Chest Ports VS PICC Lines *long sorry but hope it helps*

Hello!   Just finished 20 weeks of chemo (yahoo!)  and wanted to share some experiences that maybe rather unique to my situation.  I was 'Lucky enough' to have to use both a chest port and a PICC line.  Long story, short, the chest port became infected, quickly and badly.  Apparently when chest ports go bad, they go really bad and you find yourself facing an emergency surgery to have it removed. 

I've gotten conflicting feedback from the medical folks, Docs and nurses, as to how often chest ports get infected but based on the replies of "It rarely happens" to "It's not all that rare" I figure the truth lies somewhere in the middle.

My little veins didn't like the Taxol via a regular IV and played hard to get so my MO said, "You need a PICC line".

"Oh God", I thought, "not more surgery". 

Then I got my PICC line and I'm here to tell you ladies, that little ole PICC line and I were the bestest of friends!

NO more pokes at all.  No more lidocaine cream (which sometimes worked for me sometimes didn't).  For me personally the PICC line suited me, my temperament and reduced the stress of chemo immensely. 

Having said that PICC lines do come with their downfalls and problems as do chest ports.  I'll share the pros and cons of each to help others out there, facing chemo, learn about some options that your MO may not suggest.

NOTE: sometimes due to other medical concerns as noted by your MO you maybe limited to one or the other.  However in many cases, like myself, either or would have been fine.

Chest Port: 

Pros:  Once it's in and the insertion site properly healed you really don't need to do anything to maintain it.  You can shower, swim and move around normally.  A lot of women get along just fine with their chest ports and have them in for a year or more with no side effects or problems what so ever.

Cons:  It's outpatient surgery to have it inserted.  So you have to go through all the surgery rigor-marole of not eating, not drinking spending pretty much the whole day at the hospital.  I had mine done with twilight anesthesia in the radiology but some patients have their ports implanted by a surgeon with general anesthesia.  Either way it's 'surgery' with the larger IV used for anesthesia.  If it gets infected it can be hard to detect and can become quite serious quickly.  Even with strong antibiotics it took only one weekend for mine to go from "hmm that looks a little red" to oozing pus and OMG get it out now.  Again, many women don't have this problem but I was told by several nurses and MD (including my surgeon "Yup it happens").  In my case I had to stop chemo and had a large draining wound in my chest for several weeks.  Not good.

It still requires a needle.  You will be given (or make sure you get!) lidocaine cream to put on your port prior to chemo, talk to your MO and chemo nurses on the best way to apply and when to apply, else you will feel the needle stick in the port.  This varies given my fellow chemo patients feed back, some hardly feel the needle stick, some (like me) have problems with pain.  Ultimately be aware, if you're like me and just would rather avoid needles and pokes as much as possible, there's another way!

The other con is on a more personal level, some people, myself included just hate chest ports and never got comfortable with it.  I had trouble sleeping and at times it felt like it was strangling me.  I've read similar comments on this forum that some women just don't like them.

Enter - The PICC line!   This is a semi-permanent I.V. that is inserted in a larger vein, usually in your upper arm.

Pros:  A properly trained nurse or radiology nurse can insert them.  It's a simple shot of lidocaine and literally only takes minutes!  I laid down, felt a little sting of the lidocaine shot.  Waited a while and asked the nurse, "How's it going?"  She said "All done, I just have to clean the area and put a dressing on."  Literally less then ten minutes on the table, in and out. 

Easy to monitor for problems.  The dressing used to cover where the PICC line was inserted was clear, it was very easy to monitor it for problems, redness, infection.  If a problem should crop up and the PICC needs to be removed the MO or nurses at the Chemo clinic can quickly remove it.  No need for OMG surgery!  The nurses change the dressing once a week at the chemo clinic, clean it and therefore can carefully monitor how your PICC line is doing.  

NO needles, NO pokes, the blood for your blood tests are drawn through the external ports and chemo goes in through the ports. 

For me a PICC line was far, far less stressful then chest port or the IV in the arm.  According to one Chemo nurse she feels they are especially suited to shorter term chemo protocols.

The Cons:  For some women these cons will be deal breakers, for me some of the cons listed below made me feel more empowered and able to monitor my PICC line daily myself. You have to flush the PICC line once a day.  It usually has two ports and you will be given saline syringes that screw onto the port and push the saline in. The chemo nurses will teach you how to care for and monitor your PICC line. Hygiene is very important in keeping the PICC line from becoming infected. I used medical gloves and alcohol prep pads (again provided at the clinic) to carefully clean the ports before and after flushing. Ultimately, though, the flushing only took a maximum of 5 minutes per day once I had my routine down pat.

You cannot get it wet in the shower (see below I will be adding PICC line tips later).  It's a bit like dealing with a cast on your arm, you have to cover it in the shower.  No swimming with PICC line.  You must be careful with the arm the PICC line is in, no heavy lifting of weights so it does limit exercise on the arm involved.  You need to keep them covered so the ports don't accidentally catch on clothing or any other objects. (see below for PICC line tips on this too).

I told my MO I would have much rather had the PICC line to begin with.  He doesn't like them because sometimes people do not take care of them.  I took really good care of mine and while getting chemo recommended it to another patient who was having a terrible time with her veins and IV sticks.  Her MO said O.K. and the next time I saw her she literally was all smiles. The relief for her was immense.  

In some situations the PICC line may be a better alternative, it's good to know what your options are so that you can make informed decisions as to what suits not only your medical needs but also feel more comfortable with.  It's your body and your journey!

(((HUGS)))) To all my warrior sisters!  You can do this!