Cancer patient opts for surgery to save veins
by Paula Levy
published: August 6, 2003
Rosanne Himmelman never makes a decision about her cancer treatment until she's completed extensive research. For the past month she's been contemplating whether having a Port-a-cath installed was right for her.
The device is surgically placed under the skin just beneath the collarbone. Halifax oncologist Dr. Danny Rayson describes it as a complicated IV. The disc-shaped device has a tube that is tunnelled into a vein. It allows blood to be drawn, medicines to be given without having to access a vein by the conventional IV, he says.
Rosanne admits that she tends to focus on the smaller things regarding her treatment because sometimes the "big stuff is too much to worry about. Of all of the things I've had to deal with cancer, the IV is the most daunting for me."
As well, after extensive use of Rosanne's veins in her hands to administer the chemotherapy treatment, it has become increasingly difficult for nurses to start IVs.
"I've had 28 treatments and my veins are starting to harden," says Rosanne. "I just want to save my veins for bloodwork and CAT Scans. I could push for more chemo treatments with my veins. I could probably do two more rounds with it, but it will further deteriorate them."
Dr. Rayson says hardening veins is not uncommon for chemotherapy patients. He says chemotherapy treatment can cause scarring over time.
However, making the decision early in the process enables Rosanne to continue to feel in control of her treatment.
"I wanted to do it while it was still an elective surgery for me ... while it was still my decision," she says. As part of her research, an oncology nurse arranged for Rosanne to meet a woman who already had a Port-a-cath. Because of the location of the device, it was important for Rosanne to have a woman's advice.
After her research was completed and she was completely comfortable with having the Port-a-cath installed by general surgeon Dr. Joan Proctor at South Shore Regional Hospital, Rosanne waited for the appointment.
The day finally arrived for the 30-minute procedure in the Day Surgery Department. The procedure would see her admitted in hospital for only about five hours.
||Oncology nurse Charlene Demone accesses Rosanne's Port-a-cath for the first time. Paula Levy photo
After being made comfortable by nurse Margie Hubley, Rosanne then met with an anesthesiologist. Although the procedure can be done under local anesthetic with IV sedation, Rosanne opted for general anesthetic so she would be completely asleep during the surgery.
Dr. Proctor explains that a thin flexible catheter is tunnelled through a vein under the collarbone. Its intended destination is the vein above the heart.
Dr. Proctor uses an X-ray machine in the operating room to gauge the progression of the tube and ensure that it is in its proper place.
"You don't want to get too far down and lead it into the atrium of the heart. Once you get it to the right place, you cut it [catheter] to the right length," she says.
Dr. Proctor then makes an incision to create a pocket underneath the skin just below the collarbone and further down from the first incision for the catheter. The port is then anchored in place by stitching it to the muscle. The catheter is tunnelled down so it can be clipped to the side of the port. At the top of the port is a diaphragm and puncturing anywhere inside that circular area, any Port-a-cath-trained nurses are able to start an IV. Dr. Proctor says the diaphragm can take over 2,000 needle pokes. In fact, she says she's known patients that have had the same port for over four years.
Once the incisions have fully healed, the patient can carry on normal activities because the entire device is under the skin. The only evidence that something is there is a small lump just below the collarbone.
"What they [nurses] do when they access this is they feel for that lump and if they hit anywhere in that circle, it will work," says Dr. Proctor pointing to the diaphragm. "It doesn't matter if you're way off to the side, it's still going to work. And it [needle] won't go through because it has a titanium background."
While not in use, Dr. Proctor says the catheter is filled with a blood-thinner solution so blood cannot back up into the tube and form a clot. When not on chemotherapy, Rosanne will have to have the Port-a-cath flushed with the solution at least once a month to keep it operational.
Dr. Proctor adds that if the port causes problems it will have to be removed. However, she doesn't anticipate it will cause Rosanne any trouble.
"There's risks with everything we do but it's a pretty safe device. If it wasn't working very well we wouldn't use them obviously because these patients have been through enough. They don't need something that's going to give them lots of trouble," adds Dr. Proctor.
Just one week after the procedure, Rosanne's Port-a-cath was accessed for the first time when she began her second round of chemotherapy. After using a cream to deaden the skin above the port so she wouldn't feel the needle puncture, the oncology nurse was able to start an IV with no trouble.
"My only regret is that I didn't do it sooner," smiles Rosanne.
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