Clot-Busting in Port?

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boxhill
Posts: 789
Joined: Fri Apr 06, 2018 11:40 am

Clot-Busting in Port?

Postby boxhill » Thu Feb 20, 2020 12:31 pm

Last time I was in "the chair" I was chatting with the infusion nurse about ports and how long they usually last. I remarked that I loved my port and had never had a problem with it, knock on wood. Well, apparently some malign spirit was listening because all of a sudden he couldn't get a blood return. He repositioned me this way and that, had me turn and cough this way and that, raise arms, lower arms, breathe, don't breathe. Finally a decent blood return appeared, and we went on with the infusion. But when it was done and he went to flush the line...no return. He used 3 or 4 saline syringes. At first, I did briefly experience that characteristic taste at the top of my mouth, so we figured something must have gone in.

I should explain the I usually, as I did that time, come in the day before for my blood draw so that they have plenty of time to do the labs. It worked fine that day.

So, to make a long story short, the word is that they may have to address this problem with some kind of clot-busting procedure next time. Anyone have any experience with this?

Another point, around the time my cancer center formally associated with Dana Farber they stopped using a heparin block, just double saline instead, which supposedly worked just as well. Hmmm...maybe not on me?
F, 64 at DX CRC Stage IV
3/17/18 blockage, r hemi
11 of 25 LN,5 mesentery nodes
5mm liver met
pT3 pN2b pM1
BRAF wild, KRAS G12D
dMMR, MSI-H
5/18 FOLFOX
7/18 and 11/18 CT NED
12/18 MRI 5mm liver mass, 2 LNs in porta hepatis
12/31/18 Keytruda
6/19 Multiphasic CT LNs normal, Liver stable
6/28/19 Pause Key, predisone for joint pain
7/31/19 Restart Key
9/19 CT stable
Pain: all fails but Celebrex
12/23/19 CT stable
5/20 MRI stable/NED
6/20 Stop Key
All MRIs NED

zephyr
Posts: 363
Joined: Thu Aug 18, 2016 7:31 am

Re: Clot-Busting in Port?

Postby zephyr » Thu Feb 20, 2020 12:43 pm

I had a similar thing happen and they used some clot-busting tricks. As I recall, they injected heparin and maybe something else to dissolve the clot. It was pretty simple and it worked. That was about 2 years ago and I haven't had any problems since. My port is accessed at least 2 times every week and they always use heparin afterwards. Not saying that's the answer for you or that there isn't a better way, only that it's my experience.
Nov-2009 Early stage CRC, routine colonoscopy
2010-2014 F/U colonoscopies, all clear
Jun-2016 CRC during F/U colonoscopy, surgery, Stage 4, KRAS, MSS
Aug-2016-May-2018 Folfox, 5FU, Folfiri & Avastin
Aug/Sep-2018 YAG laser surgeries (Germany), 11 nodules removed
Nov-2018 clean CT scan
Mar-2019 New lung nodules
Apr-2019 Dec-2020 Xeloda/Avastin, SBRT, cont. Xeloda/Avastin
Mar-2021 Forfiri/Avastin
Mar-2022 Ablation & Thoracotomy
Feb-2023 Folfiri & Avastin
Nov-2023 Xeloda & Avastin

justin case
Posts: 4269
Joined: Sun Sep 04, 2011 8:26 am
Location: Katy, Texas

Re: Clot-Busting in Port?

Postby justin case » Sat Feb 22, 2020 12:09 pm

I was fit with a dual port, just in case .
7/11 diagnosed Stage 2 colon and rectal cancer
chemo/rad
lar/temp ilio
Reversal & port removal
21 round of chemo Folfox 9tx, 5fu 12 tx
Last treatment July 2012

boxhill
Posts: 789
Joined: Fri Apr 06, 2018 11:40 am

Re: Clot-Busting in Port?

Postby boxhill » Mon Feb 24, 2020 8:32 pm

Today I went for my pre-infusion draw. (I go the day before so there's plenty of time to do the labs, which take about 2 hrs.) Anyway, at first there was no blood return. Then the nurse tried a few tricks, including the usual turning the head and coughing/holding a breath/ holding a breath and bearing down a la Lamaze. Finally she tried pumping rapidly and repetitively with the syringe, and was apparently successful in bowing the obstruction out of the way. She thought it was probably a fibrin flap.

It faltered while she was drawing the 4 tubes of blood, but started up again when I took a really deep breath.

I hope it cooperates tomorrow for my infusion!

In the world of CRC, this is what you might call a first world problem, LOL! :lol:
F, 64 at DX CRC Stage IV
3/17/18 blockage, r hemi
11 of 25 LN,5 mesentery nodes
5mm liver met
pT3 pN2b pM1
BRAF wild, KRAS G12D
dMMR, MSI-H
5/18 FOLFOX
7/18 and 11/18 CT NED
12/18 MRI 5mm liver mass, 2 LNs in porta hepatis
12/31/18 Keytruda
6/19 Multiphasic CT LNs normal, Liver stable
6/28/19 Pause Key, predisone for joint pain
7/31/19 Restart Key
9/19 CT stable
Pain: all fails but Celebrex
12/23/19 CT stable
5/20 MRI stable/NED
6/20 Stop Key
All MRIs NED

User avatar
juliej
Posts: 3114
Joined: Thu Aug 05, 2010 12:59 pm

Re: Clot-Busting in Port?

Postby juliej » Tue Feb 25, 2020 6:30 pm

Sometimes fibrin sheaths encase the outer wall and the endhole of the catheter causing all kinds of problems! :roll:

However, I'd want a good Heparin flush to make sure no gunk was inside the port. You might ask if they'd be willing to do it after your infusion tomorrow.

Juliej
Stage IVb, liver/lung mets 8/4/2010
Xelox+Avastin 8/18/10 to 10/21/2011
LAR, liver resec, HAI pump 11/2011
Adjuvant Irinotecan + FUDR
Double lung surgery + ileo reversal 2/2012
Adjuvant FUDR + Xeloda
VATS rt. lung 12/2012 - benign granuloma!
VATS left lung 11/2013
NED 11/22/13 to 12/18/2019, CEA<1

boxhill
Posts: 789
Joined: Fri Apr 06, 2018 11:40 am

Re: Clot-Busting in Port?

Postby boxhill » Wed Feb 26, 2020 9:27 am

The port refused to produce a blood return for my infusion, despite the usual strategies, so the nurse ended up injecting a dose of Cathflo into it. It took an hour to work, but she got a good blood return before and after the infusion. I asked about heparin, but she stuck to the now-routine double saline flush.
F, 64 at DX CRC Stage IV
3/17/18 blockage, r hemi
11 of 25 LN,5 mesentery nodes
5mm liver met
pT3 pN2b pM1
BRAF wild, KRAS G12D
dMMR, MSI-H
5/18 FOLFOX
7/18 and 11/18 CT NED
12/18 MRI 5mm liver mass, 2 LNs in porta hepatis
12/31/18 Keytruda
6/19 Multiphasic CT LNs normal, Liver stable
6/28/19 Pause Key, predisone for joint pain
7/31/19 Restart Key
9/19 CT stable
Pain: all fails but Celebrex
12/23/19 CT stable
5/20 MRI stable/NED
6/20 Stop Key
All MRIs NED

kandj
Posts: 314
Joined: Sun Sep 27, 2015 11:29 am

Re: Clot-Busting in Port?

Postby kandj » Sat Mar 07, 2020 5:38 pm

DH has had it happen a few time with no blood return. Even with the walking, laid down, tilted back, etc. they have had to do whatever the injection they do to unblock it before. It takes about 30 mins or so to work. I assume it is a major type of heparin. He’s had his port for almost 5 yrs.
wife to DH, dx 8/15 stage IV @36, 12+ liver Mets
HAI placed 12/15
Liver resect 5/19/2016 15-20 mets (surgeon lost count)
Liver Recurrence 7/2017-radiation
Lung met 10/18 VATS
lung/adrenal gland recurrence 11/19
Adrenal ablation 2/20 VATS 3/20
Radiation: 9/20 adrenal gland, 2/21 pancreatic node
9/2021 liver, 4/22 esophageal node
7/2023 proton therapy: liver
140+ rounds of chemo and counting
Chest nodes, lung nodules, and esophageal nodes currently.


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