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CHEMO: peripheral or portacath?

Oncology   (11,195 Views | 46 Replies)
by leslie :-D leslie :-D (Member)

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my sister starts chemo on 8/4. she is scheduled to have a portacath implanted on 7/28, per the recommendation of her chemo oncologist.

today her surgeon was having her sign the informed consent. she urged lisa to speak w/onc nurses to see if peripheral tx would be feasible.

i am against it, knowing that lisa's going to be on 3 potent chemo agents and its' vesicant properties. i understand her surgeon is just doing her job but i've encouraged my sister to also get the portacath, as her tx will be up to 9 mos.

my question being, can one realistically administer cytoxan, taxol and adriamycin in a peripheral line w/o increased risks or adverse reactions????

also when my sister had her aspiration/needle/bx, the needle literally went in one area and out through the other....so she is now petrified of needles, since it was so painful and traumatic. any input would be most helpful.

thanks very much,

leslie

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VivaLasViejas has 20 years experience as a ASN, RN and specializes in LTC, assisted living, med-surg, psych.

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Leslie, for my money, I think the portacath is the best way to go for long-term chemo........I can't even imagine trying to give those drugs through a peripheral without irrevocable damage to the veins, and then what happens when she does need a peripheral line for something else?

Accessing/deaccessing the portacath isn't exactly a picnic for the patient, especially if the nurse isn't particularly skilled at this task, so you'll want to make sure whoever is administering the chemo has experience in dealing with these devices. Those Huber needles hurt, and your sister will need to be prepared for that, but it doesn't have to be an awful experience if the nurse knows what s/he's doing.

Best of luck in helping your sister choose........both of you will be in my prayers. :kiss

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canoehead has 30 years experience as a BSN, RN and specializes in ER.

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Get the Port a cath

Even if chemo wasn't an issue frequent sticks for peripheral IV's are no picnic, and a port offers a much better target than a sclerosed dehydrated vein. Plus most of her blood draws can be done by port. It'll be worth it tenfold.

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my question being, can one realistically administer cytoxan, taxol and adriamycin in a peripheral line w/o increased risks or adverse reactions????

Yes, it can. We do it all the time. So far, we have had no one on this particular regimen have a problem with it.

I replied in the general nursing forum to your post there before I saw your post here. But I wanted to answer your specific question anyway.

I can't even imagine how traumatic it would have been for a biopsy needle to puncture her breast that way! Yikes! That's not the same surgeon that she would let place a port, is it?

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11,191 Posts; 54,546 Profile Views

Yes, it can. We do it all the time. So far, we have had no one on this particular regimen have a problem with it.

I replied in the general nursing forum to your post there before I saw your post here. But I wanted to answer your specific question anyway.

I can't even imagine how traumatic it would have been for a biopsy needle to puncture her breast that way! Yikes! That's not the same surgeon that she would let place a port, is it?

i don't know joy. lisa must be a hard stick because all of the iv's she got for testing, were so traumatic for her and did complain that they kept on resticking her.

so with her needle biopsy, they aspirated 7 different areas. and yes, the needle went through as an entrance and exit wound. :angryfire :angryfire

i have a panic call into her, seeing if it is her surgeon that did the needle bx.

you've infused patients w/the combo of the 3 chemo agents that i mentioned????? i couldn't follow her regimen; but they'll be doing it q2wks and not the standard q 3 weeks...it's nerve wracking, knowing what she'll be going through.

thanks joy,

leslie

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693 Posts; 7,197 Profile Views

Quick reply here before I head out to work.

Yes, I have infused many patients with the combination you say she is getting. However, we do it q 3 weeks. Never seen it q 2. And, as I said before, if she has good veins, I would think that the port was not necessary. Sounds like she doesn't, though, if she always requires multiple sticks.

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traumaRUs has 27 years experience as a MSN, APRN, CNS and specializes in Nephrology, Cardiology, ER, ICU.

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When you have a Medi-Port (same thing as a porta-cath?) and use the Huber needles, your sister can apply a topical anesthetic prior to leaving for chemo and then the site will be numb and she will be more comfortable. Also - ask your oncology nurse about sucking on hard candy while chemo infusing to get rid of the metallic taste in the mouth.

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Ted has 25 years experience and specializes in ICU/CCU (PCCN); Heme/Onc/BMT.

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Sorry to read that your sister must undergo chemo thereapy. Will definately hold her, you and family in my warmest thoughts and prayers. :o

With regards to the portacath? I hope your sister gets one and have it implanted by a surgeon who's confident with the procedure. Portacaths verses lots and lots of venous sticks seems to be the most comfortable and safest choice, IMHO.

With only the warmest regards,

Ted

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11,191 Posts; 54,546 Profile Views

Quick reply here before I head out to work.

Yes, I have infused many patients with the combination you say she is getting. However, we do it q 3 weeks. Never seen it q 2. And, as I said before, if she has good veins, I would think that the port was not necessary. Sounds like she doesn't, though, if she always requires multiple sticks.

the q 2 weeks is something relatively new and called either dense dosing or dosage dense. they're finding that survival rates are higher with those that receive chemo q2w and that cancer cells even start growing back before the 3 weeks intervals.

of course i get nervous, wondering if this is going to be enough time to replenish her wbcs but i suppose i just have to look at the overall outcome with higher survivor rates. we're going wig shopping this friday.

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11,191 Posts; 54,546 Profile Views

i just spoke with my sister very briefly.

she is going to get the portacath implanted tomorrow. she was at the hospital today, at a workshop hosted by the american cancer society, teaching them how to apply eyebrows.

after this workshop, lisa went to the onc floor and spoke with a few of the nurses, who said to get the portacath.

i think i'm doing more crying than lisa. lisa's been doing wonderfully...i'm telling you, these people that endure these treatments, are SO my heroes. i just don't know where they get their strength.

friday me, lisa and our other sister will go wig shopping.

it's such an intangible feeling, here on this bb. i mean, we connect and support one another through cyberspace and yet, it has to be some of the most meaningful communication ive ever had.

your support and input means everything. i humbly thank you.

leslie xo

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693 Posts; 7,197 Profile Views

Leslie, I've been thinking about you and your sister all day. I think she'll be glad that she has the port, especially if she can have her blood draws from it, too. Sounds like she's being very proactive about her treatment.

My thought with the q 2 wk tx was like yours-- will she have time to rebuild her white count? But if it works better in the long run... Always new protocols coming out... I don't know how the docs keep up with it all.

Lisa is very fortunate to have you for her sister-- I can tell that from your posts.

Keeping the two of you in my thoughts. Please let us know how the surgery goes tomorrow.

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jnette has 10 years experience as a ASN, EMT-I and specializes in Hemodialysis, Home Health.

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Will be keeping you and Lisa in my warmest thoughts today, Leslie.

((((HUGS))))

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