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Chemotherapy Infusion Using A Port

I have looked, and I see relatively little information concerning what is involved in chemotherapy, from a patient's point of view. The whole matter of "What should I expect?" is a major hurdle for those newly diagnosed with cancer, and it is important to provide enough information to allay their many fears. Since Monica and I are professional photographers and since I am currently undergoing treatment for stage IV pancreatic cancer, we are uniquely positioned to provide a bit more information on the web. What is pictured here is a fairly typical chemotherapy session, as would be administered in any major cancer center. These photographs were made on September 18, 2006, at Kirklin Clinic (University of Alabama, Birmingham).

About a month ago, I had a "port" installed, which provides a simple and relatively painless method to administer chemotherapy drugs. Before I had the port installed, each chemotherapy visit would entail multiple needle sticks, both to draw blood for tests, and then again to attach an IV for infusion of the drugs. The placement of an IV is no fun, especially when, as was usual with me, they would have to make three or four attempts to hook one up, each time in a different place in either my hands or arms. The port has made this a much simpler operation. There is one relatively painless stick, and that is it. This has reduced the fear factor considerably, and is worth it for that reason alone. For some people, that fear keeps them from getting treatment in a timely manner. After having chemotherapy drugs administered both without and with a port, I can wholeheartedly say that having a port installed is a very worthwhile thing to do.

My cancer blog may be found at http://diehlmartin.com/cancer.html

Procedure

When I arrive at the clinic, I check in both with the blood test lab, and also with the infusion department. Because I have a port, the blood tests will be done using the port, rather than sticking me with a needle to find a vein. So I leave my blood test paperwork at the infusion department, and wait for them to call my name. They then take me back to one of the infusion rooms, and hook up the port.

Copyright 2006, Monica Martin Photographer
Figure 1. The port is in the lump near the third button up. The port is entirely under the skin, and is in the fat layer. There is a tiny catheter that goes from the port up to the jugular vein in my neck. The port is painless, and doesn't itch. In order to hook up to the port, I undo several buttons on my shirt, and that provides all the room they need for access.

Copyright 2006, Monica Martin Photographer
Figure 2. First the nurse puts down a barrier to keep any spills from staining my shirt. It has an absorptive layer on the top, and a plastic barrier layer on the bottom.

Copyright 2006, Monica Martin Photographer
Figure 3. Next, the nurse applies a disinfectant to the skin over the port, to reduce the risk of infection. The material they use seems to be iodine based, which temporarily stains the area, letting them know exactly where the disinfectant has been applied.

Copyright 2006, Monica Martin Photographer
Figure 4. The area is then sprayed with a chemical which cools and numbs the skin over the port, which makes it so that I can barely feel the attachment to the port.

Copyright 2006, Monica Martin Photographer
Figure 5. There is a special needle assembly which is made specifically to work with a port. Here the nurse is about to puncture the skin with the needle, and push it into the reservoir in the port.

Copyright 2006, Monica Martin Photographer
Figure 6. This picture shows the configuration of the needle assembly. It looks terrible, but I could barely feel it. It is made to hook into the port and to stay hooked to it, and not fall out.

Copyright 2006, Monica Martin Photographer
Figure 7. Once the special needle is inserted, it provides a pathway through which blood may be drawn, and through which the necessary drugs may be administered. This needle, once inserted for the day, is left in until all of the day's procedures have been completed. Once again, I could barely feel it.

Copyright 2006, Monica Martin Photographer
Figure 8. This close up view shows how the needle goes through the skin and into the port. As compared to having an IV installed, this is easy and painless.

Copyright 2006, Monica Martin Photographer
Figure 9. Once the port is set up, the procedures can begin. There are multiple vials of blood drawn. The first one is always wasted as there is some contamination possible in the sample, which would throw off the blood test results. By the second vial, the blood is suitable for their tests.

Copyright 2006, Monica Martin Photographer
Figure 10. The vials are actually little vacuum bottles, which draw the blood out without requiring any mechanical aid on the part of the nurse.

Copyright 2006, Monica Martin Photographer
Figure 11. Once the blood is drawn, the port is injected with heprin, which reduces the possibility of the blood clotting in the port, and blocking it.

Copyright 2006, Monica Martin Photographer
Figure 12. Next, the nurse adds some gauze pads to add some mechanical support to the port, and tapes it all to my skin. This is necessary, as once I close my shirt and head back to the waiting room, I could be bumped which might cause things to shift. The gauze pads help prevent this from happening.

Copyright 2006, Monica Martin Photographer
Figure 13. Once the port is accessed for the day, I can button up my shirt and have just the access tubing sticking out of my shirt. Now I go out and wait until the blood tests are completed. There are some problems which blood tests can discover which would preclude them from giving me a chemotherapy treatment. Until the tests are done, they do not know if they can proceed or not.

Copyright 2006, Monica Martin Photographer
Figure 14. After about an hour wait, I am then called back into the infusion room, and seated in one of their big recliners. The nurse first injects an anti-nausea medicine, since some forms of chemotherapy can cause nausea.

Copyright 2006, Monica Martin Photographer
Figure 15. The nurse then hooks up the port access to her infusion pump, and starts infusing saline solution (salty water, as Edna called it) while we wait for the gemcitabine mix to be prepared in the pharmacy. Once the gemcitabine is ready, the nurse sets the pump to inject it over a 90 minute period.

Copyright 2006, Monica Martin Photographer
Figure 16. Once the gemcitabine is set to pump, there is little to do but lie there and wait. Sometimes I read, and sometimes I sleep. If there are any other shots I am to receive, I usually receive them sometime during the infusion. Once the gemcitabine is done being pumped in, the nurse unhooks the access tubing and needle from the port, puts on a band aid, and I am free to leave.

Monica and I celebrate the day with lunch at some place nearby. We make the best of the day, with a date. After 35 years of marriage, we enjoy every chance we get!

From my perspective as the patient, chemotherapy is time-consuming, but with the port installed, it is not problematic at all. My only regret is not having the port installed before the first round of chemotherapy. It has made infusion so much easier, that it is very much worth the hassle of getting it installed.

Some people worry about physical scarring from having a port installed. This is a particularly baseless fear. I have some photos of what the scars looked like less than two days after the port installation, shown here: http://diehlmartin.com/scars.html Given two weeks of healing, and other than the lump where the port is, you would never know anything happened. Assuming a person is in remission, removing the port can be done, and once done, no one should be able to tell that there ever was one. There is no reason to fear having a port installed.

My cancer blog may be found at http://diehlmartin.com/cancer.html

Update
Diehl Martin passed away in October 2007. If you need to contact someone, please contact Monica Martin.

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