oncology nurse has difficulty finding the port during Chemo

fac03

Hi,

Does anyone have experience with the oncology nurse having difficulty finding the port during chemo?

I had two AC so far, during the second time, the nurse put the needle quite far from the port, when the needled could not get into the port, she got another nurse to use the needle to move around the tissue inside my body to  find the port. It was so hurt that I screamed. One  nurse held my hands while the other poked around using the needle, if it were not in an open area, I felt that she might cover my mouth. During the treatment, it was painful. I complained and they told me it would go away.They told me that it was because of the fatty tissue (I am overweight), hence the port is deep (and I think it was also that the needed was initially put in too far from the port and they never took it out, when they finally found the port using the needle, the needle was pulling my tissue).

I plan to raise the issue to the head nurse tomorrow for my AC#3, but before I do, I want to find out whether it is a common problem and what the general solution is.

Scrafgal

never ever happened to me....and I used a port Weekly for 12 weeks of Taxol and every three week for 4 FAC infusions....you should talk to the head nurse!!

exbrnxgrl

It can happen, as humans are doing the accessing and humans are not 100% perfect. I have had my port for almost eight years and have had access issues twice. I am thin, so fatty tissue was not an issue. Once, the nurse simply could not hit the right spot, but did on the third try, although the area was painful from the attempts. I have also let a trainee (an RN who was training to work in infusion) give it a try. Ouch! However, I realize the only way to become proficient at a job is practice. She did get it on the second try and will be a good infusion nurse with a bit more experience.*

I did not file a complaint because there was no ill intent, nor negligence. However if you think that was not true in your case, a complaint might be in order. How all is well now.

* I was asked if I would let the trainee access the port and she was supervised by an experienced infusion nurse.

illimae

I’m fat and have never had this issue. My port has been accessed every 3 weeks for 2.5 years but since the chemo nurses sometimes seem rushed or cause a more painful prick, I usually have the port access/pic line group handle it. The wait for this office is about an hour but to me it’s worth it.

Leydi

Oh no! I would definitely ask to speak to the head of the nursing staff and ask what the protocol is when a port is difficult to find/access. I SUSPECT that the needle should have been withdrawn if they needed to try again, not just digging around inside your tissues with it! Argh! I've had phlebotomists do that a few times when they had trouble finding a vein and that is bad enough. If it continues to be a problem, it may be worth asking the surgeon who placed it if it could be re-located to be easier to access.

MountainMia

I don't have a port, so keep in mind my ignorance. But what's the point of a port if not to provide direct access?? This seems unacceptable to me.

When I had my surgery, the nurse inserting the IV needle into my arm missed my vein. I told her "that's not my vein!" and she said, "Oh, I'll find it." NO. Withdraw and try again, don't just dig around for it. She did, fortunately.

exbrnxgrl

Well, just like not being able to locate a vein when inserting an IV, there are occasional misses when accessing a port. It does indeed provide direct venous access but it is inserted by a human being and while it works out the vast majority of the time, every now and then it can be tough. My port, I'm told, is very wiggly, which may have caused the issue I once had (second issue was inexperience on the part of a trainee). Do file a complaint , but although rare, port access is still subject to human foibles.

* Wiggling the needle around, once inserted, sounds dreadful.

fac03

Thank you Ladies,

I am going to bring up tomorrow.

I understand the work is done by human. But what bothers me was that the nurse repeatedly brought up there were too many tissues in the area. First throughout the several hours of injection, then two days later when I went back for a neulasta injection because the onbody injection did not work. We met in the oncologist's office, she asked me how I felt, when the PA looked at her, she explained that it was because that area in my body has too many tissues and was the reason I felt the pain. She again repeated the explanation to other people when we went back to the infusion center.

It made me feel that I was the cause of the pain and now she has a license to poke around using a needle.

Yes, I felt that they should have removed the needle and re-insert again. After the third nurse "finally" found the port, she went to take care of the patient next to me, she told the other nurses that "I did not even have to take the needle out". I was so mad that I wanted to tell her that I wished she pulled out the needle, but I kept quiet as I did think it would help me in the future.

I have finished two cycles of AC, but my onco nurse had never been able to put the needle in without a problem. The first time she got another nurse to do it and it was okay. The second time, she worked with another nurse and tried to find the port before they put the needle in and when they knew they were hopelessly not able to get to the port, they asked the previous nurse to help.

I do not plan to file a complaint as I like her but I need them to find a solution.

exbrnxgrl

I’ve had my port accessed regularly for almost 8 years. I am not a medical professional, but rather an informed consumer of infusion center services (sounds a lot better than it is, doesn’t it) but it sounds as if the nurse might not be as experienced as some. I’m a bit intolerant of multiple pokes to my body. I give everyone a second choice, but never a third 😩.

pingpong1953

Years ago I had surgery and the nurse who started my IV couldn't find the vein. The rule at that hospital was that the nurse gets 3 tries and then the anesthesiologist takes over. Well, she made the most of that 3rd try. Apparently my veins "roll." I've had lots of IV's since and no one else has had a problem with my rolling veins. 

Isn't there some sort of anesthetic cream that can be applied to the site that numbs through several layers of skin to make it less painful? I think it's called Emla or something? I had a PICC line and if I had to do chemo again I'd probably opt for the PICC line.

exbrnxgrl

EMLA can be used but it needs to be applied at least 40:minutes before hand. Most centers offer a quick acting numbing spray, but the op’s issue seems to be lack of experience on the nurse’s part. PICC lines are seldom used for chemo in the US

fac03

exbrnxgrl, I had ELMA and it was applied over an hour earlier, but getting the needle into the body was not the problem, it was after they used the needle to feel its way to the port.

Thanks Ladies, I worked up the courage to raise the issue and told them if it was because I was fat, then I may not be a candidate for using the port. I first brought up to the PA, then in the infusion center to the nurse.

It turned out the PA told them and they arranged the nurse who had successfully inject the needle during AC#1. I did not have a single problem, fast and easy, It also helped that the regular onco nurse was out today.

Thanks illimae , I told them my internet friend told me she was fat and never had this problem. Thanks, I hope they stop using our body as an excuse.

exbrnxgrl

Sounds like you found the nurse who has a lot of experience with all patients, regardless of size, weight etc. It can make all the difference!

JanetMara

Hello everybody/friends/sisters in this thread.

Fac03--I agree with you,a Nurse MUST BE TRAINED VERY WELL when she works in an infusion center especially long term CHEMO .A nurse must sterilize the skin,allowed to air dry for 2 minutes,the spray with lidocaine and her free hand should stabilize the port with her index finger and thumb so it won't move,insert the HUBER(L shaped needle) needle in the middle of the port and inserted perpendicularly at a 90 degree angle and there must be a good blood return,she should be able to flush your port.

I had a nurse inserted a huber needle in my port and it just burned and another nurse poked it and after she removed it,it had a hematoma for over a month. We do not want any CHEMO going to our skin.

exbrnxgrlca--They should NOT BE WIGGLING the L SHAPED(HUBER) needle for port access, because they are not accessing a peripheral vein,that is ridiculous.

Its is worth reporting them to the office,so they do not victimize the patients,we already suffered too much.

Leydi--I agree with you,this must be reported to WHOEVER IS THE SUPERVISOR. I am speaking of California--Phlebotomist are not allowed to access PORTS and PIC LINES,only RNS and trained LVNS.

Sometimes, they prefer PORTS for long term CHEMO because they last longer if they are cared for well than PIC LINES.

ShetlandPony

Fac03, I think those nurses treated you terribly, letting you endure that unnecessary pain and body-shaming you. They did this rather than admit they lacked the necessary skill and experience. Good for you, finding the courage to speak up at your appointment. From now on, only allow the successful nurse to access your port. It is your body, and you do not have to allow the other ones to do it. Yes, they need more practice, but it does not have to be you any more.

JanetMara

I agree ShetlandPony.

They must watch the YOUTUBE on how to ACCESS THE PORTS.

exbrnxgrl

janetmara,

Well, my port is tiny, and wiggly! It is not the needle that is being wiggled, it is the teeny, tiny port I have. I’ve been doing this for almost 8 years, so trust me, my port wiggles (Bard Power Port Petite)

Cowgirl13

Fac, I'm so sorry this happened. I was lucky and my chemo nurse hit it right each and every time which was quite a lot of times. I had Herceptin for a year. She sprayed my port area with the liquid novacaine and it was fine. With everything we go thru I feel its so important that the nurse who is accessing your port needs to have enough training in order to do this properly. With all the poking, prodding and whatever else, we shouldn't have to indure more pain. I see nothing wrong with bringing this up...its a simple case that she needs more training. And she will benefit from that and so will her patients going forward. That's all. And it probably won't happen unless this is brought up to someone who can do something about this. I believe she is probably doing the best that she can.

MountainMia

This is a side topic, but just thought I'd mention -- this morning I needed a simple blood draw at my regular (not chemo center) lab. The women in the lab are amazing. EVERY TIME I have blood drawn there, they do a great job. This morning the woman laid the needle against the back of my hand. And then it was IN! I literally didn't feel her insert it. I told her I wished they worked all over the hospital, because they do a better job than anyone else.

Shellsatthebeach

My port was in at an angle, so it was difficult for access on one side (it was a double) and they have to use each side so clots don't form. It would sometimes take quite awhile before anyone could get proper access on the side that was sitting deeper in my body. It was awful. When they went to take my port out, the doctor said I had tons of tissue wrapped around it. She said my body had just eaten it up.

ShetlandPony

Cowgirl (wanting to believe the best about people which is admirable) said about the nurse, “I believe she is probably doing the best that she can.“ No. If you read fac03's post it describes how fac was restrained when it hurt bad enough to make her scream, and how the nurse offered no help when the needle continued to hurt during the infusion, and how the nurse actually blamed and shamed fac by telling her the problem was that she was fat. If that nurse had actually done her best, she would have acknowledged that she was in over her head and asked for help from an expert nurse, or even offered to reschedule if no better help was available at the time. If she had actually done her best she would have at the very least shown some compassion.

ShetlandPony

One time I had to have stitches removed from my lip. The nurse tried and tried and wasn’t succeeding. It hurt a lot and I was afraid she would mess up the cosmetic outcome. She complained that I was backing away from her in the chair. Well, yes, that is a normal reaction to pain. I told her she needed to try something else, another tool, or ask for help. It became clear to me that she was mainly concerned at that point with her own ego — she wanted to accomplish the job without help. But I said, “I’m not doing this any more. Please get the doctor.” I figured the dermatology surgeon would be skillful. She said the doctor was busy. I said fine, I can come back another time. So she got the doctor and he had the stitches out in two seconds, painlessly.

fac03

ShetlandPony, Wow it was bad in the dermatology office. I am glad you stood up for yourself.

Sometimes I was just not sure how they reacted. In fact, when I raised it during AC#3 in the infusion center. The reaction was "we are all trained to be able to access the port".

A few weeks ago, the oncologist suggested me to check into ER for a different problem. She discussed with the ER doctor and asked the ER nurse to use the port to draw blood. Then the ER nurse came to me to ask me questions about the port without checking the port. Finally, she asked me whether it was a powerport because they would need it for a CT scan, I did not know but told her the port was placed in the same hospital, she checked my record and told me the record did mentioned whether it was a powerport, so she proceeded to look for a vein to draw blood, but as the plan was to inject contrast for the CT scan, therefore she used a bigger needle which made me very uncomfortable the whole time.

What I found out in the infusion center a few days later was that the ER nurse wrote in the record that the port was difficult to find even she didn't even try to find it. I wonder whether the nurses know how to access a port in general.

Solobroker

Had chemo on Tuesday which was a busy day after Memorial Day. I noticed a couple empty chairs with patient's belongings and asked what's going on with that and the nurse said I'll tell you after. 

Well after accessing port with little to no problem, she said that she was having problems with ports today and that those patients were being worked on.  My gripe was that why didn't other nurses help or offer to do mine for me but didn't have to say anything...thank goodness. I was ready to though because my prior chemo the same nurse had problems drawing three tubes of blood from my port and was getting ready to send me somewhere to have it corrected. Same nurse was too lazy to get the Ativan I requested. She said you don't really want that do you? goes on to explain what she has to do to get it and whatnot but then ends with but it's not about me, it's about you and I said " yes, it is and I would like it. Thank you. Piece of work. 

Cowgirl13

ShetlandPony, I stand corrected. Your post is excellent. Thank you!

ShetlandPony

Thank you, Cowgirl. I’m not criticizing YOU. Fac’s post awakened the mama bear in me, and I’m not letting that nurse off the hook!

Cowgirl13

ShetlandPony, I didn't get that you were criticizing me. You just called it out so clearly delineating all the points.

JanetMara

exbrnxgrl--I am sorry,I thought they are wiggling the needle. But yes ports are wiggly because they are just situated underneath the skin and tends to move and wiggly( mine too) especially if they are not stabilized between the thumb and their forefinger when they insert the needle.