1) I only have one good vein left. It's in my right arm (I'm a righty) and it's my blood draw vein. My LLMD said that's where the picc would go and I'd have to have blood drawn every two weeks from my hands (ouch! ). My hand veins are really really terrible, too, so I don't know if that would be possible. With a port I could not only keep my good blood draw vein in tact but also get blood drawn directly from the port if the doctor and nurses agreed to it. If not, at least I'd still have my good vein. If the picc line placement went wrong and the vein blew, I'd be up the creek without a vein.

2) I had trouble getting my last picc put in. My veins are hard to find and also branch off a lot. After two tries by two different nurses, one on each arm, I was sent to the hospital to get one put in with dye contrast so they could see what they were doing. This would have been fine but I ended up being allergic to the dye and had a horrible time with the whole thing. I'd rather not repeat this but I don't know what the chances are of getting a line put in without the dye. I know a port is a surgery but I don't think it would be much worse than the picc line placement ordeal.

3) I'm going to be pulsing the Rocephin, four days on three days off a week. With a port I would be able to deaccess and be "normal" for the days off. Not so with a picc.

4)I'm going to be on the Rocephin for at least four months. Who knows if a picc would last that long.

5) IF insurance decided to stop paying for the IVs I could take care of a port a lot easier myself than I could with a picc.

My LLMD said if the picc didn't work I'd go for a port but I'd rather just skip the picc and go straight for the port. So I'm wondering if I should call the doctor tomorrow and really push for a port. I didn't want to rock the boat at the last appointment but I probably should have pushed a little harder. I feel very comfortable with this doctor and she is definitely putting me on IVs so I'm not worried about her taking that away now. She looked at my arms and saw that my veins are bad and I told her about my bad experience with my last picc placement and she seemed sympathetic. Should I push the issue? Or just try the picc and see how it goes? I'm also babysitting this summer (one afternoon a week) and working with kids at a morning camp so a port would be much easier to conceal and I wouldn't have restrictions on picking up kids (or gallons of juice, etc.) What do you all think?

Thanks for any input (and for making it through the long post).

--Annie

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``The best way out is always through.'' -Robert Frost

I've realized that with dr. appointments I often end up not getting exactly what I realize I want after the appointment. I need some time to organize my thoughts, think things through, and come up with well thought out reasonings for things (like this post) before I can really make a decision on things and at a dr. appointment there just isnt' time for that. It would be nice to have the first 2/3 of the appointment, then have a break to think things over and then come back for the rest of the appointment and decide what to do. This would be helpful for me, anyway. But, I guess I'll settle for being able to call the office with questions and concerns afterwards.

Out of curiosity, how long does it generally take to have a port surgery scheduled? A week? Two weeks? And is it usually available at local hospitals?

Thanks again.
--Annie

Thanks for the responses. I've decided to write a letter and fax it over to her office tonight (I leave early tomorrow morning for my trip). I think this is easier than calling her office because I can get all my thoughts down together and she can have time to look it over and decide what to do. I basically took my post here and adapted it while keeping all the points I made on here so I think I have a pretty good arguement for a port.

Lyme ED, thanks for the suggestion. The ability to deaccess a port is one of the reasons I would rather have it over a picc line so I'm going to stick with a port.

Lymelighter, yes, Dr. H is my LLMD but it's not the Dr. H in NY. She's in Newton, MA.

--Annie

I would say be cautious about "caring for it on my own" The infection risks are there with a port as well. I've personally never had any problems with mine, but I have professional nurses who access it, and they are EXTREMELY careful about cleanliness (they use a sterile-wrapped dressing kit that has sterile gloves enclosed and basically the ONLY thing that touches my port besides the needle is contained IN THAT KIT). So do make sure everything is sterile no matter whether you have a port or a PICC.

Also...I had horrible veins when I got my last PICC put in. The nurses didn't attempt to do the PICC after looking at my arm. They sent me to radiology. However, they never had to use a dye....they ultrasounded (maybe they already tried this with you?) my arms all over and found a 2mm vein in my upper arm....then with a tourniquet they got it to just about 3mm...they used a permanent marker and marked the place where they found it...and went from there. It was kind of scary to have all those people surrounding me and working on my arm, but....it DID work. So, if your concern comes from your veins and you end up going with a PICC, you ought to suggest having it put in with ultrasound.

Also....my PICC lasted about exactly 4 months and then it cracked where I bent my elbow all the time. That's when we scheduled to get my port put in since we knew I probably had no veins left and a port was more permanent. It has been really nice.

The drawbacks with the port: First, it's a surgical procedure to put it in, your under anesthetic, your a little sore for a few days. Second, Showering...when Im accessed I have to find a way to keep my chest dry while I shower...keeping my ARM dry with my PICC was MUCH easier....but I've figured it out..lots of duct tape

Drawbacks with the PICC: lifting...my arm got very sore and the muscles got irritated and hot if I used it too much or lifted too many things...this went on the whole time I had my PICC. Second, having it put into a 2mm vein when PICC's are recommended to be put in veins of minimum 5mm....was pretty painful....not during the procedure, but afterward. It was actually more painful than post portacath surgery.

Like you mentioned also....deaccessing during your days off....that'll be a very nice break. You do have to give it 24 hours (I believe, though it COULD be 12) after your deaccessed to have it exposed to things, but waterproof bandaids work pretty well during the waiting period. And a strip of duct tape over that should keep it dry in the shower. You do run more of a risk of infection when your accessing/deaccessing more often. But with good care I'd think you would be okay. I get deaccessed, cleaned, and then reaccessed once a week.

Anyways....good luck with your decision....like I said, I love my port. There are drawbacks to both but it's been nice and I'm able to be more active (my arms are free) and I can deaccess at times where I don't tolerate my medicine or whatever....or just to take a weekend break and go to the lake

Hope it all works out for you!

Thanks so much for the great and very informative response. It helps me make a decision if I can hear other people's experiences. I will really do what I can to get a port. I really would rather go that route now instead of waiting for a problem to arise in my only good vein. And with the pulsing it does seem very ideal.

I would only care for the port myself if my insurance stopped paying so we could save on the cost of having a nurse do the changes. I know the risks of infection are there and I would be very careful about that. I mostly just meant that I would be able to reach it with both hands unlike with a picc. I would only do this if absolutely necessary and only after learning how to do everything from a nurse.

When I had my picc in I didn't have an ultrasound done first, they just went straight to the dye. I think actually the bigger problem with me wasn't actually finding the vein (although that took some time, too) but navigating through the branching off of my veins. The first few times they tried it got stuck about four inches in because it hit one of the branches off and got stuck. That's why I'm afraid it wouldn't go in without a dye.

I just have one question for you (right now at least) - do you have blood drawn through your port? This is one big advantage I see of a port over a picc. I'll be having survelience blood tests every two weeks while on the IVs and although I could handle getting the stick in my arm for the blood draw it would seem very nice to not have to do that.

Thanks so much again! BTW, I'm in Oregon right now visiting my sister (in Eugene).

--Annie

i hope your vacation is going well, i also have had both 2 ports and 4 piccs i now have a port which i love they do draw blood off of it every week for labs i am on coumadin ask your md about a blood thinner if needed if i don't have a blood thinner i get clots, when they took out my last port due to a blood infection that was discovered witha severe herx that landed me in the hospital with temp of 104.8 they had to take the port out however the infection was not in the port, they tested it and it didn't grow anything. i then had a picc line in which lasted for 1 month i only had one arm left they to used the dye but gave me mega doses of iv benadryl i had a reaction to the dye when they found my blood clot after having port removed it was in for 4 years. i then had another port placed last sept . working great, would your family learn to care for it if insurance did not cover, need to change the needle every week and apply a new dressing. I know i could not do that myself and i am a nurse. i can't have any more picc lines my last picc line took the radiologist 2 hrs to place cause my veins are so bad. they did this under ultrasound and dye.
good luck with your decision make sure they give you enough sedation so you don't wake up during the procedure my first one was not a pleasant exp. i was really nervous about my second one but it went very smooth didn't know anything till it was over. it was wonderful, pretty sore for about a week, used picc until it healed a little bit then itr was fine. good luck with your decision but if it is for longer than6 months that is probably your best way to go.

karen

I had a port for over a year. I loved it.

I had two groshong catheters, and one got so infected that I almost died! they put them in places that get sweaty, and a nurse touched the site with unclean hands!!!!!!!!!!!!!!

I too have horrid veins. I highly recommend the port! Wonderful invention!

Take care-let me know what you have decided....seems like you are leaning toward the portacath!