Emergencydpt.com: Recent Comments

Comment on The Port-a-Cath

2010-01-04T16:28:25Z

That was an inspiring post,

I have never ever heard of one of these portacath's before...

I dont quite understand how it would work... and how does an L shaped needle work... it just brings pain to mind tbh...

Thanks

Comment on Speaker Refoaming

2009-11-23T12:03:18Z

Hey, that was interesting,

They look great now,

Thanks for sharing this,

Keep up the good work,

Thanks

Comment on Speaker Refoaming

2009-11-10T01:37:26Z

Hi,

Thank you for your comments. I think these boxes benefit from the pecan facings and the acoustic suspension design. I'll bet you could put a wide variety of drivers in them and get really good sound. Re: being a lucky devil: I am occasionally lucky, I'll admit. It's never a trend though, unfortunately.

Comment on Speaker Refoaming

2009-11-09T21:47:37Z

Loved your article. I recently put my old advent speakers 'out to pasture' until I get the kits to fix them. I installed a set of 8"Lanzar 600 watt in the Advent boxes until then. They sound really good in those boxes also. Still can't believe you found so many on Craigslist--lucky devil ;-).

Comment on The Port-a-Cath

2009-09-26T00:55:06Z

Hi Maria,

Thanks for your email. I'm sorry you are having trouble with your port.

Please remember that as an ER nurse, I am not really qualified to give you advice on how to proceed. My expertise involves accessing ports only. That being said, I think I can discuss some of the ins and outs of your choices.

The first thing to do is see if the sheath will respond to Alteplace or Tissue Plasminogen Activator, the clot busters. This is usually the first step in fixing a clotted off port. Think of it as Draino for the port. The procedure is simple and no more invasive than your usual port accessing.

Having done that, the next less invasive procedure would probably be what your doctors have suggested. It is much easier than replacing the port. I will have to ask someone about the exact mechanism for removing the sheath from the distal end of the tube but I would imagine that any danger revolves around having the clot break free and travel to the lungs. This danger would probably be higher if you simply tried to remove the port altogether. Pulling it out of the vein would tend to strip the clot off, allowing it to float free and travel. That would be bad news.

The only other danger I can think of for the IR (interventional radiology) procedure with the wire in the groin would be accidentally perforating the blood vessel. I would think that would be extremely rare; a very small risk. It's done using a fluoroscope so the wire and the catheter are visualized all the time. You will be lightly sedated and the groin area will be numbed up first. Then a needle, really not much bigger than a regular IV needle will be inserted in the large, straight blood vessel in the groin. It's a very small hole. You have no sensation of the wire moving through your body. I would assume the clot is vacuumed off the catheter or otherwise destroyed. Once again, I'm not exactly sure of the procedure but it's much less invasive and less risky than replacing the port; less scarring also. Of course, post operative bleeding and infection are always possible problems, but they can happen just by accessing the port.

If that fails, then another port may have to be installed. You always want to go with the most conservative treatment first because all procedures have risks associated with them. The more invasive, the more risk. Pulling out the old port, possibly dislodging the sheath, then putting another one in, tunneling the catheter and the diaphragm assembly under the skin, sewing it all down under an area already with scar tissue over it adds risk. And of course it could easily develop a sheath again. It would be easier to just periodically strip off the sheath then to keep replacing the whole port.

While no choice is without risk, only one choice will be right for you, for your level of comfort with the procedure and with your treatment goals. So a careful consideration of the risk of each procedure vs the benefit will bring you to the correct conclusion. I hope this helps.

Wishing you health,

Spencer

Comment on The Port-a-Cath

2009-09-24T19:53:34Z

Please help again. They are telling me my port does have a sheath over it and to go to have the sheath removed by using a wire going to the groin area which I really would rather not take the chance of doing. I have some appts. with General Surgeons to discuss some of my questions but was wondering if you ever heard of them just removing the old port and using a new one. Like I told you in the past this one has been in for 5 years and I read they usually only last 2-5 years. Wouldn't you think it would be better just to replace it instead of going through that risky surgery with a wire in my groin. For some reason the Drs. seem they don't want to replace it. If I have them do the wire I have a feeling it will have to be replaced anyway in a short period of time since it has been there for several yrs for my Chemo treatments. Please help
Thank you in advance,
Maria

Comment on The Port-a-Cath

2009-07-18T18:39:31Z

Dear Spencer Miller RN.
I can't tell you how much I appreciate the information you have given me. This information is very valuable to me since I am completely lost and in the dark. Thank you for spending your precious time to inform me of my serious problem. I know I have great nurses and Drs. but sometimes want to blame them. I'm going this Wednesday for the procedure and pray it will be fine. They do use Heprin or something they inject into it which within a half hour allows them to draw blood. It's just a very scary procedure.
Again, I can't thank you enough for your response.
Sincerely,
Maria

Comment on The Port-a-Cath

2009-07-18T01:23:59Z

Hi.

Thanks for your comment. I'm sorry you are having trouble with your port.

There are several species of problem that can cause a port not to give blood. A sheath, a flap, a clot, or malposition. The first three can often be fixed with a short procedure where a small amount of clot lysing medicine is instilled into the port. The last one is more problematic.

A sheath can form around the tip of the catheter, blocking it. A flap or veil can form and act like a one-way valve over the tip. A clot can form within the lumen of the catheter when blood enters it, either through poor technique during use or simply through the process of diffusion.

Malposition of the catheter tip happens when the tip migrates; either up against the vessel wall or in some cases it can actually penetrate the vessel wall and end up outside the circulatory system all together. This is obviously a serius problem.

The first thing to do is to try changing your body position during syringe withdrawl to see if the tip of the catheter, if malpositioned, can be encouraged to move to a better position. Sometimes laying on your side or raising your arm on the cather side, moving your shoulder back and forth can cause the tip to move away from the vessel wall.

In any case, instiling anything into a catheter that does not give a blood return is against reccomendations. Pushing fluid into a clotted catheter can dislodge the clot, causing it to travel into the lungs which can be fatal.

At our hospital, the protocol for flushing the port after use is to flush with ten cc syringes of saline, twice, using a pulsitile method (stopping and starting) to create turbulance within the lumen. That is followed by five cc's of 100 units per cc heparin flush, locking the clamp on the down stroke so there is not a back flow as the syringe is withdrawn. We also use a positive pressure needleless syringe clave; also stopping negative pressure from causing inflow of blood.

It must be remembered that heparin does not break up clots. It only keeps them from forming. A TPA product called "Cathflow" is used to break up clots in ports and other central venuous access devices.

The fact of the matter is that the body does not take kindly to implanted devices. They are frought with risks that must be wieghed against the benifits recieved. You've gotten five years and been saved many minor injuries from peripherial IV starts with your port. Even regular IV starts can and sometimes do cause serious complications.

The department head at one ER I worked at caused a woman to loose part of her hand when he injected a routine but harsh medicine into a blown peripheral IV. This caused vasoconstriction, and blocked the blood supply to her hand. Her care was already incredibly complicated and the pain and suffering she went through during the ordeal and the physical and mental scarring she sustained as a result wieghed heavily on the moral of the department and of course her own. We soon put together new protocols for injecting this medicine that have since been adopted in many other facilities.

I'm glad you are researching your care and hope this problem is resolved safely.

Be well,

Spencer Miller RN

Comment on The Port-a-Cath

2009-07-17T22:07:39Z

I'm having a problem with blood coming from my port I have had in for 5 years....He said I may have to have an xray. They said there may be a veil forming around it. Great--I don't have enough problems.

Comment on The Port-a-Cath

2009-05-27T07:04:46Z

Hi! My 18-yr old son had a terrible experience when his portacath was accessed. After an hour and without the IV line yet, he started getting chills, had a high fever, and a blood pressure of 150/90, his lips started turning blue. This went on for about 3 hours before he returned to normal. The doctor said it was probably due to a clot that didn't dissolve when it was flushed and that the flushing should have been done more slowly. Another doctor said that the clot was left-over from the last time and shouldn't have formed if enough heparin was given when the needle was removed.

Can you tell me what caused this and how could it be prevented?