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» LymeNet Flash » Questions and Discussion » Medical Questions » picc or port

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Author Topic: picc or port
fatigued15
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My 17 year old is going to start IV Rocephin. She can not decide if she wants a PICC or port. Any input would be appreciated.
Posts: 488 | From NY | Registered: Oct 2004  |  IP: Logged | Report this post to a Moderator
jeffsdad
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No port experience, but I'll try to give you an idea of PICC line areas of concern since my 14 yr old son has one in place. I can give my perspective as a caregiver, and my son has indicated it really is not a big problem - certainly he'd rather not have it in. But it's just something He has learned to live with it.


My son has his PICC line exiting his left arm inner bicep. The line is held in place with a stat-lok device which clips onto the line and has an adhesive bottom which attaches to the skin. The exposed line is around 2" long, has a small clamp around it and a port on the end. The exit site is covered with a dressing that has a clear window.

Daily infusions are simple:
1. Alcohol wipe the end of the port
2. Attach saline syringe, open clamp, inject, close clamp
3. Attach infusion tubing, open clamp, infuse, close clamp
4. Attach saline syringe, open clamp, inject, close clamp
5. Attach heparin syringe, open clamp, inject, close clamp

The syringes do not require needles to inject - the port has a luer fitting so they just twist on/off.

Weekly we remove the dressing, clean around the site and add new dressing. We find an undisturbed are to work, use latex gloves, mask, and use sterile techniques while we change the dressing to reduce risk of infection. All the supplies are supplied by the infusion company.

Cons:
1. Presently we are battling what appears to be an allergic reaction to the adhesive on the stat-lok device. This is problematic since we rely on the stat-lok to secure the line. So now we lift up the stat-lok, put cortisone on the skin, place gauze between the stat-lok and skin, place another gauze over the stat-lok and then (paper) tape it down. It makes the anchoring less secure but we hope once we get it under control we can go back.

This is really a hassle at this point because we don't want to disturb the site too much since infection risk increases but it needs to be treated. Before we put a new stat-lok on we have a skin protectant we can apply to prevent the reaction.

2. You cannot get the area wet so you need precautions when showering/bathing. We bought a device (specifically for PICC line support) that is made of latex, fits snugly over his upper arm and has a bulb you squeeze which suctions the latex over the PICC line. Works well but he needs help to put it on/off. It's skin colored so for swimming it is less noticeable.

3. To keep the line/port from catching on things we cut off the top of socks (~7"-8") and slip it up his arm over the tubing. For the most part it is covered even w/short sleeve shirts, and he has many sock colors to choose from which makes it kind of cool.

4. The small clamp on the line and the port are around 3/8" in diameter. Sometime after sleeping they have pressed into the skin if he had laid directly on it. The pressure can be reduced if gauze is placed between these items and the skin.

Hope this helps. Basically there are some issues to be aware off, but in general it just becomes something everyone gets used to.

Posts: 36 | From nj | Registered: Sep 2006  |  IP: Logged | Report this post to a Moderator
hshbmom
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Hi fatigued,

I'm glad you asked this question. My 14 yo dd is supposed to get a picc line pretty soon. I'm also wondering if a port would be better.

She's supposed to be on the IV antibiotic 60 days.

What is the cost of these devices? Does insurance pay for much of it?

Are these procedures painful?

Jeff's Dad, thanks for your detailed explanation.

My dd does not want any IV treatment, but nothing else is working.

Nancy

Posts: 1672 | From AL/WV/OH | Registered: Jun 2006  |  IP: Logged | Report this post to a Moderator
CaliforniaLyme
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(((If your daughter doesn't want a picc or port I would try IM Bicillin if you haven't yet. IV is a very serious thing!!)))))))))))) There are risks to IV, people get sepsis and die from infected catheters. That said, people die from all kinds of treatment complications from all sorts of things but IV does have risk. I lost the wohle large vein in my left arm to a catheter defect and could haev died. That's okay, I would do it again. It was worth it*)!*)!!

THAT SAID, IV is easy if you learn how to take care of your picc line!!!

CareTaker Dad- I had adhesive allergies and what I did was buy "burn" bandages and cut them to fit. They did not have the same reaction!!!
They were great!~

Also, advice re IV supplies- IV companies can rip you off!! Check with your local pharmacy and you can usually get the same stuff at about half the price!!!

You can get a visiting nurse to show you how to do your line for a few days and then you can easily do it yourself for your daughter or she can do it herself!!!!!!!

PICC is riskier than port. Port is more expensive and for more longterm. Many people can't self-administer with ports but can with PICC.

I loved my Groshong catheter./

It was so easy!!!

My then-two year old would help infuse me!!
I had 2 picc lines, had hand lines for a WHOLE MONTH (YUCK!!!!!) and then a Groshong catheter.

A central line is better than peripheral because the heart is like a fire hydrant compared to a vein like a hose. For me, it was very intersting that when I started respoinding to IV Rocephin it was in the 7th month which is when I had just got my Groshong. A central line- a port or a groshong catheter- will push the abx all through your body- the small piccs that go up to the shoulder but not to the heart- they do not get as good penetration to the body!!! My LLMD told me that, he said put your hand u nder a faucet just barely turned on, that is your vein, now turn it on full blast, that is your heart. He was right!!

Groshong was easier than plain picc!!!!!!!!!!!!!!!!
But ports are safer!!!!!!!!!!!!!!!!!
Best wishes,
Sarah

--------------------
There is no wealth but life.
-John Ruskin

All truth goes through 3 stages: first it is ridiculed: then it is violently opposed: finally it is accepted as self evident. - Schopenhauer

Posts: 5639 | From Aptos CA USA | Registered: Apr 2005  |  IP: Logged | Report this post to a Moderator
lymeinnh
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I have had experience with both, and if would always pick PORT over PICC.

However, it is a personal preference. I think the port is less annoying (don't have to wear a sock, not as much tubing sticking out, etc.)

If you're only going to be on IV for 60 days or less, I'd go with the PICC line, if it's for longer treatment, I'd definitely go with the PORT. Again, for ease of day to day life, and also for less risk of infection.

The surgery to put ports is in super simple and easy, a breeze! I think you'll find that 90% of people on here LOVE their PORT... but the same is not always true for PICC line (again, more easily infected, many people have bad skin reactions... I SURE DID!!)

GO with your gut, start out with the picc line, if you don't feel it's working, switch to the port.

Goodluck!!! [group hug]

Posts: 33 | From Lebanon, NH | Registered: Oct 2006  |  IP: Logged | Report this post to a Moderator
gambler
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Everyone told me I should get a port. I got a PICC.

I just didn't want an operation. I didn't want a scar. I do lots of stuff I am not supposed to do (although I did decide that bowling was not a good idea). I guess I don't shower that much.

My PICC is on my inner bicep too, I would say the worst thing about the PICC so far has been because of my rather large chest. The exit of the line is at the absolute worst place, and gets sore. I cannot imagine how unpleasant it must be for someone who is heavyset.

Also, I have used a stat-loc that is breathable, and that helped with the reaction.

gambler

Posts: 243 | From chicago | Registered: Dec 2005  |  IP: Logged | Report this post to a Moderator
jeffsdad
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hshbmom, I can answer a couple of your questions.
Insurance did pay for most of the procedure (bcbs), I believe the procedure was a couple of thousand and insurance (bcbs) paid most of it.

My son is on his third line in just over a year. First one was removed after initial treatment ran out and we were dealing with insurance to extend treatment - of course that never happened so we're paying out of pocket. Second was pulled because it looked like the site was infected, however based on hindsight it was most likely a localized skin reaction. The third is fine except for the skin reaction we are now dealing with.

My son thought the first picc placement was somewhat painful during the procedure, but he really hates getting stuck so that was probably a large part of the discomfort. The post-procedure discomfort was handled with otc pain meds. However, after the procedure the nurse indicated he could have received some meds before the procedure to help him "relax".

For both his second and third piccs he got a script for (I think it was) Valium which he took before the procedure. This helped greatly.

A "benefit" of the picc line is you can the blood drawn through the port on the line. He gets frequent blood samples and pulling it through the picc is so much better than getting stuck all the time. The only problem is the lab where we take it said they would not do it that way, so my wife (an RN) gets all the tubes, labeling, etc. from them, draws the blood and then drops it off. When he visits the LLMD they also use the picc access. You may find a lab that would cooperate.

I am not sure whether this can be done with a port - perhaps someone else can chime in.

Posts: 36 | From nj | Registered: Sep 2006  |  IP: Logged | Report this post to a Moderator
lymeinnh
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Yes, you can absolutely have blood drawn through a port as well... a wonderful side affect [Smile]
Posts: 33 | From Lebanon, NH | Registered: Oct 2006  |  IP: Logged | Report this post to a Moderator
LymeLaura
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My daughter had both a port (two times) and a several piccs. She much preferred the port, however, we now find out there are adverse issues with a port as well. She has stenosis (narrowing of the artery) which the cardiac surgeon believes was caused by her original port (left in for two years). He says that it is her bodies reaction to a foreign object.

Just a reminder that there is a down side to every treatment.

I strongly agree with the poster who recommended IM bicillin. Much fewer adverse effects all around, IMHO.

Posts: 131 | From Kentucky | Registered: Dec 2004  |  IP: Logged | Report this post to a Moderator
   

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