My port has been infusing really slowly even at the highest pressure/rate. Has anyone had this problem?
Details are:
Port surgery 12/23/06
Difficulty getting blood at the first home health care visit
I turn the regulator up to 2 liters/hr to infuse 250 ml in 2 hrs
Home health nurse injects flushing agent to clear line on a Sat - no luck
Home health nurse comes to change dressing and gets blood from line
Meds infuse at proper rate 250 ml in 2 hrs on 125 ml/hr setting
After two or three days, port slows down again
Today it's taking over 4 hours to infuse 250 ml at 2 liters/hr and I have to push the syringe against a table or a wall in order to generate enuf pressure to force it into the line
Fluoroscopy today shows nothing unusual; venogram (after three tries - ouch! novacaine doesn't work on me!) shows catheter tip up against wall of vena cava
Imaging doc sez it's consistent with the history I gave - he said you can envision the flush dissolving any clotting that may have adhered the catheter tip to the vessel wall thus freeing it up
LLMD's nurse sez to contact surgeon about how to solve this
I miss surgeon's call and he leaves a message saying that my port is fine and that we just need to flush it before infusions and blood draws and to draw back gently.
Aargh! Obviously he doesn't understand that taking four hours to infuse ain't gonna work (in my life) and probably won't work for long. So I'm not feeling very comfortable with his advice. Maybe it will good more smoothly when I can explain it to him.
I'm tired and drained due to this, poor sleep for two nights and dealing with my 3.5 y o son's positive Bart and HME test from last week. Does anyone have experience with dislodging the tip of the port catheter without more surgery?
Thanks, Denise
Posts: 261 | From San Mateo, CA | Registered: May 2005
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posted
Hi Denise, 'Cathflow' or the likes can be injected in line, sets for about a half hour and then flushed. A doctors order will probably have to be written for the medicine.
Posts: 13 | From ohio | Registered: Nov 2005
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savebabe
Frequent Contributor (1K+ posts)
Member # 9847
posted
Yes this has happened to me. Just call your llmd and they will prescribe a script that injects in your line and clears the blockage.
Posts: 1603 | From ny | Registered: Aug 2006
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I agree with the others get your line TPA'ed by your home health nurse, and then try putting heatpacks on your muscles that surround the port and cathater area.
While the area is heated and relaxed stretch and rotate your arm neck and both shoulder s as fully as you can.
I have been where you are! I hope this helps!
Most important.... Don't worry! In the big picture it's going to be ok!
Let us know how it goes and keep asking for help!
Posts: 663 | From NH USA | Registered: Sep 2004
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posted
Thanks for all the replies. Sorry, I oopsed. The flushing agent I was referring to is the TPA, cathflow or clot buster you all mentioned. (My lyme brain wasn't able to access the words.) I can't be doing that every week.
Achey, I'll definitely try doing the technique you suggest. It sounds perfect for my situation.
Update is that tonight I pushed the huber needle harder into the port while I infused and was able to infuse in 2.5 hours. Pretty good improvement. I think my dear home health care nurse didn't get it in so well. The nurse more at ease will be placing the needle Monday, so hopefully we'll get that set well.
Surgeon sez he can replace the port under a general (he likes to use a general to reduce risk of lung puncture due to patient movement) or the doc who did my fluoro/veno can put in a port in my arm under a local.
Do any of you know if ports are typically stitched in place? One LLMD suggested trying to move the port manually from outside the skin to help pull the line away from the vein wall. It would have to move quite a bit as the line has quite a bit of curve and play from what I saw of the venogram and fluoro.
LLMD apptmt tomorrow so we'll see. Now I'm doing all the research I should have done before about ports, PICCs and graushongs (sp?). I found a really good article on placement of the tip of the catheter to avoid problems. I love pubmed.
Thanks again for the help and I'll keep you updated. Denise
Posts: 261 | From San Mateo, CA | Registered: May 2005
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stymielymie
Frequent Contributor (1K+ posts)
Member # 10044
posted
mine were all done in hospital with local floro and sutures. i've had three.
docdave make sure they use a deep vein not on the surface. my radiologist used ultrasound to find a deep vein. spuerficial veins are more friable, and don't hold up for lon term picc lines.
plus it needs to be abosolutly sterile since the end goes near the heart.
docdave
Posts: 1820 | From Boone and Southport, NC | Registered: Sep 2006
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Well, I finally did the research I should have done before I had the port put in. Having a line against the vein wall can be verrry dangerous sooo tomorrow (friday) I'm having a port put in my right arm. One LLMD refers to this as a passport and it's about the size of a thumbnail.
Turns out that there are fewer complications with going in through the veins on the right due to the physiology/orientation of the veins on the right versus left. Since I'm more ambidextrous now due to some loss of function in my right hand for periods of time (due to Lyme) I don't consider the right side to be a problem at all.
It'll be done with a local and "twilight."
Liver numbers are up so I can't infuse anyway 'til they come down. Strange since they look like the elevation seen with alcohol but I don't drink at all. (Didn't get my copies of the labs due to Lyme brain. Ugh.)
I feel so buffetted around I'm going numb. Sleep will be good.
Thanks for all your support and I welcome any more advice/comments.
Cheers, Denise
Posts: 261 | From San Mateo, CA | Registered: May 2005
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posted
My new PASPort is up and running very smoothly. Yay!
While I like that it's running well, I did like the two-handed access I had to my chest port. That makes putting on Aqua Guard before a shower easier and I was able to deaccess the port all by myself. Now I have to have someone hold the port while I removed the huber needle. I also feel more restricted mobility-wise. If I stretch my arm out to reach for something, it pulls on the huber needle and makes the area bleed a little. I did not have that problem with the chest port.
Since it was second time around, I am glad I didn't have to go under again. In addition, the doc did a fluoroscopy so he knew exactly where he placed the catheter tip: in my right atrium. Not sure if he did the fluoroscopy while he was placing the catheter or after. And I felt much better post-op since I wasn't put under completely. While I know some surgeons will place a chest port with a local, my surgeon said there was a risk of lung pucture when the patient is not put out and immobile. My SIL's mother had her lung punctured when having a port placed for chemo. Could you imagine adding an uplanned hospital stay to illness?
I'm just putting the info out there for those who might look at this topic when deciding on central line options.
Cheers, D
Posts: 261 | From San Mateo, CA | Registered: May 2005
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