any complications and hopefully with a bit of TLC the Port won’t need to be replaced anytime soon.. However if the Port does need to be replaced the Surgeon has told me that the placement will have to be somewhere else as the Scar Tissue build up from having two Ports would make if very difficult for a third Port to be placed without a heighten risk of infection.

My Feelings on Ports

I personally wish I had gone with a Port-O-Cath straight up and had never ventured down the path of PICC lines. While my Port does require on going care, it’s a small price to pay when I can have IV antibiotics going within minutes compared to within hours or even days with a PICC line.

I have never had an issue with a Port infection although I do know some CF’ers that have had infected Ports which usually can be controlled with antibiotic creams, however PICC lines also carry the same risk of infection if not more so.

So In conclusion if your having constant treatments and your in and out of hospital frequently than a Port-O-Cath may be the way to go, but if your veins are good and your relatively healthy and only require a couple of treatments a year than a Port is probably not necessary. In regards to everyday activities, you have to be careful while accessed but no more than a PICC Line, however when your healthy and your Port is not accessed you will constantly forget you even have it, just don’t take up boxing.

I hope this was helpful and not to boring. Lol

Port info on Wikipedia

PeGsOn

pegson1986@hotmail.com