CHEMOTHERAPY – Dr Bassa Oncology

ALL ABOUT PORTS

August 6, 2014August 6, 2014 Dr Bassa Oncology

WHAT IS A PORT A CATH
Port-A-Cath is an implanted venous access device, also known as an implanted port, placed completely under the skin. It is used for patients who require frequent or continuous chemotherapy administration.
The Port consists of three parts:
-The portal: a small chamber sealed with a septum on the top, made of silicone
-The catheter: a thin flexible tube
-The catheter connector: connects the catheter to the portal

Why is a Port-A-Cath used in chemotherapy?
The catheter of the port sits inside a large central vein. The port is used to collect blood samples and to give chemo medications. Before using, the skin over the port is cleaned and then a special needle is used to puncture the septum of the port, which is connected to the catheter. This allows for collection of blood samples as well as direct administration of medication into the bloodstream, using the port. After every infusion/injection, the port is flushed with heparin solution or once every 4 weeks if the port is not used regularly.

How is the Port-A-Cath used?
Generally chemotherapy drugs are very toxic and irritating to the skin, tissues and veins. Giving such potent medications into a small vein can irritate and cause inflammation of these blood vessels, resulting in long-term scarring and blockage of these veins. Also, giving chemo into a small vein allows the medication to leak into the nearby tissues and cause tissue damage. As a result, such medications are administered into a large central vein so that they can be immediately diluted by a large volume of blood and be delivered effectively throughout the entire body. The chemotherapy drugs are usually administered into the Internal Juglar or Subclavian vein; but sometimes Brachial vein may also be used. Studies show that the use of the Port-A-Cath in treatment & management of cancer patients, results in shorter hospital stay, less nursing time spent trying to access veins, preservation of the small veins, fewer emergency visits, decreased cost of therapy and overall greater patient satisfaction. As a result, the port serves a safe and effective route of giving chemotherapy drugs.

How is the Port placed?
Placing the Port is a small surgical procedure and takes less than an hour. It is performed by surgeon in theatre. The procedure involves a 3cm skin incision on the chest wall for the port pocket and 5mm incision in lower neck to enter the vein. The port is placed completely inside the body. One end of the catheter is inserted into the vein while the other end is connected to the portal, under the skin. The tip of the catheter lies in a vein just above the heart.

Port placement:
Chest-placed system: The Port is placed in the chest and the catheter is inserted into a vein in the chest. The tip of the catheter lies in a vein just above the

Generally, the patients can go home two hours after the procedure or after the effect of sedation has worn off. However, patients are advised to not drive or operate any machinery for 24 hours. When the incisions are healed, one can notice a small bump under the skin.

What preparations are required for the port implantation?
One is asked to not eat or drink anything starting at midnight before the procedure day. Clear fluids and medications are allowed till the time of procedure but it is best to verify with your doctor. Also mention to your doctor if you are on aspirin, plavix or warfarin to find out when to discontinue these medications prior to surgery. The medications can be resumed the day after the procedure. If you are sick with an active/ongoing infection, your doctor might choose to postpone your Port placement.
What are the aftercare precautions required?
-Keeping the port-site clean at all times is very crucial. If an access needle is in place, it is covered with a dressing to keep the site clean and prevents the needle from dislocating. If there is no needle in place, one can bathe/shower regularly.
-After surgery, it is normal to have some redness and tenderness at the area of incision which should resolve in 24-48hrs. However if you continue to have redness, tenderness, swelling or drainage from the site for more than 2-3 days or notice any other unusual skin changes, contact your doctor immediately.
-Avoid any strenuous activities involving the chest/arms for at least ten days. If the port is not used in 7 days after placement, follow-up with your doctor for a wound check and dressing change.
-If your portacath is no longer being used, you need to follow-up with your doctor every 4 weeks and get it flushed with saline water and locked with heparinized saline to prevent formation of blood clots.
-Minimize physical activities that involve excessive, repetitive upper extremity motion: such as swimming, golfing, weight-lifting as there is risk of catheter damage/ fragmentation (breaking). Check with your doctor to make sure you take proper precautions while engaging in such activities.

What are the potential problems /risks associated with Port-A-Cath?
-Risk of infection: although the risk of infection with the port is minimal, catheter-related bloodstream infection is a concern in cancer patients. This can be prevented by keeping the port site clean, using antimicrobial catheters and antibacterial solutions to flush the catheter. If infected, the port is removed and one is treated with appropriate antibiotic medications.
-Risk of forming clots: After months of insertion, clots can form in the catheter. This is prevented by flushing the catheter regularly after blood draws and not giving any contrast through the port. Patients do not need to be on any treatment to prevent clot formation in the Port-A-Cath.
-Air outside the lungs: at the time of port placement air can leak out of the lungs but usually resolves with time.
-Irritation or blistering of skin where chemotherapy is being given
-Catheter dislocation if not properly secured with sterile tapes or surgical strips
-With the use of modern imaging technology, there is very little risk of bruising, bleeding or damage to the blood vessels.

How long does the Port-A-Cath need to stay in place?
The port can stay as long as your doctor wants. Talk to your doctor or nurse about how long your port needs to stay in place.
Is it ok to have MRI with the Port in place?
Port-a-cath is MRI conditional, which means that they may safely undergo magnetic resonance imaging with magnetic field strength of 3.0 or lower. However do mention that you have a port-a-cath placed prior to having an MRI done.

Will it be ok to go through security alarms/metal detectors with a port?
Metal detectors will not harm the Port-A-Cath. The Port will not activate the security alarms. However since the sensitivity of metal detectors varies, it might be helpful to have your Port Identification Card with you.
Additional guidelines for your Port.
-Do not inject any fluids or solutions in your port unless you have been asked to do so by your doctor or nurse.
-Inform your doctor if you notice that fluids are not flowing freely through the port and stop any infusion at that time.
-Inform your doctor if you notice any skin changes, such as redness, swelling, or drainage at the site of Port placement.

CHEMOTHERAPY

CARING FOR YOUR NAILS DURING CHEMOTHERAPY

August 6, 2014August 6, 2014 Dr Bassa Oncology

Just as chemotherapy affects your hair because of the rapidly dividing hair follicle cells, it also affects your nails.

You may see a line in the nail related to the cycle of chemotherapy. This line is not permanent and grows out with the nail, usually in about six months. There may even be multiple lines and indentations reflecting the different cycles of chemotherapy.

Your nails may become pigmented or discolored. They may become more brittle, so they won’t grow as long as they used to and may break more easily.

The area around the nail bed may become dry, and your cuticles may fray. Don’t rip or peel off the loose cuticle. Cut it carefully with a CLEAN pair of nail scissors.

The nail may actually lift off the nail bed. While this, too, is reversible, you need to be very careful, for two reasons. First, the nail is more vulnerable and may fall off. Second, because the nail is not tightly bound to the nail bed, it can become a site for bacteria to enter. So be sure to practice excellent hygiene to avoid infection.

Nail care is first-line prevention for lymphedema, a condition that develops when lymph fluid accumulates in the soft tissues of the arm, causing it to swell. If you’ve had an underarm lymph node dissection (with mastectomy or lumpectomy), you should be particularly careful of damage to the nail, such as hangnails or cuts or burns on the hands or fingers, which could lead to infection.

Tips for better nail care
Clip your nails short. Imperfections show up less in short nails.
Don’t cut your cuticles. Use cuticle remover cream or gels and push your nails back gently.
Don’t bite your nails or cuticles, particularly on the hand on the same side as your affected breast. If you have a hard time stopping, consider wearing thin white cotton gloves around the house to help you break this habit.
Massage cuticle cream into the cuticle area daily to prevent dryness, splitting, and hangnails.
Wear gloves while doing chores, such as washing dishes. Excessive exposure to water can lead to fungal infections of the nail bed.
Wear nail polish to help keep nails strong and protected from the environment (and looking nice, too). If your nails are very dry or falling off, you might want to consider a nail moisturizer instead of polish.
Dry nails can become weaker or more brittle during chemotherapy treatment. To take off polish, use non-acetone-based remover, which is less drying than acetone.
Don’t use acrylics or other nail wraps. Fake nails can trap bacteria that may cause infection.
If you have a professional manicure, bring your own instruments, regardless of how the salon cleans theirs.
Ask a professional manicurist for more information on daily home care to keep your nails healthy and strong.
Alert your doctor to any signs of inflammation or infection.

CHEMOTHERAPY

HAIR CARE DURING CHEMOTHERAPY

August 6, 2014August 6, 2014 Dr Bassa Oncology

Why do some chemotherapy patients lose their hair, not just on the scalp, but also on their eyebrows, eyelashes, and the rest of their bodies?

Many of the drugs work by attacking the rapidly dividing cells in the body, and tumor cells or cancer cells are rapidly dividing cells. But there are normal cells in the body that are also rapidly dividing, and the chemotherapy drugs affect those normal cells as well, which gives us side effects. Because hair follicles divide fast, they’re also susceptible.

Some chemo drugs are more likely than others to cause hair loss, Lacouture says. Ask your doctor about the likelihood of hair loss before you start your treatment, so you are prepared and know what you may expect. After chemotherapy begins, any hair loss usually progresses quickly.

Generally, patients notice it when they wake up in the morning and they look at their pillow. They’ll see hair on their pillow, Then they’ll start brushing it and noticing that it comes out in clumps.

It is emotionally challenging for someone who is losing their hair. Once a person takes steps such as wearing a wig or cap to feel more attractive, self-esteem may improve.

If your doctor says that your hair is likely to fall out, decide before you begin chemo whether you want to wear a wig. You may want to shop before treatment to match your hair color.
The CANSA association can direct women to places that can help them with wigs. Sometimes, medical aids will also help cover the cost of a wig for cancer patients.
Hats, turbans, and scarves can also camouflage hair loss, although some people prefer to leave their heads uncovered. If you go bare-headed outdoors, be sure to use sunscreen on your scalp.
Cut your hair short. It eases the inconvenience of shedding lots of hair, but it also can reduce the emotional impact of watching your hair fall out.
Don’t perm or color your hair during chemotherapy. Those chemical treatments are already damaging to hair and can enhance hair loss. Once your chemo treatments are done and your hair has grown back, it’s OK to resume dyeing or perming hair.

With chemotherapy, hair loss is almost always temporary. But when it grows back, it may be a different color or texture. In older adults who still had hair color before chemotherapy, the new growth may be completely gray. Often, new hair is very fine and soft.