Port doesn't return blood

[bejuce]

Yesterday I had some blood work done but the nurse could not use my port. I had not applied the EMLA cream and the nurse gave me a Lidocaine shot prior to accessing my port.

When she did so, she was able to flush it with Heparin but unable to get any blood return. Has this happened to anyone before? I've been flushing my port monthly but forgot to do so last month with the holidays and kids at home.

I had to get my labs done from a vein in my hand, which was very painful. She couldn't feel the veins in my left arm and asked me if I had had enough fluids that day - supposedly it helps open up the veins.

Any ideas on what could have caused the lack of blood return? I'm going to try to have it flushed again next week.

Thanks!

Marcia

[Sheila]

The blood return lets them know they are "in the port" correctly, although there can be times when the opening on the needle or the lumen is against something, then they ususally have you take a deep breath or change positions until they get a blood return. My bigger question is why she would give you a shot of lidocaine to the port area in lieu of emla cream....an ice pack would have been a perfect idea...using lidocaine to numb the area is certainly not protocol before accessing it. If they never got a blood return, how do they know they were in the port?

[Mary L]

Marcia, This used to happen to me often. They would all but stand me on my head and if that didn't work they had what they called "rotorooter" that they would inject and that usually worked. I am with sheila as to why they would give lidocaine in your port. That makes no sense. I hope they check it out and make sure the port is functioning properly. Mary L

[Ellie F]

Hi Marcia
I also had the same concerns as Sheila.I have a port in which I flush every week firstly with saline then a heparin solution.They always draw blood first to ensure it's in the right place before transfusing vit h. I have never had any cream or local anaesthetic applied.

Ellie

[NanaJoni]

Marcia - I had similar problems last summer when I was doing chemo. They suspected that I had what they called a "sheath" at the end of the catheter part of the port. There is a drug they injected which is supposed to dissolve that and it worked a couple of times. Finally, the port quit working all together. So they did a "port-a-gram" with dye and found that the catheter part was pulling against the vein wall when they tried to draw from it. I have lost about 55 lbs and this was a "contributing factor". So that port came out and a new one went in the same place. It never worked - was installed incorrectly. So I had a different doctor install the third one on the other side of my chest. He put the catheter part going up into the jugular vein and I've had no problems since. I'm doing Herceptin every three weeks so have had no need to flush. During the problem time last summer, I did have to have treatment once through a vein and it was not pleasant. I'm also on warfarin and have to have PT/INR blood tests done about every 10-14 days and they can't use the port at my family practice drs office (no one in the lab is comfortable accessing it and they have to pull several waste vials before getting a test sample). So there are lots of possible problems with ports - hope yours resolves quickly and without having to do the changes I did.

[NanaJoni]

Oh yes - I forgot this - since I stopped the chemo treatments, I usually don't use the EMLA before Herceptin treatments. The nurse just says "take a deep breath" and pushes the needle in with no problem. It's only a minor stick feeling and doesn't hurt at all so I'm not sure why the lidocaine? Have you ever tried an access without EMLA?

[ElaineM]

Ask your doctor to prescribe Altiphase. I am not sure I am spelling it correctly, but it is something that can be injected into the port to clean up debris in the port cavity. It is not systemic. It is not painful. It stays in the port for 30-60 minutes and drawn out by a needle after that time. It works the same way drano or baking soda and vinegar work to unclog sink drains. The port usually works well after Altiphase. You can also have a simple xray to make sure the port is still placed and corrected correctly.
Good luck.

[Colleen007]

Hi Marcia,

I just had the Altiplase (also called "Cath-Flo") last Friday. It is just as Elaine describes...they accesed both sides of my port then pushed it through (kind of like how they push the Heparin in at the end of treatment). They let it sit for awile and then suck it out (and hopefully get blood return). My inner side of the port worked after one dose...we repeated it on the outer port and got blood return there after the 2nd dose.

I'm also confused about the Emla and lidocaine...I was prescribed Emla at the start of my treatment and only used it once as I really didn't think it did much (and if I recall, it was really expensive)...now I just take a deep breath when they access the port and it is like a pinch.

Good luck!

[Sheila]

I forgot about cath-flo...my brother gives inservices to nurses on administering it to unclog port a caths.

A fibrine sheath can form in the port. making a blood return impossible...It usually forms at the end of the cath part of the port that enters the heart. If they can't break it up, usually a new port is required.

BTW, they dont even use EMLA cream where I go...maybe my skin is tough, but i dont even feel it when they access my port. It may have to do with how much tissue covers the opening..mine is thin over the opening due to weight loss.

[1rarebird]

All this talk about clogs, sheaths, films, etc. distresses me. What are the chances of pieces of these breaking loose and flowing with the blood in the vein? I hate to consider what that could lead to. I had my port flushed yesterday for about the 58th time (including the year of Herceptin) and I think about this risk each time the nurse pushes the plunger on the syringe. But I do use Lidocaine creme before each flush and it works for me to ease the pain of the stick.

bird

[ElaineM]

Lidocaine is for pain. For example if you have alot of pain when a nurse accesses your port or your vein they can give you an injection or you can ask your doctor for a prescription for Lidocaine cream which you rub into the area about an hour before access. It is also used for biopsies or surgeries that do not require general anethesia. Sometimes a dentist uses Novacaine. I don't know what Emla is.

[Sheila]

Elaine, Emla is a numbing cream like Lidocaine...used to deaden nerve endings on the skin....I would not understand them injecting lidocaine in a port....as far as the sheaths go, my grandaughter developed one and when they tried to remove the portacath, the tip broke off and they were unable to retrieve it from the heart...several cardiologists were called in and it was decided less risk to leave it...it will be covered by a sheath or film in the body.

[Chelee]

Marcia,
This last port I had installed had problems each time I went for infusion...couldn't get blood return. But my chemo nurse told me not to worry because they have all kinds of tricks to make them work. She would have me cough, take a deep breath, lay me way back in my recliner...jump up and down 3 times. lol (OK..that last one I made up.) Eventually it would work. Whatever was wrong with it cleared up after about the 3rd infusion. So don't worry...they should be able to clear it.

I don't understand why the nurse was using Lidocaine any where near your port? Lidocaine is use for things like breast, bone, liver biopsies and so forth. I have never had that EMLA cream used to numb my port area. It doesn't hurt at all. I even tease my chemo nurse...she always says, "Take a deep breath"..and sometimes I yell "OUCH". Then I start laughing. It's not at all painful for me. It's just a quick little poke. Hang in there Marcia...I bet they get it to work next week.

Chelee

[whatz]

Just adding my little "trick" to making the port access less painful (since mine was to start with). Stretching the sking on the port as tight as possible before they access it just about makes the "sting" sensation of the needle totally disappear. Works for me.