Sunday, February 18, 2024

Port For Chemo In Chest

How You Know Chemotherapy Is Working

Chest port for chemo

During chemotherapy treatment, you see your doctor often. At these visits, you are likely to have physical exams, blood tests, and imaging tests. The results of all these tests let your doctor know how well your body is responding to the chemotherapy.

Its very important to remember that you cant tell how well chemotherapy is working based on side effects. Side effects have nothing to do with how well chemotherapy treatment is working.

What Are The Risks Of Using Catheters And Ports During Cancer Treatment

Each catheter type can have side effects and risks. These include potential infections, blockages, and clots. Less common problems are a twist in the catheter under your skin or the catheter or port moving.

Relieving side effects is an important part of your overall cancer treatment. This type of care is called palliative care or supportive care. Talk with your health care team about the side effects you experience and ways to manage and treat them. This conversation should include what signs, symptoms, or problems you or your caregiver should report right away.

Inside The Procedure Room

Once youre in the procedure room, your healthcare provider will inject of local anesthesia. Local anesthesia is medication to numb an area of your body. Your healthcare provider will inject the anesthesia into your neck and chest.

You may also need general anesthesia to have your port placed. General anesthesia is medicine to make you sleep during your procedure.

Your doctor will make a small incision at the base of your neck . It will be about 1 to 1.5 inches long. They will make a second small incision of about 0.5 inches long on your chest, under your collarbone. Then, they will make a pocket under your skin. This will hold your port in place.

Figure 5. Incision sites for port placement

Your healthcare provider will place the catheter through the second incision and connect it to your vein.

Your care team will use sutures or surgical glue called Dermabond® to close your incisions. If you have sutures, they will be absorbed into your body. You will not need to have them removed. They may also use Steri-StripsTM. These are short, thin strips of surgical tape that are stronger than a regular bandage.

Your procedure should take about 1 hour.

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Types Of Implanted Ports

Ports can be shaped like a circle, oval, or triangle. Your port may be a Mediport®, BardPort®, PowerPort®, or Port-A-Cath®. They can be a single lumen port or a double lumen port . Your healthcare provider will choose the one thats best for you and your treatments.

Single Lumen Port

A single lumen port has 1 access point. Most people get a single lumen port.

Double Lumen Port

A double lumen port has 2 access points. You can put a needle in each access point. You may get a double lumen port if you usually need more than 1 point of access for treatment.

Figure 3. Single and double lumen ports

Power-Injectable Ports

Most implanted ports are made to be used during imaging tests. These include computed tomography scans or magnetic resonance imaging . These ports let you have high speed injections of contrast. These are called power-injectable ports .

Your healthcare provider will tell you if you have a power-injectable port. They will also give you a wallet card with information about your port. Carry this card with you at all times.

Figure 4. Single and double power-injectable ports

Chemo Ports For Breast Cancer: Types Pictures What To Expect

Recovering Cancer Patient Showing Subcutaneous Chemotherapy Infusion ...
  • Chemo ports are devices that sit under the skin and can make it easier to receive chemotherapy.
  • If you have a chemo port, you may not need as many needle sticks when undergoing cancer treatments or blood draws.
  • Surgeries to implant and remove chemo ports are generally short and dont require a lot of recovery time.

Chemotherapy, a common treatment for breast cancer, may be given before surgery to shrink a tumor or after surgery to kill any remaining cancer cells.

Some types of chemotherapy drugs need to be given intravenously, which may mean getting a lot of needle sticks. To avoid this, doctors may insert a chemo port, which allows the medications to be more easily administered. This device is surgically implanted before treatments and then taken out after chemotherapy is complete.

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Does A Chemo Port Provide Any Other Advantages Over An Iv Catheter

In addition to streamlining the delivery of chemotherapy medications, a port can provide several other benefits as compared to an IV catheter:

  • A port site is prepared with a sterile technique, which ensures that all surfaces are free of microorganisms and thus greatly reduces the risk of infection .
  • A port can also be used for delivering fluids and transfusions, drawing blood for lab testing and injecting dye for PET and CT scans.
  • A port reduces the risk of medications coming into contact with and possibly irritating the skin.
  • A port can be used to provide treatments that span several days.

If you have further questions, you are welcome to talk with an expert at Moffitt. Call or complete our new patient registration form online.

What Happens During A Port Implant Procedure

A port implant is an outpatient procedure that takes about an hour. You go home the same day, but someone should drive you.

Most people get ports under the skin on the right side of their chest. Sometimes, providers place ports in the inner side of the upper arm or in abdominal skin below the ribcage.

Youll receive anesthesia to put you into a light sleep. Youll be conscious during the procedure but wont remember it. Youll also get local anesthesia to numb the surgical site. A child may have general anesthesia to sleep more deeply through the procedure.

To place a port in your chest, your provider:

  • Uses continuous X-ray imaging to guide the procedure.
  • Makes a small incision in the neck area to reach the vein .
  • Creates an access point in the vein.
  • Makes a small incision in the chest, arm or abdomen to place the port.
  • Uses that incision to create a pouch under the bottom layer of skin.
  • Places the port in the pouch of skin.
  • Threads the catheter from the port to the vein.
  • Uses the neck incision to connect the catheter to the vein.
  • Performs a chest X-ray to make sure the device is in the right spot.
  • Closes the incisions with dissolvable stitches.

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Are There Different Types Of Ports

A port can be single or double lumen. Single lumen ports are most common and typically sufficient for patients requiring scheduled intravenous therapy.

However, having a double lumen port is advantageous for patients who often receive multiple intravenous therapies at once. If two intravenous agents arent compatible in the same line, you can infuse both simultaneously in different port lumens without complication. The double lumen port also allows concurrent infusion of medication, chemotherapy, blood products, or parenteral nutrition. It is also beneficial for drawing labs without interruption of an infusion.

Ports can be referred to by brand name, like Port-a-cath or Mediport. Regardless of the terminology, all ports function the same way, with the exception of the PowerPort.

A PowerPort is a special type of port, available in single or double lumen, which can withstand higher injection pressures. This is an important consideration for receiving intravenous CT contrast dye. A PowerPort must be accessed with a particular type of needle, a PowerLoc needle, in order to inject contrast.

  • A single lumen port is a port with 1 access point.
  • A double lumen port is a port with 2 access points. A needle can be put in each access point.

The surgeon determines the location of the port on the body based on a patients internal anatomy or personal preference. It is most often placed under the subcutaneous tissue of the chest, upper arm, or lower rib cage.

How Long Does It Take To Take A Port Out

Chest Port Placement
  • The procedure itself does not take long however, typically the numbing medication will need to sit for 5-10 minutes to take full effect. Then the removal and closure process takes about 15-30 minutes.
  • *This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease.

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    What To Expect When You Arrive

    Many staff members will ask you to say and spell your name and birth date. This is for your safety. People with the same or similar names may be having a procedure on the same day.

    You will fill out a brief questionnaire if you have not already done so through MyMSK, the patient portal.

    You will get sedation through a catheter. The catheter may be an IV in your arm or hand. It may also be a CVC, such as a peripherally inserted central catheter , if you already have one. A member of your care team will go over this with you before your procedure.

    A staff member will bring you to the procedure room when its time to place your port.

    Characteristics Of Included Studies

    Table 1 depicts the characteristics of included studies in this study. Of these included studies, two29,30 were RCTs, and two10,31 were prospective non-randomized cohort studies. The remaining studies3240 were retrospective. As for indications, the majority of included studies were about cancer patients with upcoming chemotherapies, and most of the reported studies used commercial venous port devices . For port implantation, the majority of studies used percutaneous puncture approach, while there were three studies31,37,38 and four studies29,31,39 which used direct surgical cut-down methods to implant chest port devices and arm port devices, respectively.

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    How Are Chest Ports Implanted

    Sometimes, if the patient requires surgery for cancer treatment, the chest port will be implanted during the surgery. If no other surgery is needed, chest port insertion is a minimally invasive, outpatient procedure. First, physicians place a small disc under the skin of the upper chest through a small incision. Next, x-ray imaging is used to guide a catheter attached to the port disc into a large vein in the neck, checking that it is properly placed. A resealing rubber center, called the septum, will allow medical technicians, doctors, and nurses access to the port.

    What Are The Benefits Of Ports For Cancer Treatment

    Girls on Chemo: Cancer survivor seeks peers for supportive, fun get ...

    Ports can remain in place for weeks, months, or years. Your team can use a port to:

    • Reduce the number of needle sticks.

    • Give treatments that last longer than 1 day. The needle can stay in the port for several days.

    • Give more than 1 medication at a time through a double port.

    • Do blood tests and give chemotherapy the same day with 1 needle stick.

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    Tubes Used To Drain Fluids From The Body

    Draining tubes might be used to help drain extra fluid that builds up after surgery or a procedure, or because of a tumor blockage. Draining tubes can be used in different ways. For example, a tube might be:

    • Put in through the nose that goes to the stomach, called a nasogastric tube might be used if there’s a blockage or obstruction. Or, a tube can be put into the stomach or rectum to drain excess fluid or help with a blockage.
    • Inserted into the chest between two ribs to drain extra fluid from the lungs or to help keep lungs filled with air.
    • Inserted into the abdomen to drain extra fluid that builds up due to certain cancers.
    • Put into the bladder to drain urine after surgery or because of other problems that might come up.
    • Put into a colostomy or the rectum to help drain intestinal waste if needed.

    If you leave the hospital with any drainage tubes, your nurse will teach you how to care for them and what problems to watch for.

    What To Do About Chemo Port Discomfort

    After doctors insert a chemo port, it is fairly normal to experience some discomfort. A person will likely experience some swelling, inflammation, and tenderness. Bruising may also occur, which can take longer to go away.

    It is important to avoid any clothing or items that create pressure or friction over the chest during the first 1â2 days after the procedure. Examples include:

    • tight clothing, such as bras
    • cross-body bags or straps

    People also should not lift heavy objects or participate in strenuous exercise until the incision heals, which takes about 1 week. A doctor can advise on when it is okay to start exercising again.

    For tight clothes and straps that are unavoidable, such as seatbelts, people can cushion them with pillows or padding.

    Some mild discomfort is normal for those with chemo ports. However, it is important to get medical help immediately if a person develops:

    • swelling or discoloration long after the initial procedure
    • excessive pain, especially without a clear cause
    • fluid or pus around the port site

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    What Is A Port And Why Would You Want One

    A port is a plastic disc that is placed underneath your skin, usually above your breast or below the collarbone, and is used to intravenously feed medication directly into a large vein and into the heart. It can also be used to withdraw blood as well.

    If you are in treatment, you will need to have your veins accessed frequently. A port is used to avoid poking your arm with needles numerous times and for protecting small veins. It is removed after therapy and leaves a small scar behind.

    Although a port may be recommended, getting one is a decision you need to make with your doctor. There are many factors to consider including cost, type, and schedule of treatment, as well as other existing medical conditions you may have.

    It can also be inserted in your upper arm, but this is something you often have to advocate for in Canada, as it is not the standard placement.

    Make sure you do what you feel is right for you, and understand the risks and benefits of getting a port.

    How The Port Is Put In

    Chest port access

    The doctor or nurse will put a small needle into a vein in the arm or hand. They will give you medicine to help you relax. Your nurse or doctor will then inject a local anaesthetic into your skin to numb a few small areas on your chest and neck. You might feel some pressure on your chest or arm during the procedure, but you should not feel any pain.

    The doctor or nurse will make 2 small cuts in the skin. These cuts may be called incisions. The first is made to create a pocket under the skin for the port. It will be about 3 to 4cm long. There will be a smaller incision above this. This is where they will put the catheter into the vein. This incision is usually less than 2cm long.

    If the port is being put into a vein in the chest, the incisions are made on the upper chest. If the port is being put into a vein in the arm, they will be on the inner side of the arm.

    The doctor or nurse will put the port under the skin. They then tunnel the catheter attached to the port under the skin to the smaller incision. Here, it will be put into a vein in the chest. They will then stitch up the incisions. You will have a chest x-ray to make sure the port is in the right place.

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    Normal Imaging Appearance After Implantation

    No universally accepted definition of the ideal position of the catheter tip exists. However, it has been advocated that the catheter tip is ideally located in the distal superior vena cava in port systems implanted in the internal jugular or the subclavian vein: the large volume of blood in a wide caliber vein immediately dilutes administered medication and reduces risk of vascular damage. This is especially important in chemotherapeutic drugs, which are administered in solutions with high osmolality. They are known to damage the vascular wall with subsequent possible complications like infection and thrombotic occlusion and narrowing of the venous caliberhence suboptimal tip position may lead to delayed complications .

    On chest radiographs, the distal SVC projects over the right main/intermediate bronchus. Thus, placement of the tip at the crossing of the SVC and right main bronchus will provide adequate positioning . During flow confirmation studies, complete filling of the port chamber with contrast material should be seen. Contrast material fills the venous tube without leakage, coming out of the tip to flow freely in the SVC .

    Fig. 1

    Does It Need To Be Cleaned

    Yes, it does. During your chemo session, after your IV is connected, the nurse will flush out the port lines before administering the chemo drugs. This is also the last thing that the nurse does after administering your chemo, before removing the IV.

    If your port hasnt been accessed in about a month, you have to have it flushed out. This can be done at your local hospital blood lab department and will only take a few minutes. This will help prevent blood clotting, infection, and other complications.

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    What To Watch For

    But ports can also cause serious problems. Be sure you know what to watch for, what to do about it, and when to call your cancer care team.

    Blood clots: One can block blood flow in the vein or travel to your lungs. Sometimes, it can be fatal.

    Jean Connors, MD, who directs the anticoagulation management service at Brigham and Womenâs Hospital and Dana-Farber Cancer Institute, both in Boston, says just having cancer makes blood clots more likely.

    âCancer causes inflammation and compresses blood vessels — both risk factors for blood clots,â Connors says.

    Having a port raises your chance of a clot even more.

    You can help prevent clots by making sure your portâs flushed regularly when youâre not using it. Flushing means putting saline, the anti-clotting drug heparin, or both through the port and the catheter. This should be done by a nurse.

    âFor some ports, itâs recommended you have flushes every 4 to 6 weeks. Other ports only require a flush every 90 days,â Krishnamurthi says. Your cancer care team should be able to tell you which kind you have.

    A clot can also cause swelling in your arms, shoulder, neck, or head. If you have this, call your doctor right away. Clots can usually be treated with blood thinners, but your port may need to come out.

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