Chemotherapy: Peripheral IV or PortaCath??

[leslie :-D]

as i have discussed under the oncology forum, my sister is starting an aggressive round of chemo (3 different kinds) on 8/4.

her chemo oncologist recommended a portacath, which i whole heartedly agreed with. now today, her surgeon/oncologist, who was having my sister sign the consent form, was encouraging her to talk w/other onc nurses re: peripheral iv's for her chemo.

i am trying to find info to give to my sister re: risks of both types of therapy.

but i so want her to get the portacath, which is scheduled for 7/28.

any feedback as to experiences with peripheral ivs and chemo would be helpful. my biggest concerns are its' vesicant properties, going into small veins and lisa getting stuck everytime. since she had her aspiration biopsy (x7 diff areas) and the needle literally went in one part of the breast and came out the other, lisa is petrified of needles. and that was another reason i wanted her to get a portacath.

i'm not sure precisely what i'm looking for but any type of experiences with above might give me more info.

any websites would also be helpful. thanks guys. you're always there when needed.

leslie

[julieK]

I cannot express enough that I think a port-a-cath is the way to go. It all, of course, depends on how long the course of treatment will be and exactly which kinds of chemo she'll be getting, but this way, she doesn't have to get stuck every day for lab draws. Most places only require the needle to be changed once a week. Also, with peripheral iv's, you MUST have blood return in order to administer chemo. If there is no blood return, she must get a new IV, no matter what. Chemo also tends to wreck the veins, making it harder and harder to get a new IV.

-Julie

[leslie :-D]

hi julie,

she's getting adriamycin, cytoxan and taxol x 8-9 mos.

i just don't know why her surgeon would discourage the portacath...even though it's a surgical procedure that takes around 1.5 hours, she won't be receiving gen'l anesthesia; and he chemo onc DID recommend the pac right away.

but my sister, not being in healthcare, is trying to make an informed decision and it would be helpful if the healthcare team agreed on the plan of care. but perhaps this is part of the consent process? nothing worse than too many varying opinions.

thanks for responding.

leslie

[Kim44]

Our patients typically have a PICC line inserted. I would definitely recommend anything other than a peripheral IV.

I hope her treatment goes well.

[VivaLasViejas, ASN, RN]

I too am in favor of the portacath.........Things can be a bit uncomfortable during accessing/deaccessing the device (those Huber needles aren't nice!) but if the nurse is skilled and your sister is prepared, it's not the end of the world. It's soooo much better than using a peripheral line for chemo; those drugs do horrible things to the veins, and her options for other IV therapy would be reduced.

I'm not really wild about the use of PICCs for chemo, either, partly because the catheters are so thin and fragile, and of course if THOSE veins get ruined, then a central line becomes the only option.

JMHO. :)

Best wishes to your sister for an uneventful and complete recovery. Both of you will be in my prayers.

[mm nurse]

I work Pediatric infusion and all our nurses have said that if we need chemo, we want a port!! We use PICC's, and Broviacs with many of our kids but they require either a nurse or family to do drsg. changes as needed. With the port, once the needle is out, there is no other care required. If your sister is truely afraid of the needle, you can have the Doc. order her some Emla (lidocaine) to apply topically about an hour before she is to be accesed. We use it on a lot of our kids although many more of our kids use nothing. Good luck!!

[NRSKarenRN, BSN, RN]

My MIL went through a year of Chemo in 1979 --first month with PIV her veins were terrible! Portacaths were just introduced then, and I insisted she get one. After a month, she couldn't believe how much better the experiece getting chemo.

Only 2 RN's at the hospital were Portacath trained in those days so I often would access her the AM of treatment if they weren't on duty. She wasn't expected to live three months but beat the odds dying 10 years later and got the chance to see my two sons born. She was even able to wear sleavless tops with no one the wiser in summer.

My advice and desire if i get sick: PICC if 1-3 months tx; Portacath for longer treament.

Info:

potacath instruction for patient + device picture

http://surglinks.com/central.lines.htm

Vascular Access Infections in the Outpatient Setting--Power Point Required

www.idlinks.com/slides/ins.ppt

eMedicine - Venous Access Port Problems : http://www.emedicine.com/aaem/topic472.htm#target1

[jeepgirl, LPN, NP]

go for the port... it's so much easier on the patient. the more she has the chemo, the harder an IV stick she might become.

working in peds, i am a true believer in EMLA! we use it to access ports all the time.... it helps a lot. just apply it to the puncture site, leave it there at least an hour, then it wipes off and you can clean and access.

it sucks being stuck over and over again, especially if you are a "hard" stick. i know. if i was ever sick for an extended period of time, i would go for the port. no second thoughts.

[jemb]

Will she be treated in an outpatient setting? How are her veins? How often will she need labs drawn?

TAC generally is given only every 21 days. Some doctors want labs drawn more often, but unless there is an additional problem that needs to be monitored, she should only need chemo related labs drawn before each treatment.

Where I work, we have the patients with ports come in a few hours before their chemo. We access the port, draw the labs, and leave the port heplocked until they return for their chemo appt later in the day so they only have to get stuck once.

Most of our patients receiving chemo do not have central lines/ports. If they have decent veins and are getting intermittent doses(vs continuous infusion over a period of days), we will use peripheral sites. The only exception is Vinorelbine. I've seen about the same number of problems with ports (infections, positions shifting, catheters floating up into the jugular!) as problems from using a peripheral vein. We have a well staffed clinic, though, (well, most of the time), and can monitor the patients closely. I have worked in other places where staffing was poor, infusion pumps were unavailable, and the chance for an IV site going bad would be much higher.

I would be more concerned if the frequency of treatments were weekly. Chemo is hard on the veins, but it is not likely that her veins will be 'ruined' from the regimen she will be receiving.

If she will be treated inpatient, I would definitely go for the port since she will less closely observed during her treatment. If she has good veins, is getting her treatment in a well staffed and well equipped outpatient facility, and does not need labs drawn more frequently than her treatments, I would have no recommendation either way. It would just be a matter of weighing the pros and cons of her preferences.

[Tweety, BSN, RN]

The good thing about the port is that it's there for the long term. Even if the chemo can be given peripheral, she might need access for future needs. It would be nice to have the port for the long haul.

Best wishes.

[janetrette]

having a port could increase the risk of having an infection. would that be the reason why the doctor prefer the other? i seem a lot of ped oncology usually have the port. have it access once a week. good not only for chemo but for blood work, and blood transfusion if needed. just one catch - infection.

and thank goodness for emla cream. it very very painful if there's no emla cream.