Monday, October 24, 2011
Port Drama - A New Series on Prime Time
Okay, it probably wouldn’t net many viewers, but I for one sure would like to know how it’s going to play out. Remember back HERE and HERE and HERE and HERE and I could probably go on and on. We opted not to leave Marissa port-less at the request of pretty much everyone employed by the hospital. The venous access team has been unsuccessful in their attempts and only one of the pediatric anesthesiologists has been successful in obtaining peripheral access and that was under general anesthesia after four attempts. That IV lasted less than a day. If there were an emergency or if Marissa just needed labs drawn (which she does fairly frequently), we would be completely out of luck. When her Hickman infiltrated back in May, the decision was made to give her a port-a-cath. Because she has no alternative suitable sites, her surgeon decided to try and place the port catheter over a wire into the vessel that was occupied by her Hickman. He was successful and we were beyond thrilled; especially when he marched in and proudly stated “she’ll have it for at least 3 years!” After 18 months of managing a line that needed daily flushing and every three day dressing changes, she now had a completely hidden port that we didn’t have to do anything with. We (and she) really enjoyed the remainder of the summer. Baths! Swimming! No more Line tugging!
Until….we went for the first flush. The port didn’t work. I didn’t freak out at first, but had a sneaking suspicion there wouldn’t be an easy solution. We TPA’d the line and were able to get blood return and even draw some labs. We went home and returned a month later. The port didn’t work – AT ALL! Marissa had surgery the following the week and they used her port for anesthesia – it infused okay although it still wouldn’t draw. We went home, again. We returned a month later. Do you see a trend here? The port didn’t work. This time, I came prepared, bag packed to spend the day – ready to stand my ground and demand answers and wasn’t leaving without some. I didn’t have to try real hard. When they tried to infuse – it wouldn’t even do that. In fact, she screamed and the skin around the port began to blow up like a little balloon. I figured it was either disconnected or infiltrated once again although I couldn’t figure out how either could possibly happen on a brand new port. She had a chest x-ray – looked great, a line study – which showed the vessel was obviously occluded. Under normal circumstances, the port would be removed and a new port implanted. Of course, where Marissa is concerned, there is never a normal circumstance! It was decided to perform an MRV and first of all assess the actual condition of the vessel the current port catheter resides in as well as whether there were any other vessels that could possibly accommodate a new port. Then, depending on what the MRV showed, either an angioplasty to try and save her port or surgery to implant a new one.
The MRV was performed last week and we quickly learned that the thrombus in her vessel was not something treatable by angioplasty – the current port is unsalvageable. As for new sites, the radiologists have weighed in, but the jury is still out. Or rather, the general surgeons are still out….at a conference that is. Stay tuned.