Port removal

• By momanderson920
• Posted November 15, 2008 at 8:47 am
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Verlinda, I had my port inserted supposedly under light sedation plus a local in an office vice a hospital. Supposedly they gave me IV valium and versid. Something went terribly awry as I never felt any sedation whatsoever and I kept telling the vascular surgeon as he began performing the procedure that I could feel everything. I have had versid for several endoscopes and a colonoscopy and it knocks me out almost immediately so obviously something was not right as I felt no sedation AT ALL. I felt every cut and was screaming at the top of my lungs for something to knock me out during the whole procedure and the vascular surgeon said he could not give me anymore because I was not in a hospital where he had equipment to intubate me in case of emergency. I suspect the nurse goofed up and did not give me the valium and versid because I felt absolutely no change and I took half a 5 mg Zanax on occasion during chemo and it made me woozy as I am very drug sensitive like my mother was...needing half the dose of most medicines than other people. I recommend you tell the doctor you insist that it be done in the hospital with sedation. Then you will be comfortable, have all the emergency equipment and staff needed in case of any problems. I think that doctor is insane. Why would it hurt any less taking it out given that it is probably imbedded in your tissues and muscle after all this time? I grow tired of these insensitive doctors who need to have some of these procedures done to them before they tell us what the pain level is going to be. I also was very sore afterwards and I will give the vascular surgeon credit in that he prescribed a fentanyl patch which I only took one day and switched to hydrocodone. But at least he was aware of the pain which I did have after the procedure.

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• By Freedie22
• Posted November 15, 2008 at 11:31 am
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MomAnderson,

I didn't realize that anyone could give a sedative dose (as opposed to a normal dose similar to your 1/2 mg of Xanax) of Valium &/or Versed without having a crash cart in case of emergency. These are both benzodiazepines and can drop your pressure. Xanax is also a benzodiazepine, which may explain why you didn't feel the full sedation as you may have built a little tolerance to it even if you didn't take it that much. I had a similar situation with Versed & Fentanyl. I had to have 9 upper & 1 lower teeth removed--I opted to pay 3x as much as my dentist to go to a oral surgeon so I could be sedated. I told the surgeon at my consultation, reminded him again the day of the procedure that I have a Benzo & opiate tolerance and couldn't understand why he was giving me a Benzo (Versed) & Fentanyl (opiate) instead of giving me the most commonly used drug for concious sedation Propofol (Diprivan)--Anyway, I was awake for the whole thing and the surgeon kept lying to me everytime I asked when I was going to go to sleep and telling me "soon". Turns out they had given me 15mg of Versed (normal dose to put you out is between 2 & 5mg). I'm sure my pressure bottomed out, which is why he didn't give me anymore or anything else. They had a blood pressure, heart rate & Pulse Ox on me--but I never thought to ask if they had intubation equipment or a crash cart--just in case. You've made a really good point that everyone should keep in mind. Fortunately, I was at least numb from the local (lidocaine)--so I couldn't feel the full effect--but I felt all the pressure and them grinding down my bone--Eechhh!!! I can't imagine feeling the pain you went through. Although, I have assisted physicians putting in & removing central lines (temporary-but usually goes through the same vein as a port) on concious patients. Some scream bloody murder and others remain calm and say it's not that bad. Pain is subjective & each individual needs to be treated for pain based on their own pain tolerance level--regardless of what the physician or nurse may think. This is drilled into your head in nursing school.

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• By Freedie22
• Posted November 15, 2008 at 11:53 am
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Verlinda,

Great news that you're ready to have your port removed!!! My mom had one removed from her arm in the gyn/onc's office-I don't think she had any sedation (I think just a local, prob. Lidocaine); however, her port was literally being pushed out of her arm. Also, her physician's office was in a hospital, so if there were any problems, she was prepared. MomAnderson brings up a great point regarding receiving sedation in an outpatient facility. It sounds like they're not planning on sedating you if they said they were just giving you local anesthesia.

Regarding having a chest wall port removed, I believe the risks would be the same (possible pulmonary pneumothorax or hemothorax--collapsed lung if it is punctured during the removal). The physician will do a Chext X-ray usually before you can leave to make sure this didn't happen. With sedation, you always have risks as everyone responds differently to different drugs and there's always a chance of an allergic reaction. I would check with your physician (the one removing the port) to make sure they're ok with you taking ibuprofen (Advil, Motrin, etc.) as it is a blood thinner and anytime I've had surgery I've been instructed not to take any aspirin or NSAIDS (Non-Steroidal Anti-Inflammatory Drugs--the class ibuprofen, advil, etc. are categorized in). I can understand them using an NSAID rather than an opiate due to the constipation--but they may change their mind when you remind them that your having your port removed. They may opt to give you something mild like Tylenol w/codeine, Tramadol, Darvocet, etc--these all carry risk of constipation; however, you can usually take a stool softener or a laxative prophalactically to prevent it. Colace (stool softener--Docusate Sodium 100mg twice a day) is almost always given in the hospital to anyone taking any kind of opiate to prevent constipation--but you should still check with your physician. Have you tried just regular Tylenol--is that effective enough? If not, they may recommend one of the other mild narc's I mentioned. If your pain is under control from ibuprofen, you shouldn't need too strong of a narc to control the pain.

Regarding the reflux--do they have you on any GI meds like Nexium, Protonix, Zantac, etc.? My mom had a ton of GI problems and took (at last count) 27 pills/day, she said Nexium was a wonder drug for her--treating her ulcers, hiatal hernia, esophogeal ulcers, etc.--leaving her pain free. Hope this info helps and I'll keep you in my prayers so you stay in remission!!!
Colleen

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• By zircons
• Posted November 15, 2008 at 1:38 pm
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I hope that the person removing the port is a surgeon. Ask them to do it in a surgical setting, not necessarily an operating room, but nearby. I am superstitious and do not want my chest port removed, so it is flushed every three months when I go for a checkup.

Protonix worked for me.

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• By momanderson920
• Posted November 15, 2008 at 4:28 pm
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Freddie, when I had my port installed, I had taken maybe 2 5 mg zanaxes total between Jan. 30 and the end of March when I had it done and my primary who prescribed it told me it was a very low dose and I was taking half of one and not the whole thing when I took it. I had built no tolerance to either valium or versid as I had an endoscope well after this and the versid knocked me out within a minute of injecting it in my IV. I think the nurse forgot to administer it since I felt nothing as far as drug effect. It doesn't take much to have an effect as I seem to be drug sensitive. All I know is that the vascular surgeon did it in an outpatient surgical suite which was part of an office and near no hospital. He told me when I was screaming in pain to be put out that they were not in a hospital and could not intubate me so he could give me no more IV meds for sedation. I think that nurse forgot to administer the IV versid and valium. I figure dental surgeons give you these IV drugs and are not in a hospital so I guess they can give it but have restrictions on how much they can give if you are not in a hospital. All I know is that I will never go through something like that again....I went through my radical hysterectomy for the cancer and was off the morphine within less than 2 days post surgery and other than the one fiornal that they forced on me, never took another narcotic for pain for my surgery. I don't have a low pain tolerance. I developed a postop infection and had to stay in the hospital on IVs for several extra days and did not require painkillers even then. I feel certain that somehow that vascular surgeon's nurse made a mistake. Even if it had not knocked me out I would have felt some sedation and I felt nothing. Something was not right. I was literally screaming for the surgeon to stop or knock me out. It was a nightmare. That is why I recommended to Verlinda to have it done in a hospital....safer and more painfree since they apparently can give you more medication for sedation safely. When mine is removed I am going to insist that it be done in the hospital or they are not touching me.

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• By Freedie22
• Posted November 15, 2008 at 7:43 pm
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MomAnderson,

I think it's a very good decision for you to not attempt any procedures outside of a hospital considering what you've gone through. You're right, the dose of Xanax you are on is really low--it's possible you're IV infaltrated (came out of the vein) and the meds were delivered into your tissue instead of your bloodstream. I'd hate to think that the nurse didn't give you the meds--As a nurse myself, I know I check my meds 3x before giving them to a patient and if you weren't responding to the meds, they should've checked to see if you're IV was okay.

I'm the opposite of you regarding medication sensitivity--I have an extreme pain tolerance--so much so, that I've had 2 potentially fatal (maybe even 3) infections this past year and I blew off the pain. They actually sent the surgeon home when I perforated my bowel because they didn't believe me when I very calmly told them that I was in 8/10 pain--then they had to call him back once I was scanned. I develop tolerances very quickly. When my mom died, I really fell apart--it took waking up in that ICU bed to pull me out of the heavy depression I was in. During that time, I began seeing both a Psychiatrist & a Psychologist. I chose to go to a Psychiatrist because my depression was being treated by 2 different MD's and I wanted one person to do it. Well, I didn't do well with that as the psychiatrist just filled me up with Xanax and tripled my antidepressant. My antidepressants were so high, he had to call my insurance company every month for approval--He had me on 6mg/day Xanax. I have a bachelor's in Psych and I went back to school when I turned thirty to get my BSN--I knew these drugs. My husband kept telling me to let the Dr. be the Dr. and for me to just listen to him instead of always challenging them. Well, that'll be the last time I do that. You really do have to be your own advocate. Fortunately, when I came out of the ICU, I got a new PCP and stopped seeing the Psychiatrist and the Psychologist. I was on such high doses of Attivan, Dilaudid and Morphine in the ICU, the nurses and the MD's couldn't believe it. My PCP got me down to 2mg/day of Xanax (which I really only take for sleep--I don't need it anymore). Anyway, my point is that you don't have to be a martyr--despite what happened to me, less than 1% of hospitalized patients become dependent on pain meds. Don't be afraid to use them when you need it. Even the Xanax is OK, especially at the lower doses; however, Xanax is a very addictive drug, so you just need to be careful (which you definitely have been).

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• By momanderson920
• Posted November 15, 2008 at 10:40 pm
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Freddie, I did wonder if that might have happened...that the medication didn't go into the vein. I didn't see any bubbles under the skin or have any unusual pain but perhaps it can go internally without causing one or the other. I don't know what caused it but didn't recall seeing the nurse inject anything into the IV, but it still may have been caused by a very legitimate reason. And I apologize for leaving out the decimal point on the zanax dose I take....it is not 5 mg but .5 mg of the generic and I take half of that .25 only occasionally. I have had alot of trouble with depression and know how horrible it can be. And I know what you mean about the addiction risk of zanax. I was given zanax after the birth of my third child for what was diagnosed as a postpartum psychosis though I have always suspected I may have had a mini stroke as a battery of tests revealed areas of brain deficit not consistent with postpartum psychotic or depression but I had had a negative MRI so the findings were left inconclusive. During this the psychiatrist had me on zanax 3 times a day for over a month and I had to be weaned off it which was very difficult. When my primary wanted me to take it I was apprehensive but I don't take it very often and only half a .5 mg tablet and he assured me he would not let me get addicted. So far I have not had a problem but I agree with you totally, when you are going through a difficult health condition whether it be pain killers, antidepressants, or tranquilizers, if you need it you should take it and not suffer. And something else I wanted to share with you....you mentioned you lost your mother and suffered terrible depression. I have great empathy as I lost my mother a year ago November 27 and it is a terrible loss. I pray you receive comfort as it is a terrible pain to lose your mom. No one loves us quite like our moma and as I am sure you feel, you miss her so much. Thanks for your posts and sharing your medical knowledge. it is most helpful.

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• By verlinda
• Posted November 15, 2008 at 11:12 pm
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Sorry I wasn't clear.

I don't take anything for pain now. Throughout my surgical recovery and all my chemo (finished a year ago), we fought over the pain issue. I was underdescribing my pain with the numbers but was giving enough details that, if they'd paid attention, the office staff should have caught it. I'd say 3, then immediately follow it with, "My legs ache enough that I don't get up to go the bathroom until I nearly wet the bed because it hurts so much to walk."

The ibuprofen recommendation was given me at my second chemo session when I said I'd had a good deal of pain, that I had fibromyalgia, so I was accustomed to pain and this was worse. I was avoiding narcotics as much as possible, so we were trying to determine what I could take. The chemo nurse told me to try 800 mg of ibuprofen at a time. I explained that I had been on prescription meds for reflux for over 10 years and didn't tolerate ibuprofen very well at the best of times. She told me to try it anyway. At the end of that lovely day when they asked if I had any questions and I again expressed my concern about the ibuprofen, she came back in my room, started literally yelling at me for questioning her judgment, then stormed out. Then the oncologist came back and chewed me out for "abusing his nurses." I was so stunned I just sat there like an idiot and took it.

Anyway, these are the people that told me they would remove my portacath in the office under local anesthesia. I obviously don't trust them about pain medications, and they obviously don't give up rip how much I hurt.

So, my two questions are: Is it SOP to remove a clavicle portacath under local anesthesia? The anesthesia is so mild they said I could come alone and drive the 45 miles back home immediately after the procedure.

Secondly, would it be wiser to leave the portacath in? How long was it before most of you had a recurrence?

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• By verlinda
• Posted November 15, 2008 at 11:25 pm
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Sorry about the venom about my pain meds. I still can't believe the nurse treated me that way and the doctor didn't even have the courtesy to say, "What seems to be problem?" but immediately blamed me for the nurse being upset.

We've since straightened out our relationship. He has a region-wide reputation for compassion and going way beyond the call of duty; I just seemed to bring out the worst in him. We get along much better now; joke around together, etc.

I just can't understand why the port had to be inserted under general anesthesia, yet it's safe to pull it our under a local. It seems to me after a year and a half that tissue would be attached to it and the physical sensation, at best, would be like ripping off a very thick scab that wasn't ready to come off.

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• By Artemis
• Posted November 16, 2008 at 4:36 am
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I was sedated when my port was installed, and I have no intentions of having it removed. What if you need it again?

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• By PattyKey
• Posted November 16, 2008 at 7:26 am
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Hi Verlinda. Congrats on NED. That's wonderful. I had my first port in for well over a year and then had it removed in the surgeon's office. No problem - I swear. Didn't feel a thing, except a little pulling and tugging. No pain whatsoever. I did have a recurrence and had another port put in the same spot a few years later, and have since had the second port removed. The second one was removed under sedation in an outpatient facility. Why? I don't know. Different doctors. When I told my onc. that my first port was removed in the dr.'s office, he seemed kind of surprised. To be honest, when the second surgeon wanted to remove the second port as outpatient, I was surprised because the first time in the surgeon's office was just no big deal. I even asked him to clean it up for me (there is tissue, etc. attached) so I could put it on my Christmas tree. I don't know, it seemed like a good idea at the time. (I also have no cancer activity and sometimes darn little brain activity as well. :-)
Best, best wishes for continued NED!! Patty

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• By OldieLocks
• Posted November 16, 2008 at 11:50 am
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Hi Verlinda,

A port was put in my left front shoulder before I left the hospital after debulking surgery in 2005. After chemo, I was in remission for 28 months and after about six months, the port was removed.

In July this year, cancer cells were present again. Before chemi, another port was put in my other side and it is called a Power Port. Scans can be done through this port.

There is no way under Heaven that they would have put either of these in without me being sedated (I mean out-of-it).

I didn't read all of the replies and I don't know a lot about different medicines for pain, but I can't imagine it being yanked out.

I hope you don't ever have a recurrence. It is really hard to hear after doing so well the first time.

Hopefully, our replies will help you and your doctor make the best decision for you.

Blessings to you,
Rachel

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• By Teresalynne
• Posted November 16, 2008 at 1:22 pm
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I also had a port put in in 2005 for the first time and it was down in 1 day surgery, had it removed in 2006 as an out patient without any problems. Have had to have another one put in this year as I had a reoccurnace and have nt had any problems. If you are not comfortable with them removing it in the office discuss with your doctor the pros and cons, but I did fine with mine. godd luck in whatever you decide
Teresa lynne

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• By pmiller
• Posted November 16, 2008 at 1:37 pm
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Verlinda, I still have my port in, one year now with no blood return for 6 months too, my surgeon told me when he put it in, it had to go in in a completely sterile area, (surgery) and taken out the same way, under sterile conditions in surgery. I would not have it any other way, it's my body and we are all sensitive to infection thanks to chemo. Hugz
Pam

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• By pmiller
• Posted November 16, 2008 at 1:39 pm
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I am so sorry for what you had to go thru. Sounds kinda fishy that you felt nothing, how was the nurse acting???
Pam

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• By laughingnikki
• Posted November 16, 2008 at 2:24 pm
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Hi my friend,

Couple things I'm curious about. Did the doctor suggest you having it out? I didn't have the option, I had to have my mine out. (just went and reread, and it seems that the doctor did order it out, so that's good)

Secondly, I had my port in the same place as yours AND had it put in and taken out with the INTERVENTIONAL RADIOLOGY (IR) group in the hospital. They did it under 'twilight' sedation. I had my mom with me, because I was tired after the procedure. It's really quick, came in 45 mins before procedure, took more time in prep than it took for the procedure itself. Then was in post op for about 45 mins after. I had no pain meds with it other than the sedation.

Ask, if you get do with IR guys at the hospital. I loved my IR team..just an aside.

Tell us what happens,
n

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• By verlinda
• Posted November 16, 2008 at 5:22 pm
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Thanks for all the input, y'all. The oncologist didn't recommend I have it removed, just told me several months ago it wouldn't hurt to leave it in as long as I get it regularly flushed. When I discussed this with him last visit, he said most patients got tired of having the port flushed and opted for removal about this time. It orginally was sold to me as one of those, "Every procedure requiring needles can be done through your port."

Someone forgot to tell the imaging departments that. They would never do it, and refused to call someone in the hospital who could do it down. One person would say, "Of course, you can have all this done through your port." Then I'd show up for the procedure and they'd say, "I don't know who told you that. That's not the hospital policy."

I could understand that the imaging doctors wanted to clearest possible pictures, so that wasn't a huge deal. It just irritated me that I'd been misled, since the oncology office is an adjunct of the hospital.

Anyway, I don't mind having it flushed every month. The biggest issue I have is taking the coumadin on an ongoing basis, and having to worry about the bleeding issues that accompany it. I'm not worried about bleeding to death, but I do handle papers done by 80 different sixth and seventh graders with all their cleanliness issues daily. I've been fairly fortunate with paper cuts, but when I get one I bleed and bleed!

I think I'll see what my CA 125 is this week, then discuss it again with the triage nurses before I make a decision. This sounds really selfish, but I almost want to get it removed, so if I do have a recurrence they can put in the newer Power Ports. Of course, that assumes I can get the oncologist to write orders that the technologists must use it.

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• By momanderson920
• Posted November 16, 2008 at 7:15 pm
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Verlinda, I empathize with your quandry over removal. And dealing with the coumadin issue must be very anxiety producing. That is alot to deal with. My oncologist told me to keep mine a year and if no recurrence I could consider removal. She however said only chemo infusion was allowed for my port, so I had everything else done through my arm or hand veins. I would be interested in knowing what the Powerport is. Mine is a double phalange mediport in my upper right chest wall. I don't know alot about other options. I pray you can make a decision and it goes smoothly.

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• By Freedie22
• Posted November 17, 2008 at 9:16 pm
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Pam--you can have sterile conditions outside of an OR. I've assisted on many bedside procedures that were completely sterile. Every time your port is accessed for chemo or anything else--it is done under sterile conditions.

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• By Freedie22
• Posted November 17, 2008 at 9:36 pm
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Verlinda,

Sorry I misunderstood you about the ibuprophen. What that nurse and your MD did was completely unacceptable. I've had some really poor nurses during several hospital stays and I always chalk it up to their having a bad day and I'm a difficult patient (nurses don't like to have nurses for patients, we ask too many questions!). We're all human and have good days and bad; however, what you described is deplorable and an embarrassment to the nursing profession (the physician profession as well--but I can't speak for them). I would think you could ask the physician to place you on Colace twice a day and take a light narcotic or even a moderate--depending on the level of pain you're in. This should prevent constipation. If your constipated currently, I'd ask your physician if you can take a laxative (Miralax works very well--not painful--I had to give it to my 8 yr old daughter last year every night for several months--The pediatrician assured me that this was safe and she shouldn't become dependent on a laxative to move her bowels), possibly an enema or suppository if the laxative doesn't work. I'd make sure you were not constipated going into the procedure and if your physician approves the Colace, you should be okay to take one of the lighter narcotic pain meds I mentioned in a previous post or even a moderate pain med (like Percocet 5 or 10/325 or Vicodin/hydrocodone 5 or 7.5) for a day or two if you need it.

I believe they've described giving you a local anesthetic, probably lidocaine, that they'll inject to numb the skin where they'll make a small incision through which they'll remove the port from and then put maybe a few stitches in to close the incision. I don't believe you'll feel the incision due to the local--you may feel some pressure & pulling as it is pulled out. I'd imagine If there is anything obstructing removal of the outside portion of the port (where it is accessed--basically the lump you feel under your skin), they'll detach it from the port before pulling it out. The other end of the port is in a blood vessel which really shouldn't have anything attached to it. I believe it's pulled out pretty quick--whereas when it's put in, it is a much longer process as they have to be careful to place it properly, which may explain why they sedate for insertion, but not always removal.
If you're uncomfortable with not being sedated, you can ask your MD to give you something to relax you (Attivan, Valium, Versed, Xanax etc.); however, I wouldn't drive home after taking these if you're not used to them.

If it were me, I would want to have the port removed in order to stop taking the coumadin. While you are on a low dose--it's still a risk/benefit ratio. The bleeding risk is higher than the need for the port right now. They can always put another port if recurrence occurs. Hope this helps.
Colleen

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