Has anyone had a clavicle (upper chest wall) port removed under local anesthesia after it's been in at least a year?
My oncologist told me this is an easy procedure, and that they do this in the office with a local anesthetic, but this is the same group that recommended ibuprofen for my chemo pain, so I'd appreciate advice before I decide to go along with this. (Being fair, I was tremendously constipated at the time. But I also expressed concern about taking 800 mg of Ibuprofen at a pop when I'd been dealing with reflux for over 10 years.)
I wonder why the port had to be inserted with light general anesthesia, but after it's been there for over 18 months with the possibility of tissue attaching to it (I haven't had blood return for at least 6 months.), there shouldn't be a good bit of pain attached to yanking it out! I'd love to hear this is true; just don't trust this idea without verification from my sisters.
Also, ladies, I had clear cell, but have been NED for a year (depending on the outcome of this latest CA125). Has anyone had a port removed then been successful with having another one inserted when they had a recurrence? I'm believing I'm going to be in the blessed non-recurring percentage, but want to be wise about this.
Thanks.
I hope you ALL have a wonderful day.
Verlinda
Thanks.
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Port removal
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27 replies
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- By Jaywalker
- Posted November 19, 2008 at 5:38 pm
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Verlinda - I can't speak from experience but my mom had her port near her clavicle. She had this for almost a year and decided to have it removed. She had no problems. Minor discomfort. She has since had to have one inserted again (this time on the other side) and no real pain. I believe if you have the right surgeon doing it, there should be no problems. Good luck!
- By verlinda
- Posted November 19, 2008 at 6:15 am
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Ladies,
Thanks so much for all the information and support. I especially want to thank my RN and MSN sisters for listening to my fears and not being insulted for their profession. My mother was a nurse, so I think I tend to put all nurses on a pedestal.
I just got back latest my CA125 results. I've been at 16, my lowest ever, for over a year. This one was 18. I'm trying to remember all the advice and information I've read here (and given!), and know this could just be a fluctuation, but you all know how that goes! Anyway, I'm certainly not removing my port this visit!
Now I guess my choice is "Do I stay at a place where the oncologist is absolutely outstanding, but I hate the isolation of their private-room-only infusion centers and their impersonal attitudes? Do I transfer to the other cancer center in the big city?
Nurses, frankly, my question is, "Are my records going to show me as a major attitude problem or neurotic patient? If I go to the other place, has charting at this office been done in such a way that the new office will view me as a patient with an attitude?" If so, will it do me any good to leave where I am now?
- By sblakeley
- Posted November 18, 2008 at 11:53 pm
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Actually now that you mention it had this done on 11/14. They used a local anesthetic and i was lightly asleep. I'm a weenie so i didn't want to be awake during it. Also i have had almost no pain from this removal!!
- By PamRn
- Posted November 18, 2008 at 2:56 pm
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Verlinda
I still have my right subclavian port in after 13 months. I'm just not ready to get it out. I keep thinking I might need it again. At my gyn/onc's clinic they send you to the lab first, where they access your port and draw lab. Then you go on to the ct or whatever you are having done. Mine still works great, although it does cause some discomfort at times if I move the wrong way. I guess I will keep it until there is a real good reason to get it removed.
Pam
- By Freedie22
- Posted November 17, 2008 at 10:02 pm
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Verlinda--sorry to post so many times, but I keep thinking of things as I read yours and others' replies. The problem with them not using the port for a CT/MRI, etc. is probably not that they are unwilling, but usually (at least in PA) only an RN is able to access any type of central line/port. Most CT/MRI, etc. suites do not have a nurse available to access the port. You could see about stopping by your physicians' office prior to a scan and having them access the port and possibly the CT/MRI tech will be able to use the port. You'd have to check with your physician and whomever is doing the scan, though. In the hospital, the phlebotomists (people who draw blood only--are not allowed to use any type of central or arterial line, so the nurses do it and send the labs ourselves).
My mom used to get butchered everytime she went for bloodwork and I used to get so angry. I actually sent her to the lab with the port accessed; however the lab still wouldn't access it as they said that they were still Not allowed to use the port.
Your physician was right in saying that it can be used all the time for any time of blood access or to infuse any med (not just chemo) through. Unfortunately, it's just that there isn't a nurse available where CT's, etc. are done.
- By Freedie22
- Posted November 17, 2008 at 9:53 pm
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laughing Nikki/Verlinda,
Ports are often put in by a radiologist in the IR suite as you mentioned. This is usually done with fluoroscopy (a kind of glow in the dark dye is injected and they look at a monitor as they guide it in to place). My mom had her first port placed this way in her left arm--she had a lot of trouble with it and it eventually had to be removed. When she had her next port placed--I asked that it be placed in the chest wall and done by a surgeon.
Most IR suites are extremely competent at placing these as well as other devices. I worked at a Neurosurgical ICU and we had INR (Interventional NeuroRadiology). I think my mom just caught a bad break with the 1st one--I really don't think it was placed correctly.
- By Freedie22
- Posted November 17, 2008 at 9:46 pm
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Verlinda,
I wanted to put this post separate because it deals with such an important issue. We are taught that pain is whatever the patient says it is and we are to treat it whether we think they're faking or not. The pain scale is how nurses/physicians judge your level of pain. What you described is NOT a 3, probably closer to a 7 or 8 (moderate to severe pain). Usually 0-2 or 3 is considered mild pain, 4-6 or 7 is considered moderate pain and 7 or 8 to 10 is severe pain. Often the MD's orders are written to give one drug for mild to moderate pain (maybe Tylenol or Ibuprofen) or give a different drug/dose for moderate to severe pain. The pain scale is supposed to go from 0, meaning NO pain through 10 meaning the worst pain imaginable. If you're underreporting your pain, you may not receive adequate treatment to achieve pain relief. I'm still not defending how that nurse and your MD treated you--I'm just letting you know how to try and prevent it again. Also, you have the right to refuse any drug for any reason--when you told that nurse that ibuprofen irritates your reflux, it was her responsibility (as your advocate) to discuss this with the physician for a recommendation for something that wont aggravate the reflux or intensify the constipation (although--not too many drugs--maybe Tylenol) or to give you something with the ibuprofen to protect your digestive tract so it doesn't get irritated or give you something with a narcotic pain med to prevent/relieve constipation.
Colleen
- 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
- 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.
- 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.
- 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.
- 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
- 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
- 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
- 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
- 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
- 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
- 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?
- 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.
- 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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