Cancer: Port Problems and Infections

As I’ve often said, there is always something when living with metastatic cancer. This post is about two of those somethings.

The National Cancer Institute defines a port-a-cath as follows:

A device used to draw blood and give treatments, including intravenous fluids, blood transfusions, or drugs such as chemotherapy and antibiotics. The port is placed under the skin, usually in the right side of the chest. It is attached to a catheter (a thin, flexible tube) that is guided (threaded) into a large vein above the right side of the heart called the superior vena cava. A needle is inserted through the skin into the port to draw blood or give fluids and other treatments. A port-a-cath may stay in place for many weeks, months, or years.

Most refer to this as a port for short. I had my port for almost 9 years.

My port had always been comfortable. It was flush in my chest and didn’t stick out like a raised bump that I’ve seen in many photos. It was noticeable but not eye-catching or prominent. It was just there. Lately, I noticed mine felt tender and sore. The soreness stretched all the way up to my neck. I would feel sore for days after a treatment. It pulled and tugged at the port site and along the scar on my neck when I was both active and inactive. I chalked it all up to my port being used weekly. I’m receiving Taxol as my chemotherapy and thought it was more or less kicking my butt. I would recover and feel normal before the next treatment and the cycle would start over again.

One day I noticed the incision scar at the port site looked a little pinker. Again, it’s been used a lot more lately. It didn’t give a blood return regularly, which was accompanied with pushing, prodding, and all kinds of maneuvering to get it to work. The pinkish color was expected in my opinion. Still, I put my port at the top of my list to discuss with my oncologist. I wondered if it had moved a bit, had leaked, or was just plain worn out.

When I go to the cancer center, my schedule has a consistent order: labs, office visit with my oncologist, then treatment. The port is accessed for labs and then covered up until treatment is given. My oncologist never sees it. Due to some strange twist in scheduling, I was to see my oncologist two days before my labs and treatment. The port wouldn’t be covered. If not for this odd anomaly in scheduling, I’m not sure my issues would have been discovered. A higher power was intervening.

My oncologist agreed my scar looked pink and not quite right. She ordered my CBC panel early from the lab and also included blood cultures to check for infection. She also wanted me to check in with my surgeon to do a port check which would make sure the port still operated efficiently. She was doubtful that anything would turn up in the blood cultures or in the port check. All was precautionary.

My CBC blood panel was all fine. Even those absolute neutrophils were behaving, although they were a bit lower than I would have expected for Day 1 of a new infusion cycle.

The blood cultures were new for me. These are tests to check for infections in the blood (bacteria, yeast, fungi, other microorganisms). Knowing the kind of infection helps determine what the best antibiotic is to treat it. Blood is taken centrally from the port to see if only the port is infected. More blood is taken peripherally from the arm to test if an infection has gotten into the bloodstream. It takes 24-48 hours for an infection to grow and the test to come back positive.

My day suddenly became a lot longer. I headed from the cancer center to a building about ten minutes away to see the surgeon who had installed my port. He wanted to take it out immediately because it was so old. The discussion became one of multiple scenarios. I wouldn’t really need a port check done if he was removing the port the next day. There wasn’t much point if it was coming out regardless. On the other hand, we should wait for the blood cultures to come back before removing it. He was fairly confident they’d be negative, but to be safe we should wait. If he installed a new port to an infected area, the new port would need to be removed and we’d be starting from scratch. Then again, there also was no hurry. My port could come out at the next convenient gap in treatment. Now was an ideal time to remove the old and place a new port since my counts were all good. It went back and forth. I decided to be thorough, have the port check, and wait for the results to come in from the blood cultures. I’m glad I did.

The next morning, I headed out for my port check. The port check showed a leak in the catheter up near the neck. Little spurts of contrast dye leaked out and swirled like tiny puffs of smoke. This port was done. It could no longer be used in any circumstance for blood draws, injections, or treatments. I was to let no one near it. No one could touch it. I got the message. I’d wrestle anyone who tried to get at it, and I would win.

A leaking port explained a lot. I had experienced strange symptoms ever since I started a new treatment. An allergic reaction was first thought to be the issue. Then the position of the chin strap on the cold cap was thought to be the problem. You can read a past post about those experiences HERE. The swelling continued without knowing what caused it. No one but me seemed to notice. I finally connected that it was swelling in the areas where the port was located in my chest and neck. At last, my discomfort and pain made sense.

I returned home to begin a lot of rescheduling. It looked like I could get a new one placed the following morning. I would need to reschedule my chemo to the afternoon but that was possible. I had everything set up. I was ready to head out for my required COVID test.

Then came the calls that the blood cultures were positive. First one was positive. The port would not be replaced the next day. I didn’t know how chemo would be affected. Then came the call from my oncologist that both cultures had turned positive. No chemo. White blood counts would drop more. The infection had to be cleared before chemo could be resumed.

She wanted me to have IV antibiotics.

I was to stay overnight in the hospital for two nights. My port would be removed while I was there. To be clear, the leaking port and blood infection were two separate issues that just manifested at the same time.

Rats, shoot, darn, and fart up a tree. I hadn’t expected this, but it had to be done, and I could accept how events were playing out. Get it done quickly and get me back on track. Looking back, I am grateful for the quirk in scheduling that allowed this infection to be caught in very early stages before I showed any symptoms like fever, sweats, and chills.

I arrived at the hospital and settled in for my two-night getaway. I started receiving an antibiotic called vancomycin in my IV immediately. Later daptomycin and dalbavancin were added. Little did I know my adventure was just beginning.

Stay tuned for a special post tomorrow to read about relatively simple surgeries that aren’t that simple and other tests.

Author: Kristie Konsoer

I am a breast cancer survivor, living well with metastatic breast cancer since 2012. This blog is a place where I can share thoughts and ideas on how I feel perceptions of cancer must change, and how I am finding a way to live with strength, hope, meaning, resiliency, humor, and hopefully a little wisdom.

10 thoughts on “Cancer: Port Problems and Infections”

  1. Sounds like we had a similar week! Praying you are home safely and on the mend. Darn those pesky ports! Sending love and light♥️

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  2. You are a very astute patient! Thank God for the sequence of events leading up to the hospital stay and removal of said leaking catheter.
    Let us be thankful for your early detection and hospital response.
    Go girl!
    Margit

    Liked by 1 person

  3. Oh f—k Kristie. Erm, we all sound like something beyond fate has taken over and do note YOUR ONCOLOGIST found the problem because she’s trained to do so. Trained with cancer and her years of experience. Which is why Venn diagrams exist. All oncologists are doctors but not all doctors are oncologists and no nurses are oncologists and no actors who play doctors on tv or otherwise are neither nurses or oncologists. Which is why this pandemic and the notion that my port need only be flushed every three months now because it’s all that’s required is preposterous. Nine years is a long time for that trusty device we’ve come to both love and hate, it’s certainly not the kind of jewelry I prefer to adorn my neck.

    My friend Vyre who’s also got a blog and MBC just was released from a week at the hospital after becoming septic and luckily the infection was caught early and port removed. Given the infection in my body I’m becoming seriously nervous, and I’m going to ask for a few days of respite care when I see both of my oncologists this week. The handoffs may still happen but after my ordeal yesterday and the way I feel today who knows, but it’s looking like the season of port infections or infections and bad ports.

    I had blood taken from my arm and from my port to make sure the infection wasn’t septic but it’s impossible the hospital could have known in 10 hours and releasing me because I refused it spend the night surrounded by Covid patients and not in the safest condition of the oncology ward just bowled me over. I’m more than disgusted. No one knew what they were doing until the last nurse I saw who was an oncology nurse said “you’re not remotely safe here, go home – I couldn’t hug my dad who has cancer at his house and I may never see him again,” she kept her tears well hidden I felt terrible for her and afraid to the point of tears and she took me out to my car herself and said please don’t let them ever try to put you there again.

    Very different outcome than expected. I’m worried about you. Shoot me a text when you’re up to it, I’ll do the same.

    Rats, shoot, darn, and fart up a tree indeed!
    Love you love you love you!

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    1. I read Vrye’s blog and have read of her similar problems. What a mess for us all! My oncologist had me skip an ER visit and admitted me straight to a bed in oncology once one was found. So glad to be home. I know you are following up with your care. Don’t skip anything you need. You are important, you matter, and you are loved.

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