Ports, PICC lines and pumps
Many chemotherapy, immunotherapy, and targeted therapy drugs are given intravenously — which means they’re injected directly into the bloodstream.
For early stage patients who need just a few cycles of chemotherapy, your healthcare team might use a regular IV to deliver drug infusions. But chemo regimens can go for many weeks or months. After a while, it can get annoying to get a needle in your arm every time you go in for an infusion!
This is where devices like ports and PICC lines come in.
Ports and PICC lines help your healthcare team reliably access your bloodstream. Most patients receiving chemotherapy or immunotherapy will receive drugs through a port or PICC line at some point during their treatment. Patients who get 5FU infusions may receive the drug through a 46-hour external pump, which is hooked up to either your port or PICC line.
Your healthcare team will decide which device is most appropriate for you!
So what’s the difference between them? Here’s what you need to know:
What is a port?
A port is a small device made up of 2 parts: a reservoir compartment with a silicone bubble for needle insertion (called a septum), and an attached plastic tube (called a catheter).
The reservoir is implanted under the skin in the chest, and the flexible catheter is tunneled under the skin and inserted into a large vein near the collar bone or neck. Then, it is secured so that the tip of the catheter allows the drugs to drain directly into the heart.
For patients undergoing multiple cycles of chemotherapy over many months, ports allow for safer, easier, and more effective drug delivery than a traditional IV in the arm. If you need a port, it will be implanted before you start chemotherapy.
In the US, stage IV patients usually get a port straight away. But in other countries, you might use another method of accessing your veins first.
What happens during the procedure?
Port insertion is done as a simple outpatient procedure, usually with local anesthesia and some sedation. In some places, this is done by an interventional radiologist with the help of ultrasound or fluorographic guidance (a type of x-ray).
After administering the anesthesia, your doctor will make a small incision in your chest, usually on the right side, and insert the port and catheter. Then they will attach the catheter to a vein near the collar bone.
A port can be left in the body and accessed for many years. It can be removed through a simple outpatient procedure. Patients may prefer to take it out as soon as chemotherapy is done, or they can leave it in for up to 5 years during the surveillance period after treatment.
Will it hurt?
You will have stitches in two places: in the chest (where the reservoir part of the port is placed) and in the neck (where the catheter attaches to the vein).
Your neck and chest will be sore for anywhere from a few days to two weeks after the port is implanted. Most people have very little pain, while others may find recovery quite painful for the first few days. You can manage the pain with medication like acetaminophen (Tylenol) or ibuprofen (Advil).
It’s important to keep an eye on your port between treatments and let your team know if you notice anything unusual — such as redness, swelling or pain in your port area. Although these things are rare, they could be a sign of infection or a problem with the port.
What happens when my port is accessed?
Before receiving your infusion, a nurse will access your port. This means that they will stick a needle through the skin on your chest and into the reservoir, so blood can be sampled and drugs infused through the port.
Some people find numbing cream, such as lidocaine, helpful to reduce pain the first few times your port is accessed. Apply the cream 30 minutes to an hour before your appointment. Some people don’t mind the needle stick feeling, but others may find it uncomfortable. Some people get used to it, and others may not!
After accessing your port, the needle is left in place. The area is covered with an adhesive dressing, which is left until the infusion has finished. After the infusion, the dressing and needle are removed. For most patients, this is a quick and easy process.
In general, your nurse will flush your port before and after receiving any chemo drugs. This means that they will inject a syringe of saline solution into the IV line to make sure the catheter isn’t blocked, and that liquid can flow both ways. This is completely painless. Some patients experience a salty taste or smell from the saline solution. This is normal! Staying adequately hydrated can reduce the intensity of this feeling.
To prevent blood clots, sometimes your team may give you an injection of a blood thinning medication like heparin. However, it’s been shown that saline flushes are as effective as heparin flushes at preventing blood clots — so saline flushes are becoming more and more common.
Patient perspective by Tesia
Take a look at the video below to learn how to numb your port before access!
How might a port affect my life?
Although the port is visible, it just looks like a small bump under the skin. It can be easily covered with regular clothing.
For the first couple of days after the procedure, protect the incision from water when you shower. But after that, you can shower, bathe and swim without any restrictions.
Your port will need to be flushed regularly. Your healthcare team will flush it on infusion day, but if you are not currently on treatment, you’ll need to go to the cancer center to get this done. Usually it will be done every 6 to 12 weeks. Sometimes you can schedule port flushes during regular surveillance scan appointments, but check with your cancer center for more information.
Patient perspective by Scarlet
Diagnosed: April 2014
Stage: IV
Type: Colon cancer, metastases in liver and lymph nodes
When they told me I had to have a port I was terrified! I was 29 and just barely diagnosed. I was only 20 days out from having my primary tumor removed and a month shy of my diagnosis. In my mind the port seemed terribly permanent; even though they said chemo for life and surgery was not an option, I was determined to beat this. Inject the drugs into my arm and let’s get on with life, I could handle it, the port was not necessary.
Boy, was I ever wrong, one of so many things I was wrong about. My port was my saving grace. It’s literally your lifeline to beating cancer. Protect it, name it, and keep it as long as you need it. Don’t let just anyone access it; infusion nurse and oncologist have the ok but the guest list is pretty small. This port is going directly into a major vein in your heart.
When they implanted the port everything went perfectly. You couldn’t even see it. However, as it healed when my infusion nurse would access it, it was very painful initially (I think it was from the scar tissue) however, a little lidocaine helped until it was completely healed up. It didn’t hurt at all after that. I was expecting a lot of pain, but I think it’s all the fear we have built up in our minds on top of all the fear we already have with our diagnosis.
I know when you’re first diagnosed everything seems to be happening quickly and for me, my port was another permanent aspect of the cancer or perhaps it was another uncontrollable change that came with cancer that I was not interested in having. I didn’t want it in the moment, but killing the cancer is the primary goal and the port made it that much more possible for me to do just that.
My doctor assured me on the day it went in that he could take it out just as quickly. However, I have to be NED for 5 years before that happens. That’s another goal I’m working on. This is just my experience and this is my doctor’s policy; I know it can vary from place to place.
Patient perspective by Tiffany
Diagnosed: August 2019
Stage: IIIB
Type: Colon cancer, tumor located in cecum
The first time I heard the word “port” was in the recovery room after my first colonoscopy, shortly after the doctor told me that I had a “very large mass that was almost certainly colon cancer.” After some legitimate freaking out, I mostly fell into a state of shock, which he took as an invitation to explain things like “you will need your right colon resected.” I didn’t know what “resected” even meant. My autocorrect didn’t recognize it as a legit word. I was 36. He listed off many next steps and added, “you will also need a port for chemo. I can install that for you.” I had never even heard of a port before. Install it? Where? In my car? No… IN MY CHEST! Nobody had ever suggested installing anything in my body before but everyone acted like it was no big deal. I was very unprepared for everything I experienced that day and every day after, until I found COLONTOWN.
I got my first port 2 weeks before my first round of chemo (4 rounds of CAPOX.) I had my tumor resected about a month previous and compared to that experience, the port operation seemed very easy. My surgeon used a general anesthetic and the only surprise for me was that there were 2 incisions. One on my chest to place the port and a smaller one nearer my neck for the tube. I had not expected the smaller one, but it also never gave me any degree of discomfort. The surgeon reported that he had a problem placing the port, so it was on a different side of my chest that I was expecting. It was also slanted diagonally because he couldn’t put it in the place he normally would, for reasons I didn’t retain. He assured me it wouldn’t be a problem. It wasn’t a big deal but I wish I had known about it beforehand. I had almost no pain. I was, however, terrified to remove my dressing and left it on for many days until a nurse/friend told me I had to take it off and did it for me. I am not squeamish about my own body stuff but I was worried it would be poking out a lot and I wasn’t sure how well I would emotionally handle that. As these things usually go, I had made a bigger deal of it in my brain than it was in real life.
I was glad I had a couple of weeks to heal before chemo began. I was uncomfortable with the idea of anyone putting a needle in an open wound where the skin was tender and still healing. (I didn’t realize that the needle wasn’t going into the incision but below it.) When I expressed this anxiety to the chemo nurses in advance of my first infusion, they provided me with a lidocaine cream. Per their instructions, I put on a thick layer of the cream about 45 minutes before my infusion appointment and covered it with plastic wrap. When it was time for the needle, I felt almost no pinch whatsoever, and was glad for it because that was the last good thing that happened that day. 🙂
My virgin port did not work. They tried reinserting the needle many times, they had me bend over, lay down, roll onto my sides, arms up, all kinds of acrobatics. Nothing seemed to work. They were getting the saline into the right place, but were convinced one of the tubes was kinked because it took tremendous pressure to push fluid through a syringe. After every nurse gave it their best, they called for the oncologist.
He came in and was also stumped. (Apparently this doesn’t happen too often.) He decided that it was more important that I get chemo on schedule than it was for me to have chemo through the port. The plan was to do my first infusion through my arm and then have a port study done by a radiologist to determine the port malfunction before my second infusion in 3 weeks.
I was fitted with an IV. I had blown several veins during my colon resection, so the only good option was in the crook of my right elbow. That meant I had to leave my right arm straight and couldn’t use it for the next several hours. About halfway through the infusion, I started to feel a slight burning sensation in the arm that was receiving the chemotherapy oxaliplatin. By the end, it took all my big-girl grit not to cry. The intense burning went from my arm to my chest. The nurses assured me this was normal (and why they prefer to use ports, when possible!) I was so relieved when the bag was finally empty and they flushed the burning medicine from my vein.
I went home and started to deal with all the not-so-lovely side effects of chemotherapy. But the burning pain in my arm was worse than any symptom I had. I couldn’t lay on my right side to rest. It felt like I had a very severe sunburn UNDERNEATH my skin for almost a week. The pain got a little better each day and eventually did go away completely. But to this day, there is significant scarring in that arm and it’s usually impossible to place an IV or successfully draw blood from that side.
I went for my port study the next week. I was positioned in front of a live xray monitor. A nurse accessed my port and had the same issues that the nurses at the infusion center had. I was instructed to do many acrobatics to no avail. She had to press so hard on the syringe to flush my port that it left a deep red mark on her palm. But the radiologist was seeing the dye go through my tubes and arteries as expected, so he reported that there was no malfunction. I was told getting chemo through my port in 2 weeks wouldn’t be a problem.
I went into the infusion center for unrelated issues about a week before my second scheduled chemo appointment. The nurse had the same issues again and I was told that my port was useless. The oncologist came in, reviewed the radiologist’s notes and determined that the port hose had to be kinked and I needed a new port. This was a few days before Christmas. I didn’t know how I would be able to get a new port in time but he assured me he would find someone.
By the time I left, I had an appointment in 2 days to get a new port. This time, a vascular surgeon would be doing the procedure. It would be done in the radiology department and I would not be fully sedated. I was pretty nervous about that, but it turned out to be quite nice. It was much faster than an outpatient operation. They gave me some kind of sedative so I wouldn’t feel the incisions. When he started to work I felt a very light pinch and burning sensation. I told the surgeon/nurses and he instructed that I be given some more sedative. I still didn’t fall asleep but felt a warmth spread through my body and felt no more pain. He removed my port (and the hose, as it turns out, was kinked) and installed the second port on the opposite side of my chest without incident. I told stories and talked and laughed throughout the whole short procedure. The nurses shared that I abruptly fell asleep for about 10 minutes at some point but then I woke up and just carried on with my story. I had no memory of that. 🙂
This port worked like a boss for the remainder of my chemotherapy treatments, which were much more comfortable than my first round.
After my treatment ended, I was anxious to have my port removed. I live 40 minutes from town and taking time to drive in for port flushes every 4 weeks (This was sometimes stretched to every 12 weeks during the height of the pandemic shut-down.) was not ideal when I was trying to live my best NED life. It was also just a daily reminder of the trauma I had experienced at the hands of cancer. I was also convinced that it was causing some discomfort in my shoulder, especially at night or if I slept on the side where the port was located.
However, on the flip side, having a port made getting blood drawn or receiving contrast for MRI/CT scans a breeze. I also had a lot of fear of recurrence and didn’t want to remove it prematurely, and have to get another port if the cancer came back. Finally, my youngest child liked to rub my port “for good luck.” He was 6 when I was diagnosed and called it my “tombstone” because he couldn’t remember the right word. It stuck and we still refer to it as my lucky tombstone.
About a year after chemotherapy ended (and four negative ctDNA tests) my oncologist agreed that we could remove the port and see if it helped with the shoulder pain. (Let it be noted that the oncologist and several other doctors and physical therapists told me that it was not possible that my shoulder pain was related to the port.) On March 4, 2021, I was “de-ported.” It was, again, an outpatient surgery – which I did feel was unnecessary but didn’t feel was worth the fight. I had no complications and very little discomfort in healing. I was mostly back to normal things later that day. (Let it also be noted: My shoulder pain disappeared immediately along with my port, and has not returned.)
When all is said and done, my biggest takeaways are: I would NOT recommend chemo without a port. I would definitely have a vascular surgeon “install” it (he was much more confident and successful) and don’t think general anesthetic/outpatient surgery is necessary.
Last month, I was swimming down at the river with my kids and took a selfie. I noticed my 2 jagged/uneven port scars and wrote the following:
“Today, I am paying tribute to my port scars. I have 2 because my first port was a dud. (One scar is lighter, older, higher on the opposite side of my chest.) It was hard to love my ports and even harder to love their scars. They were a sloppy reminder of a very personally difficult time in my life. They would stare me down in the mirror each morning. People noticed them.
But then I started to notice that my scars connect me with people. Others see my port scars and then show me their own, or tell me about their loved ones who have/had matching scars. We are not alone and that is beautiful. Now I look at my scars and wonder who they will introduce me to next. They are my own little rainbows 🌈: a reminder of what I have experienced and hope for tomorrow.”
Patient perspective by Robin
Diagnosed: August 2019
Stage: Originally stage I, progressed to stage IV
Type: Colon cancer, liver metastases
My port placement was uneventful. I received my Stage 4 diagnosis on a Friday and the following Friday, I was scheduled for my port. Not a lot of time to even process everything and I didn’t ask any questions beforehand (I realized afterwards that I had no idea what the port even looked like or how it functioned).
The procedure was pretty easy. I was given mild sedation (which essentially put me in twilight sleep) and a local anesthetic. When I woke up about 45 minutes later, the port was in and I had about a 1-inch incision that was stitched with dissolvable sutures and covered up, with a tiny incision higher up that just had a band-aid.
I was able to shower the next day but had to keep the port area dry. I was able to start chemo on the following Tuesday (4 days later). Using Lidocaine is key to numbing the area before the chemo needle is inserted (I just put a pea sized amount on the port, don’t rub it in, and cover it with saran wrap about 1 hour before chemo).
My port does stick out as a small lump so it must be pretty close to the surface. I really don’t notice the port most of the time and can sleep on my port side but I worry about putting a kink in the catheter so I avoid that side most of the time (I don’t even know if you can manipulate the catheter that way – might just be all in my head!).
I LOVE my port? Why do I love my port? I have terrible veins that like to play hide and seek and roll over so I’ve been able to use my port not only for chemo but also for several surgeries and procedures. It was a blessing in the hospital for my liver resection. The nurse couldn’t find a good vein for the IV so after several tries, I asked if they could use the port. They hesitated but finally agreed. By using the port, they were able to put me under in the OR and then go searching for an IV vein without my feeling it. I was able to use the port for my blood draws while in the hospital as well. It has treated me well!
What is a PICC line?
Some patients will receive chemotherapy through a PICC line. PICC stands for peripherally inserted central catheter. It’s a long, thin tube that’s inserted through a vein in your arm, and runs up the arm to connect to a large vein that drains into your heart.
What happens during the procedure?
PICC lines are inserted in a short outpatient procedure. After numbing the skin with a local anesthetic, your healthcare team will identify a good vein in your arm. A needle is inserted to access it. Then, a cut is made in the vein, and a long, thin hollow tube (called a catheter) is inserted into the vein.
With the help of ultrasound or x-ray guidance, the catheter travels up the vein into a large vein that drains into the heart. The other end of the catheter sticks out of the vein in your arm, and is capped to keep it nice and sterile!
A PICC line can be left in as long as needed, and can be removed after your treatment is done as a simple outpatient procedure.
Will it hurt?
The procedure should not be painful, but the area around where the line is inserted may be sore for a few days afterwards.
It’s important to notify your team if you see any unusal redness, swelling or pain near your PICC line. Although complications are not common, these symptoms could indicate some type of infection or problem with the line.
How might a PICC line affect my life?
Your PICC line may be taped down so it doesn’t get in the way of your daily activities.
PICC lines require weekly dressing changes and flushing. Some patients are trained to do this at home, but others go to their infusion center or have a home health nurse come to help out with flushing.
You must keep your PICC line dry, so you’ll need a waterproof cover for showering. Avoid submerging your arm in water when you bathe or swim.
What is a 5FU pump?
If you’re receiving FOLFOX, FOLFIRI, or FOLFOXIRI chemo regimens, you’ll probably receive the 5FU portion of your chemo through a 46-hour pump. The pump is connected to your port or PICC line.
5FU delivered through the bloodstream has a very short half-life — meaning that it doesn’t stay active in the body for very long. So instead of receiving the 5FU dose all at once, a pump slows down the delivery time. You might receive 5FU through pill form instead.
There are two different types of pumps:
- A mechanical/electric pump, which is battery operated
- A bulb pump, which is activated by body temperature
How do I get a pump?
At the end of your IV infusion of oxaliplatin or irinotecan (or both), your nurse will flush your port or PICC line, then give you a preliminary dose of 5FU. This is also called a bolus or push. This is done to make sure you don’t have any accute reactions or side effects from 5FU.
After this push, you’ll be hooked up to a pump, which you will take home for 2 days. The pump will administer the rest of your 5FU dose over 46 hours.
In some cases, you’ll be given a time to come back to the infusion center to get disconnected from the pump. Some patients might have a home health nurse come disconnect the pump at home. Others may receive training to do it by themselves at home!
What’s the difference between the two types of pumps?
There are two kinds of pumps: a mechanical pump and a bulb pump.
The mechanical pump is battery operated, and is a bit larger and heavier than the bulb version. You’ll be given a fanny pack to help you carry it around and keep it out of the way.
The bulb is a small, lightweight plastic container containing the 5FU drug. It’s connected to a small heat sensor, which your nurse will tape to your skin. It’s important to keep it securely in place, as the heat activates the pump and keeps the 5FU infusing on the correct schedule.
How might a pump affect my life?
Pumps are usually contained in a small fanny pack that you can easily wear or carry around. It’s important to keep the pump dry while it’s running, so you might be advised to skip showering while wearing it. A small bath should be safe, as long as you’re careful to keep the pump and your port or PICC line dry.
When you get the pump, you should be given some information about how the pump works — and what to do if something goes wrong. Pumps rarely malfunction, but it does happen occasionally. You should also receive a clean up kit in case of any leaks or spills. Make sure you have a 24-hour phone number you can call if you run into any problems.
Patient perspective by Robin
Diagnosed: August 2019
Stage: Originally stage I, progressed to stage IV
Type: Colon cancer, liver metastases
I know there are different types of pumps. Mine is the CADD-Legacy Plus through InfuSystem and comes with a fashionable black case – an essential accessory for the chemo patient looking to rock their fanny pack. Naturally, I named my pump “Fanny.”
Fanny and I have a fairly good friendship and she IS a really good friend but we only hang out for about 46 hours every 2 weeks. Fanny is the kind of friend I want to have – a warrior ready to defend me and annihilate any cancer in my path (and she’s been pretty successful at that) but let’s face it, she is also quite the third wheel during the 2 days she stays with me – always hanging around and never giving me any peace. Despite her fierce support of me, Fanny has her faults:
- She makes me tired and nauseous during her 46 hour stay and often the day after she leaves (but my friends Compazine and Zofran take turns looking after me and help me feel better)
- She’s a loud sleeper and I have to stash her in my nightstand to keep the peace, but we’re always connected (as I’m often rudely reminded when I take a bathroom break in the middle of the night and forget to invite her to come along)
- I usually need a good manicure & pedicure when she visits as she leaves my feet and hands a peeling mess, but Udderly Smooth lotion is a big help there
- She leaves a bad taste in my mouth for a few days after she leaves but then all returns to normal
Fanny and I have been friends for about 1-1/2 years but we’ve taken several lengthy breaks when I had surgeries and SBRT. Fanny and I are hanging out again for a few months and she is her wicked awesome self – kicking cancer’s @ss on my behalf just like any BFF would. And just like any BFF, she has her quirks, but my life is significantly better with her in it.
Patient perspective by Pam
Diagnosed: July 2021
Stage: IIIB
Type: Colon cancer, one involved lymph node
I’ve mentioned the “chemo pump” several times, and I know there’s some curiosity out there, so I thought I’d do a post to clarify a few things. For some folks, this might fall under the TMI category, and if that’s true for you then scroll right on by. However, y’all have probably figured out that I really want to de-stigmatize…de-mystify…de-fear-ify (yeah, I know that’s not a word) this thing called cancer and its treatment. Putting stuff like this out there is one way to help do that, and – for me – it’s empowering. Having said that, I totally respect the many people in my life who have kept cancer treatment private. With so much we can’t control with this disease, our privacy is one thing we can control, and for those who choose to keep it private…more power to you, friends.
First things first: Why a pump and what does it look like? (A pool pump? Tire pump?). The “why” is related to the type of chemo I am on. It is called FOLFOX and is common for treating colon cancer. The therapy involves a short infusion of pre-meds (steroid/anti nausea) followed by a long infusion of a drug called oxaliplatin. This part takes about 3 hours, and this is what is happening when I post pictures of myself “in the chair.” (Note that, by the time I hit the chair, I’ve already been at the hospital for 2 hours for blood work and a consult with the doc about the results.) The second part of the treatment involves a drug called 5FU, and this particular drug must be administered slowly, over a long period of time – 46 hours exactly (and, let me tell you, they are *very* exact about it). Well, it’s not like they can keep me “in the chair” from Monday until Wednesday, so after the oxaliplatin is done, they insert a little bag of 5FU into the pump, set the infusion timer, and send me on my way with an appointment to come back *exactly* 46 hours later. The pump itself is a little rectangular box made of clear plastic, powered by a single 9v battery. (Yes, they send a spare just in case.) It’s roughly 4” high, 6” wide, and about 3 inches deep. Every 30 seconds it gives off a little whirring noise indicating that the pump has just dispensed a dose of 5FU. There’s a thin tube that runs from the pump to where it attaches to the port just under my right collar bone. This is how the meds flow into my blood stream.
Now, you may be wondering how this little contraption gets carted around with me for 46 hours, while still allowing my to do regular daily activities. Well, that leads to an introduction to my best friend for 46 hours, every other week….My fanny pack! She’s a beaut, all right! Her name is Fanny. The pump company sends you home with a little shoulder bag for the pump, and I really tried to make it work. However, it became obvious that we were just never going to be compatible, so we broke up and I got a new mail-order friend from Amazon. I was able to get all the proper measurements, figure out the best fit, and really get everything I wanted knowing we’d be eating, sleeping, exercising, showering, cooking, and…well…everything together for 46 hours at a time. Let me tell you she’s perfect. Honestly, most of the time I forget she’s around at all.
This probably leads to two other questions. Do I sleep with the pump? Yes. No choice there. With Fanny it’s actually easier than you’d imagine. I can sleep on either side or my back (I wear her in front, since that’s where the pump connects to the port). The days I’m on the pump I’m also on steroids which disrupt my sleep, so it’s not like I’d be sleeping like a baby anyway. But, it’s actually fine and I’m able to get a reasonable night’s sleep with the pump. (If I had responded to this question when I was still trying to make the shoulder bag work, the answer would have been quite different and would have involved sleeping in the recliner and language not befitting civilized company.) Do I shower with the pump? Kind of. I can’t get the pump or port area wet while connected, so it takes some contortions. Luckily we have a big, walk-in shower with a shower head attached to a hose. So, I latch Fanny to the outside of the shower door, keep my right side aimed at the door, then use the shower-on-a-hose to do a reasonable job getting clean…other than my right arm and shoulder. For that I use baby wipes. (Total tangent here, but when we designed our house we put in a lot of features with the intention of making it easy to age here. Little did I know that a whole bunch of these things would come in handy while debilitated after surgery and during chemo. I am sometimes stunned by how fortunate I am, especially when I read in Colontown about the challenges that so many other people face.
In the event of a spill…. One of the things about going home with the chemo pump is that you basically have to be prepared for a chemical spill, in the event that your line somehow detaches or the tubing gets cut. Make no mistake, this stuff is toxic. They actually provide a chemo spill kit to take home. It’s sobering, really. At the hospital, the nurses have to wear protective gear when handling the chemo bags. I have to double-flush the toilet to make sure no residue is left behind. So, if you ever wonder about why there are so many side effects, and why they are so unpleasant, keep in mind that the stuff going directly into my blood stream is…unkind to the human body. Of course, that means it’s *really* unkind to cancer cells, which makes this all way more tolerable.
Are your activities limited while on the pump? Not really. I cook and exercise and do whatever else is on my agenda for the day. People in Colontown continue to work on “pump days.” Some even travel (with some interesting stories to tell about TSA). Those who travel have generally been trained to do their own pump disconnect at 46 hours (which I am not *at all* interested in doing myself). If my neutrophils were not low, I’d be able to go out shopping, or whatever. However, my low neutrophil count, and consequent risk of illness and infection, keeps me at home. But that’s my blood, not the pump. With these meds being so vicious, one might wonder: Does it hurt? The short answer is no. You might think it might burn or something as it flows in through the port, but it really doesn’t. If the port would leak, then the skin would burn and it would hurt. But, being deposited directly to a vein (which apparently has no nerves?), it doesn’t feel like anything. The port, on the other hand, is occasionally uncomfortable. There’s a catheter that runs from the port to the jugular vein in the neck, and the catheter passes over the collar bone. This is sometimes uncomfortable and gets a little sore. This has decreased over time. If I bend forward, the port (which isn’t heavy, by any means, but does have some weight) kind of stretches the skin, and that’s…irritating. I have a prescription for lidocaine (which is a topical anesthetic) that I put on the skin over the port an hour before they have to insert the needle attached to the tubing into the port. So, even the prick through the skin to access the port is painless, and I only have one poke because the nurse inserts a short catheter with an attachment at the end where everything else can be connected as necessary later. It beats the heck out of trying to access veins in my arms, which wouldn’t work anyway when you have 46 hours attached to a pump. They even do my blood draws through the port, which is awesome. And when the time comes for more CT scans, they’ll also be able to inject the contrast solution through the port. A miracle device, to be sure.
What if I don’t get a port or a PICC line?
Many early stage patients only receive 4 cycles of the CAPOX chemo regimen — which only requires 4 infusions of oxaliplatin total, once every 21 days. Therefore, many patients receive oxaliplatin through a peripheral vein in their arm (standard IV) instead of a port or PICC line.
Will it hurt?
Oxaliplatin can cause blistering, and is an irritant — which means that if it spills out of the vein during an infusion, it can damage tissue and cause pain.
Being well-hydrated can increase blood volume, and help oxiplatin dilute quickly in the blood stream. So drink a lot of water before and during your infusion! Some cancer centers give patients warm blankets to place under the arm with the IV. This helps dialate your veins, also helping the drug mix into your blood easier.
You might experience some arm pain after the infusion. Keep track of how much it hurts, and how long it hurts, and talk about this with your care team. You can alternate arms used for each infusion, so each arm is only used twice during the entire duration of treatment.
If you experience pain for a long time after oxaliplatin infusion, your healthcare team might recommend you get a port or PICC line.
So why does all of this matter?
Knowing how you might receive your chemotherapy can help you prepare for what to expect — and reduce the number of unknowns in your life. Knowing what to expect with a port, PICC line or pump can help you prepare for any problems or unexpected circumstances that arise.
If you have any questions or concerns regarding port vs PICC line — or figuring out the different kinds of pumps — talk to your healthcare team. It’s important that you understand the decisions that are being made about your care!
Still have questions about ports, PICC lines or pumps?
Join us in the COLONTOWN Downtown Facebook group, where you can find support and answers to your questions.