My First Portacath and Tips!

Are you considering a Portacath? Do you already have one and want to learn about my experience with the device? If so, read on!

After years of having PICC lines (Peripherally Inserted Central Catheter) placed to receive weeks of intravenous antibiotics for Cystic Fibrosis I decided to consider having a Implantable Port Device placed so that I would no longer have to deal with getting a PICC line for each hospitalization requiring weeks of IV antibiotics. I considered having a port placed for several months prior to talking to my CF doctor about it.

On January 4th 2011 I experienced Hemoptysis for the first time after experiencing chronic low grade fevers for nearly a year. Experiencing hemoptysis was a clear indication that my lungs were declining and this in combination with feeling unwell for over a year, I knew it was time for a longer-term solution. I decided it was time to consider a portacath. Why?

1. My last PICC experience was unpleasant to say the least. Initially a nurse tried to thread the PICC, but after several minutes of her being unsuccessful (which I blame, in part, due to the fact that she was too busy gossiping about a friend and was clearly in a foul mood) I had to demand an M.D. to be paged to VIR to place my PICC; the M.D. had the line placed in record time and without pain! However, the thought of another distracted nurse causing me unnecessary pain during a PICC procedure made me think twice about having another PICC placed.
2. Hemoptysis on January 4, 2011: I realized that my lungs were no longer functioning as well as my PFTs (Pulmonary Function Tests) reflected. For a year I suffered with chronic low grade fevers, fatigue, increased shortness of breath, and the inability to tolerate much physical exertion. Although my lungs looked good on paper--I felt terrible.
3. I wanted a long-term solution that would allow me to preserve my veins in the future as opposed to having countless PICC lines and labs that would only add further damage to my veins in the future.
4. Many of my friends with CF have or had Ports and most of them have had positive experiences with them. 
5. I considered the facts: I was quite sick for over a year, my lungs were not functioning as well as they used to, and my last PICC was pulled just 6 months prior to having my Port placed. Why continue having PICC after PICC placed and damaging healthy vessels when a port can eliminate the need of having multiple lines placed over a short time period? 

While I did ask many of my Cysters and Fibros about their Port experiences I wish I knew more about Ports prior to having mine placed. Because Ports are commonly placed in hospitals and in CF patients I believe nurses and doctors see them as routine. They may forget that a Port is NEW to a patient and the patient may be completely clueless about the placement, process, recovery and what to do if ____ or ___ occurs. I heard so many GREAT reviews about Ports that I was clueless in terms of how they actually function, the fact that a needle was used to access a port once a week during IV therapy, and what is abnormal.

My CF doctor was the Attending Pulmonologist during my hospitalization in January. She and I discussed having a port placed and within a couple of days I was in VIR having my port placed. The procedure went well and I did not experience any complications. It took me approximately two weeks to feel fully heal from my port surgery. I am pleased with my decision to have a port placed. It has not been smooth sailing by any means, but it has saved my veins from numerous PICC lines and blood draws. Since having my port placed January 10th I have had two instances where tPA (Tissue Plasminogen Activator) had to be injected into my port due to it not giving a blood return.

Unfortunately shortly after going home to do home IV's I learned very quickly of something no one told me was a potential complication of a Port: the mixing of two medications causing the port needle to crystallize. Of course, the doctors and nurses I saw in VIR (Vascular Interventional Radiology) told me that they had never seen a port needle crystallize before. But I know I am not the only person who has experienced this complication. It was not a problem that originated with my port, but the mixing of two medications: Zosyn and Micafungin. What I now know is that the formation of crystals would have occurred in a PICC, port, or a peripheral IV. Therefore, having a Port did not raise the risk of the medications crystallizing. (Click picture to enlarge)

My crystallized port needle was changed out and the line thankfully continued to work. But it took two emergency trips to CF clinic, VIR, and another hospitalization before anyone realized the combination of Zosyn and Micafungin were causing crystallization. That said, if you are prescribed Zosyn and Micafungin be aware that the combination of these two medications can cause crystallization in your line (port, PICC, midline, etc.).


                              Port Advice:

1. Use AquaGuard port covers to shower. Reinforce the AquaGuardAquaGuard adhesive and additional tape around the edges will be more effective if you take a cotton ball and rubbing alchohol to thorougly clean the area that you are placing the AquaGuard and tape around the edges.

2. Learn how to access and deaccess your own port. You will find this will save you time in the long run. Find a nurse you trust and know uses sterile technique to teach you proper protocol to access your port. You want to learn from the best. A nurse named Kathy L., who used to work in my CF Center clinic, taught me how to access and deaccess my port. She told me what to do and what not to do and to make sure others access my port the way she taught me, because when your accessing a port you have to be perfect in sterility to avoid potential infections and complications. Thank you, Kathy, for teaching me so much!

3. Port needles and dressing must be changed weekly. Always keep extra supply of port needles, tape, saline, heparin, alcohol wipes, biopatches, and dressing in supply. Sometimes your port dressing will peel back and need to be replaced before the week is up, and this is when you will need the extra supplies on hand. This is also when your knowledge of accessing your own port will save you time and an extra visit from your home health nurse.

4. Keep an information card with you at all times that includes the doctor who placed your port, contact information, location of your port (ie: upper right chest), size/type of port, and type/size needle that must be used with your port.

5. Teach your family members how your port should be accessed. You never know when you will be in an emergency situation or unconscious and this is a time in which your family member(s) having knowledge of your port will be in your best interest. Your family member(s) will be able to ensure the nurse accessing your port is (1) knowledgable and (2) uses sterile technique to reduce the risk of infection associated with port access. The more of your family and friends you educate on sterility with port access, the better your chances are of reducing or eliminating infection risk due to improper access of your port.

6. Keep a close eye on your port site. If you see any redness or irritation on the site call your CF doctor immediately. It could be a minor skin irritation or it could be signs of infection. If your CF doctor is as wonderful as mine, he or she will not mind you e-mailing a picture of the site to get an idea of what is going on--and ordering blood cultures if needed.

7. Always use a gentle non-irritating soap on your port site, even when it is not accessed. I use Cetaphil Gentle Cleasning Bar because it does not dry out my skin and does not cause any irritation.

8. IV Course: When your port is accessed for weeks at a time always deaccess your port and shower prior to reacessing your port. You will want to take this time to clean off any residual tape that may be lingering, which could harbor higher levels of bacteria. I use Detachol to remove my port dressing, large clumps of residual glue leftover from the dressing, and then I clean thoroughly with alchohol wipes. Sometimes I will find sticky areas even after all of this, which is when I take a soft wash cloth and soak in it warm water with antibacterial soap to gently scrub the sticky areas on my skin. Caution: do not scrub the actual site of the port where your needle accesses your skin! Only scrub the areas where the dressing glue sticks to your skin as this is the only area where you will find residual glue left behind. After I finish my shower I once again take clean alchohol wipes and wipe over my port site once again, this time including my access area, prior to setting up my sterile area to reaccess my port.

9. Flush your port slowly and draw back blood slowly. I have found that when I am admitted and my nurses are rushing to get blood from my port they draw back the syringe quickly and this is when my blood return starts to get sluggish and eventually tries to clot. What I found works best for me is flushing slowly, pumping saline into my port, and gently drawing back for a blood return. The blood does not have to enter your clave before you know you have a blood return. As soon as you see the beautiful line of blood in the beginning of the port needle line, you have a blood return and it's time to flush it back and begin your next step, whether it is an antibiotic or using heparin to hep-lock your line.

10. Protect your port! I have found there are nurses I trust wholeheartedly with my port and others I have caught being unclean when accessing my port. For example, never let a nurse access your port without first using an alchohol wipe to thoroughly clean your clave. I was told a minimum of 15 scrubs with an alchohol wipe side-to-side around the diameter of the clave is what it takes to kill bacteria that may be lurking on your clave. I have also caught nurses opening up clean alchohol wipes, throwing them on my bed (which I cough all over and put my dirty feet in, by the way) then trying to use them on my clave to access my IV line! At first I was hesitant to say anything, but the wonderful Kathy L. taught me to worry more about preventing infection and less about being nice. All nurses are taught to be sterile and use proper technique when accessing a line and you have to enforce these teachings sometimes. SCRUB THE HUB!

11. Use the skin protectant that comes in your dressing change kits. For several months I did not use the skin protectant swab stick that came in my dressing kits. My skin became red and irritated from being accessed for nearly 9 months and it burned when I cleaned it with alchohol wipes at times. What I found is that the skin protectant that comes in my dressing kits work! These skin protectant swabs are sterile and should be used as the last step during dressing changes. Only apply the swab after the germicidal formulas (alchohol and ChloraPrep) have dried and only apply the skin protectant in the areas where dressing will be applied. Do not apply skin protectant over the port site where your needle will be inserted!

12. Set up space at home for accessing your own port: I use a long mirrow and a folding breakfast-in-bed tray as part of my port access. Obviously the mirror is so that I can see what I am doing, but the tray serves a very helpful purpose of allowing me to set up my supplies without dropping anything. First, I clean the breakfast-in-bed tray (which is only used for my port access) with Chlorox wipes and allow it to dry. Then I gather 2 of everything I need to access my port: needles, biopatches, saline flushes, heparin flushes, dressing kits, SorbaView dressing, an extra pair of sterile gloves, and a box of alchohol wipes. This ensures that if I drop something I can leave it on the floor and open up a new package without having to worry about leaving my port supplies unattended. After I finish accessing my port and my site is covered with dressing, I throw away all opened dressing supplies; all unopened port supplies are returned to my medicine cart for future use.

13. If your port site accidentally gets wet: Remove dressing immediately, deaccess your port, clean the site thoroughly and reaccess using sterile technique. If your port site got wet in the shower see tip #2 again and reinforce with extra tape. Sometimes it helps to hold a dry wash cloth over your port site in addition to the AquaGuard and extra tape around the edges to soak up any water that may get near your port side or run down your neck during showering.

14. You can use your vest after having a port placed: When I first had my port placed I called Hill-Rom the Vest company and they sent me two squares of a durable foam that I used to go around my port site until it fully healed. This helped prevent irritation to my incision and port site. You can use any piece of durable foam you have around the house, just make sure you cut out an opening large enough to allow your port needle to rest inside of without the foam pressing down on it. Basically you will want to cut a dohnut shaped hole into the middle of the foam, because this is where your port will be resting during vest treatments. However, you may want to wait a day or two after port placement to use your vest during which time you will need to use an alternative form of airway clearance.

If you have any questions please feel free to ask. I am an open book and will do my best to answer your questions.