Arm port versus chest port

Paula O · 01-04-2013, 05:24 AM

If anybody here doesn't have a port yet but is going to get one, I highly reccomend an arm "Passport". Mine has been very comfortable (after an initial brief minor adjustment) and more discreet than a chest port from what I can tell. It is inserted above and on the side of the arm where there's a bend in the elbow, hardly shows and doesn't feel like anything. It apparently threads to the same place as a chest port without another scar on your chest and without the risk of puncturing a lung on insertion. I met a couple patients who had lungs collapse during their chest port insertions ---yikes---a surgeon's and patient's nightmare. It's not a common problem but a genuine risk and it does happen sometimes.

Passports have been around a long time but not many people get them and I'm not sure why because they sure seem much better from the patient point of view. With all my infusions I never saw anybody else getting hooked up with the arm port like I was. Mine worked very well and had easy access without unbottoning my shirt. The nurses thought it was wonderful and other patients who saw mine thought it was a great way to go and I did too. Anyway, I'm sharing this not to boast about the location of a port (!) but to pass along a tip that if you are going to need a port, you might want to consider an arm passport if your surgeon does them.

Anyone else here have an arm port too or heard of any disadvantages over a chest port?

Paula

Lauriesh · 01-04-2013, 06:03 AM

When I was deciding on one, my surgeon said she didn't like the arm ones because there is a greater risk of blood clots. Don't know if it is true, but it was enough to convince me to go with a chest one.

Laurie

Jackie07 · 01-04-2013, 09:36 AM

Here's an abstract on the arm port:

AJR Am J Roentgenol. 2012 Aug;199(2):447-52. doi: 10.2214/AJR.11.7970.
Follow-up of radiologically totally implanted central venous access ports of the upper arm: long-term complications in 127,750 catheter-days.

Busch JD, Herrmann J, Heller F, Derlin T, Koops A, Adam G, Habermann CR.
Source

Department of Diagnostic and Interventional Radiology, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany. jd.busch@uke.de

Abstract

OBJECTIVE:

The purpose of this article is to retrospectively evaluate radiologically totally implanted central venous access ports (VAPs) of the upper arm in terms of safety, technical feasibility, and device-related complications.
MATERIALS AND METHODS:

Five hundred seven consecutive patients (mean [± SD] age, 59.2 ± 11.4 years) who received a totally implanted central VAP between January 2005 and July 2010 were included. The insertion procedure was performed in an interventional radiology suite using the Seldinger technique. Neither antibiotic prophylaxis nor long-term anticoagulation was administered.
RESULTS:

In 507 patients, a total of 523 devices were implanted. Of these 523 procedures, 512 complete datasets were available during follow-up. The primary technical success rate was 99.04%. All procedures were completed without major complications. During follow-up and with a total number of 127,750 days of totally implanted central VAP implantation (248 ± 279 days/patient; range, 1-1687 days/patient), 50 devices had to be revised because of complications (9.8%). Complications occurred at a mean of 114 ± 183 days (range, 1-1113 days) after placement. Early complications were noted in 21 of 512 cases (4.1%), and late complications were noted in 29 of 512 cases (5.7%). Complications were as follows: local infections, 4.9% (25/512); systemic infections, 0.4% (2/512); venous thrombosis, 1.6% (8/512); paralysis of the median nerve, 0.6% (3/512); skin dehiscence at the port site, 0.2% (1/512); and mechanical problems including catheter line displacement, port hub rotation, and catheter fracture, 2.1% (11/512).
CONCLUSION:

Radiologic placement of a totally implanted central VAP is a safe procedure with a low rate of both early and late device-related complications. The method is effective for delivery of chemotherapy, parenteral nutrition, and frequent IV medication.

*******************

and this one is about chest port?

Gan To Kagaku Ryoho. 2012 Nov;39(12):2404-6.
[Complications associated with the placement of subcutaneous central venous access port devices: reasons for removal and complications observed].

[Article in Japanese]
Danno K, Ohnishi T, Watanabe A, Ueda M, Yanagawa T, Kim C, Fujita S, Fujita J, Yoshida T, Tono T, Monden T, Imaoka S.
Source

Dept. of Surgery, NTT West Osaka Hospital.

Abstract

Objective: To clarify the complications associated with subcutaneous central venous access port devices, we investigated the patients who underwent placement of central venous access port devices in our hospital. Methods: Overall, 171 cancer patients who underwent placement of subcutaneous central venous access port devices (119 for chemotherapy and 52 for home parenteral nutrition) between February 2006 and December 2011 and who were followed up for 1 month, were retrospectively analyzed in this study. Univariate analysis was performed on complications related to clinical factors, including age, gender, insertion sites, intended purposes, duration of catheterization, surgeons, catheter materials, and use of bevacizumab. Results: The mean follow-up time was 213 days (range, 31-1,873), and 35 patients (20.5%) required the port device to be extracted due to complications, including infection in 24(14.0%), wound dehiscence at the port site in 2 (1.2%), obstruction of the catheter in 6 (3.5%), catheter-induced venous thrombosis in 1 (0.6%), and catheter fracture in 2(1.2%). No statistically significant differences were observed between the frequency of complications and age, gender, insertion sites, intended purposes, duration of catheterization, surgeons, catheter materials, or use of bevacizumab. Conclusion: The incidences of complications related to implantation and management of these devices are relatively high and early. Patients should be followed carefully by chest radiography at regular intervals.

SoCalGal · 01-04-2013, 10:57 AM

Thanks for sharing your info.
I'd like to remind people that you can DECLINE to have a port installed if, like me, you prefer not to have yet another "thing" installed in your body. I believe that for many, the port is installed as a convenience to their doc's. And for many, the port is installed because they prefer not to "get stuck" each time or due to "poor veins" (whatever that means-mine are pretty poor but it's funny how a very excellent nurse has NO trouble getting an iv in on the first try).
Just want to remind you fellow her2ers, as I recently told a friend, THE CHOICE IS ULTIMATELY YOURS!
#16+years@no-port-for-me
SO CAL GAL

jaykay · 01-04-2013, 11:44 AM

Just out of curiousity, wouldn't the arm port interfere with doing arm exercises, like lifting weights?

I requested a port (only have 1 good arm left) and was not even given the choice of an arm port. I honestly don't mind the chest port since I don't wear low cut tops :-)

Janis

karen z · 01-04-2013, 01:41 PM

I was advised against an arm port but i was very very unhappy with .....not so much the placement of the port itself (I had a smaller port not typically done by my breast surgeon- i think a mistake in hindesight- but by another team at the hospital). The line from the port went over my clavicle and (i think) maybe into my juglar. At the time I started the process I was quite thin (unlike now) and one could just see the line go over my clavicle. I was miserable the whole time I had my port and very self-conscious. I honestly hated that thing. I would have rather had an arm port if that would have been a true option for me. That is what i initially wanted and asked about but I got "talked down"---------not sure why! BTW: I was told (by two oncologist chemo nurses) that I "had" to have a port with my nearly impossible to find veins. But I have large veins in my hands (I know- not a pretty thought) and I would have rather not had the port and just have them use my hands (they seem to care about such things more than me)

KsGal · 01-04-2013, 01:43 PM

Same as JayKay, I don't think I was offered an option. They slipped the powerport in at the same time I had my mastectomy, and just kind of told me they were doing it. Maybe it was because I only had the one good arm....So far the chest port has been fine and haven't had any issues.

tricia keegan · 01-04-2013, 04:30 PM

My friend had one and found for herself they are more prone to infections and there's a lot more maintanence involved in having one, also with a chest port we could both go swimming but think this was not doable with the arm port???

Paula O · 01-05-2013, 06:52 AM

To answer Tricia's and Janis' questions: the arm port doesn't interfere with any excercise or swimming, doesnt get in the way, and isn't any more prone to infections than the chest port as it is surgically implanted BELOW the skin like a standard chest port--nothing at all is external. I put on lidocaine cream before appointments (GREAT stuff--way better than injectable IMHO) so access is pain-free. I like that the little scar or any bruising after access is so unnoticable-because it's tucked away out of view above the elbow crease on the inner SIDE part of the arm closest to the body, I've never bumped it and it barely shows. The only "maintenance" is a heparin flush after infusions or periodically to keep the line open if you are done with treatment. Again, like a chest port, there's nothing external.

I had one breast removed and it is in the opposite arm.

My breast surgeon inserts both chest and arm ports but strongly prefers arm passports and mostly does them --what she told me was that her opinion and expperience is that it is less risky, has less complications, and her patients like them a whole lot better so I was glad to be offered the option. I've never had a chest port to compare it to. I do have a couple friends with very uncomfortable chest ports like Karen described but it seems most people don't have any problems with their chest ports. I suppose any port anywhere ccould be uncomfotable or get infected or have a vessel develop thrombophebitis/clot, etc.

Like So Cal Gal said, even choosing not to have a port at all is an option that some people prefer.

I look forward to being port-free soon but was glad I got the kind I had and just wanted to let others know that it is another option out there and is a terrific alternative to a chest port IMHO.

Paula

tricia keegan · 01-05-2013, 03:41 PM

Thanks Paula, I think I must have been mixing this up with something else as know for sure my friend was told not to swim but can't recall the name she told me now. The arm port does sound a better way to have the chemo than the chest port going buy your recent post.

Joanne S · 01-05-2013, 10:50 PM

Mine is in my chest too. I was fortunate I didn't get it out immediately as I was able to use it for several weeks of daily IV antibiotics. And since my veins aren't very good and my port doesn't bother me, I've kept it in. I go in every two months and get it flushed. I guess we all have different mediport preferences.

chekmark · 01-06-2013, 09:15 AM

I was never offered a port but I had already decided against it if it had come up. I also only have one good arm and it endured all 29 IV's between surgeries and treatment, muga scans etc. Did fine but do have a lot of scar tissue from it. I just did not want a devise in my body. The scars are enough. Just my personal view on it. If they had insisted on a port I would of done it but they didn't and I am happy with that.