Port-a-cath Placement

It's like a well-rehearsed dance now.
Except some dances are better than others.
Port Placement Polka?

This is what's going inside me, right side of chest below clavicle:

  1) Pick up (today it's 9am) by chauffeur sister for drive to hospital. Since this procedure is done by radiology group it's at the hospital and not separate surgical center building, and because mild sedation is involved it again requires the chauffeur thing.
  2) Enter through Outpatient Surgery doors.
  3) Register my name at kiosk.
  4) Wait to be called by Admitting.
  5) Verify who I am and pay the copay.
  6) Get wristband.
  7) Wait in different waiting room.
  8) Gal nurse calls me back to get prepped.
  9) Change into lovely ^snark^ hospital gown.
10) Phlebotomist draws blood vial. He found vein in left arm, first stick, but came up with a dry well.  How do you find a vein that has no blood? Second stick in right arm was a strike!
11) Wait...different gal nurse comes in with paperwork but can't find the 'permission' one. Goes looking for it.
12) Wait...and more wait.
13) Different gal nurse comes in to do vitals and says she'll also be inserting the IV. Doesn't like the set of equipment in my curtained off area so goes to find another.
14) Get hooked up to BP, temperature taken, finger hooked to pulse/oxygen, IV inserted on first stick and connected to IV solution and 8 heart monitor patches stuck to me - 4 down left leg and 2 each front and back of shoulders.
15) Wait...and more wait.
16) Nurse comes back in to see how I'm doing and tell her my bag of clothes needs to go to sister in waiting room...who usually comes in to wait with me but not sure why today she didn't. Asks if I mind if she comes back, "of course not, she's welcome to."
17) Guy nurse comes in and says he'll be assisting in procedure, verifies who I am and what is being done, then leaves.
18) Sis comes in and two of us wait.
19) Vitals nurse comes back and asks if anyone has come to explain the procedure. Uh, no. She leaves.
20) Wait.
21) Another guy nurse comes in and says P.A. (Physicians Assistant) will be in shortly to talk with me.
22) Wait.
23) A gal I swear that looks about 20 years old comes in and says she'll be doing my port placement. Asks if anyone has explained the procedure to me and I tell her 'kinda, but only in a brief summary type of way.' However, before she starts she does admit, and apologizes for my wait because no one notified her she was doing a port placement today. WHAT?! She continues and says she does this all the time and provides a lot of step-by-step detail in what they'll be doing. Also mentions how the drape they use works so they have access to chest site. All her info was good, BUT something about having a catheter inserted into your jugular vein is slightly unsettling. She leaves.
24) Paperwork and permissions signed. Puffy blue cap put on my head.
25) I'm finally wheeled to the procedure room where it's cold. Well, everyone else does have more clothes on than me.
26) Hooked up to new set of vitals monitors and then I move to skinny little table for procedure. It feels like my head is about 2 inches lower than my feet. Maybe it's just the missing pillow. Warm blanket put on and feels good. Can feel solution going into my IV which must be the super antibiotic they told me about to prevent infection.
27) Look around as gal nurse explains why she's taping up parts of me so they don't interfere with port placement procedure. She's funny and very pleasant. That's nice. She asks what type of cancer I have and how I found it. Then I'm told to turn my head to the left (where it will remain during procedure) and the cold antiseptic is slathered over my neck and chest and shoulder and runs all over. Brrr.
28) Numbing injection is given and then they put the drape on/over me. I chuckled to myself thinking about the CT and PET scans when I was asked repeatedly if I was claustrophobic, but for this no one ever asks although the drape is literally completely covering my face and all I can see is a few square inches of floor; and even when they put up a metal support for it there is only about 2" between me and the drape. Okay, it's official. I'm not claustrophobic.
29) Supposedly there is to be some sedation but as I listen to them talk about where the best schools for P.A. are and who is interested in training and as they explain this or that I don't recall the room going fuzzy like in other 'mild sedation's' I've had done. Did hear something about catheter being too short...don't want to hear stuff like that...but apparently they got it worked out.
30) Then it's over I guess. They remove the drape and I can see the 50 or 60" x-ray monitor with the port clearly distinct on it. The x-ray is used to guide, and verify, the placement of catheter. Looked a bit like this internet-lifted image...

...except there's more of me. Asked nurse if that was me on monitor and answered in the affirmative. It really was quite fascinating. My neck is really sore and tender and feels like skin is being pulled. Funny gal nurse tells me my blood pressure went down so they backed off on the sedation a bit. Oops, forgot to tell her (like I have others) that 144/86 and similar BP's pre-procedure are not my normal BP and when they see it 'drop' (as others have) not to panic.
31) Move back to the wheeled bed, but wow my neck still hurts and the place they inserted port is miserable with skin feeling very taut.

here's diagram of Port and Catheter placement.

32) P.A. gal says everything went okay and is as it should be. I wanted to ask about that 'too short' comment but decided to let it go.
33) Wheeled to a curtained recovery room where sister is waiting. Hooked back up to vitals monitor again I'm told if all goes well I'll be there another hour. Nurse asks if I want something to drink. Cranberry juice sounds refreshing.
34) Wait.
35) Frequent nurse visits to check on me and vitals.
36) Yay! Hour is up and with post-procedure instructions given and release form signed we are outta there.

And that's the 36-step Port Placement Polka.

On the way home my sister pulls down the passenger sun visor so I can see incisions. What I also see is the orange colored antiseptic solution still covering my cheek, jaw, neck and chest. How embarrassing to be out in public with that all over. Good thing I didn't know!

We stop at a drive-thru and pick up lunch then on home to enjoy it. Okay, here's a pic of my old, wattled and wrinkled neck with it's new scars. I'm told (either by nurse or PA, not sure now) the white area around incisions is from the numbing solution because it prevents blood from going there. Once numbing wears off then the blood flows again. Oh, also warned there will be large area of bruising but 2 days later, while there is some bruising it's quite minimal. Whew.

Ow. Ouch. Owie!


Top incision is for catheter access into jugular vein, and then other end of cath feeds into the Port. Yup.




Bottom incision is what Port was placed through; it now sits just below that scar.


(Ignore farmer-tan freckles please.)

Tonight is my scrapping night with Mom and sisters. We got to our usual 11:00pm stopping point and I'm glad to have had something to occupy my mind because the areas where this Port stuff was worked on is really miserably uncomfortable.  Two Tylenol at bedtime don't help much for the pain but I'm so tired that by 2:00am exhaustion eventually takes over. Fortunately once I get to sleep I stay asleep until morning. Then, two more Tylenol in the afternoon. By Saturday night the pain is less and it's a better night's sleep.





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