New Port- line occlusions

[Jane]

This is all new to me. Josh's port (or the line) is becoming occluded several times during his doses of IVs. The nurses said it could be that his tissue is still swollen, or that the needle is placed too far in (close to the back of the resevoir) or it could be the wrong needle all together. It gets better when he moves position but it is terribly uncomfortable and inconvenient.

He's really discouraged because the new port was suppose to solve his IV problems- not create more.<img src="i/expressions/face-icon-small-sad.gif" border="0">

I'm sure some of you have ideas for us to try.

Thanks!

 

[CowTown]

Hi Jane, the only thing I've heard of when ports aren't working smoothly is that it means they're blocked due to not having used heparin. Could this be? Or the other thing is with mine they weren't able to draw blood from it and the nurse thought maybe the cathedar was up against a vein or blodd vessel and then when you draw and suction for blood, the cathedar suctions on to the vein. She kept wanting me to move around and cough to try and get the cathedar in a different place so that things ran smoothly. It didn't work for me....never got blood. This is different than your situation though I know, but I wonder if your cathedar is up against a vein. I don't know.

From what I've heard is the port needle is suppose to go all the way to the back of the port box/thing. Since the needle is tapered I can't imagine it won't work b/c it's all the way in. The needle I had right after they put it in was super long too. It stuck out far from my skin but was in all the way. Once I got home, they ut in a smaller size (3/4" length) which fit me perfectly.

I don't think it's a good thing if it's "terribly uncomfortable" although the whole thing was painful for me for about 5 days.

What does the doctor say? Did the surgeon come in afterwards to make sure Josh's port is working well yet?

 

[Jane]

Thanks Kelly,

I'm glad to hear there is a smaller needle- this one sticks out almost an inch! Josh is not in pain and is not uncomfortable with the port itself, just the awkward positions he has to get into to avoid occlusions. Who decides what size needle he gets after he comes home?

The surgeon came twice to check things out. I don't think its blocked because it flushes fine, it just that the pump shuts off a lot during infusion. We'll see how it goes.

 

[CowTown]

If it flushes fine...I would ask for another pump. See if the pump he's using is just old or seen better days. Maybe that's all it is. Some machines definitly become 'sensitive'. As long as it's flushing fine....I wouldn't worry about the line.

After the 1st week he has his port, they'll have to change the needle. They change it 1x a week while you're using IVs. Tell your nurse (if you're still in the hospital) when that week is up that you want them to use a smaller needle and they'll need to gauge which size should fit him. For me 3/4" fits nicely. In the hospital they had probably a 1-3/4" on me too. I guess it depends on how much meat there is on every person's chest.

Once he gets home, you'll have to line it up with the home care for them to send you a range of hubber needle sizes, since the one in the hospital was super long. My home care was very familar with this situation.

Good luck!

 

[littledebbie]

I had mine not work because the needle was too long.  if it
hits the back of the port it won't work right.  I'd say ask
for a smaller needle.  they always headed for a longer needle
for some reason with me and I would have to say it only requires a
3/4 I swear.  <br>
Don't give up hope yet.  I'm putting money on the needle is
too long.

 

[kybert]

hmmm. i cant remember if you said whether it was placed in the subclavian or jugular, if you said it at all. do you know where the catheter was placed?

 

[thelizardqueen]

Funny - when I had my picc, the nurses couldn't draw blood out, but I was getting my meds in. They kept giving me dose after dose of heparin, but to no avail. The nurses said that it may have been because the line was up against a vien or vessel like Kelly mentioned.

 

[Debi]

I haven't had a port, but did have a similar experience with a PICC. It kept getting occluded, and the nurses would tell me to move my arm or reposition myself. I kept telling them to try a different pump. Finally one nurse actually listened, tried a different pump, and lo and behold, no more occlusion. I don't know if that's the case here, but if they keep trying to solve the problem by having him contort his body, I'd definitely push them to try another pump. It's a pretty simple experiment, after all.

You are your sons are always in my thoughts. You've been through so much in such a short time period, and always keep such a positive outlook. I really admire your family.

Debi
54 w/cf

 

[Jane]

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>kybert</b></i>

hmmm. i cant remember if you said whether it was placed in the subclavian or jugular, if you said it at all. do you know where the catheter was placed?</end quote></div>

I didn't say because I didn't know. I just went back to look at the discharge papers and it wasn't there. I called the hospital and the nurses just told me its in the subclavian. They also said THEY had trouble flushing too and wondered if they should have changed the needle before he left. They decided it would have caused him too much stress. (like this doesn't) They did recommend changing the needle and said with a low-profile port, the needle should only be about 1/2". What I can see (under the dressing) of this needle is WAY more than that.

Nothing's easy.

 

[kybert]

hmmm. get the docs to look into pinch off syndrome as the cause. heres something that can explain it well. <a target=_blank class=ftalternatingbarlinklarge href="http://www.venousaccess.com/complications.htm#Pinch%20off%20syndrome:">http://www.venousaccess.com/co...inch%20off%20syndrome:</a> get it checked out asap.


p.s. lol, just realised thats the second time ive 'hmmm'ed. i feel silly now lol.

p.p.s. tell josh to take a deep breath in and relax. anything that can go wrong with ports can be easily fixed despite being a pain in the a hole. trust me, i know hahaha.

 

[Jane]

OMG that's scary stuff. Let's hope its the needle size.

Thanks for the info Kylie.

 

[Jane]

...just an update...

The nurse is coming out tomorrow to change the needle. Our nurse practioner asked for a 3/4" one, so we'll see how it goes. Hopefully it will get better.

 

[Jane]

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>littledebbie</b></i>

I had mine not work because the needle was too long.  if it
hits the back of the port it won't work right.  I'd say ask
for a smaller needle.  they always headed for a longer needle
for some reason with me and I would have to say it only requires a
3/4 I swear.  

Don't give up hope yet.  I'm putting money on the needle is
too long.</end quote></div>

Debbie, you were right on the money with this! The nurse came today, changed the needle and it works awesome (like it should). I'm so relieved it wasn't something complicated.

It went fine except that Josh had a <b>hysterical-anxiety attack-meltdown-stroke</b> (yes, that's a medical diagnosis) for 45 minutes when the nurse tried to take the needle out. I've never seen anyone so upset, he hyperventilated and his eyes rolled back in his head. Completely disoriented. It took him 15 minutes before he was able to speak again. All because he expected to use emla and the nurse wouldn't do it because the port was new and the accessed. He's fine now, but it took years off my life. He said it didn't even hurt, but next time we use atavan.

thanks for your help everyone

 

[Debi]

Poor Josh! Poor Jane! I am prone to anxiety attacks when I have procedures done or have unexplained events. Atavan (lorazepam) has been a lifesaver during those times. I am happy that the fix was medically simple, even though it was emotionally draining. Now, I am hoping that Josh is on his way to regaining his strength.


Debi
54 w/cf

 

[HairGirl]

Glad it was the needles Jane. Isn't your trip soon? You need it!!!!!!! Hope it's all uphill from here.

 

[Jane]

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>HairGirl</b></i>

Isn't your trip soon? You need it!!!!!!!.</end quote></div>

We leave for the two weeks at the beach on Saturday! YAY US! We DO need it. We've been renting the same house since Jesse was born. The picture of the boys on my blog was last summer.

We also got the clearance to go to Georgia to see my brother's family. We'll go in AUgust for a few days.

 

[Jem]

So sorry that Josh had to go through this all but how it must have
been so difficult  for you Jane to see him have the
anxiety meltdown even though it is perfectly understandable that he
would---who wouldn't? Seeing our child/children suffer is the
worst.   I'm glad you all have the beach vacation to look
forward too and the trip to your brother's as well in August.
  Everyone needs to get away and have some fun!
 Here is hoping to smooth sailing ahead! <img src="i/expressions/face-icon-small-happy.gif" border="0"><br>

 

[kybert]

woohoo for the port working!!! not so woohoo for the panic attack. id say most get a bit anxious when it comes to others fiddling around with their ports.