Day 15 - PICC's or Ports ... you decide

One of the topics I've noticed among CFer's is the debate between whether or not to take the plunge and get the surgically implanted port or stick with getting PICC line's every time you need IV antibiotics. Before I get into the pros and cons, I want to give a brief background for people reading this who are not overly familiar with CF patients and IV antibiotics.  When our lung infections get bad enough, CF patients require heavier antibiotics via intravenous infusion.  The problem with these meds is that they are so strong that they cause the veins to collapse, typically in less than 24 hours.  Meaning we would need a new IV daily ... obviously, not a fun idea.  This leaves two alternatives, PICC lines or IVAD ports.  PICC lines (Peripherally Inserted Central Catheter) are a catheter/tube typically inserted into the arm just above the elbow (I've heard they can also be done on the leg as well), the tube then follows the vein all the way to the patient’s heart.  This means there is no vein that can collapse and the meds get dispersed so quickly by the blood flowing through the heart that they don't cause damage there (This is a VERY rudimentary description, but good enough to allow people to get the gist).  IVAD's (Intra Venous Access Device) are a small domed port inserted subcutaneously beneath the skin and stitched into the muscle with a tube that in my case goes from my port into the jugular vein and then onto the heart. 

First here are two pictures of my port, one from the side and one front on (please pardon my pasty whiteness, it rains a lot here):

Now I'm not going to get into the medical benefits between the two because ... well, I don't really know them and I'm not a doctor.  All I'm going to do here is describe the pros and cons of having a dome as I've see them for myself.  So the pros first:

1)Whenever I go on IV antibiotics I just stick in a needle slap on a Tegaderm op-site bandage and I'm good to go.  With PICC's I always just found the insertion process to be a bit of an ordeal, uncomfortable and yes, painful.  When I'm sick, the last thing I wanted to go through was something that hurt.

2) Perhaps one of the more superficial benefits, but one that is really great, is the ability to shower properly.  With a PICC, I always had to shower with one arm covered and elevated away from the water while I tried to shampoo one-handed.  With the port, when it's time for my weekly dressing and needle change, I can just remove it all, have a good long relaxing shower without worrying about keeping any specific area dry.  It may seem like a small thing, but I find it really nice.

3)The next pro is a bit more specific to my own circumstances.  I have two infant daughters who grab at EVERYTHING.  They’ve already accidently pulled the needle out of my port once.  Fortunately, because I had the port, all I had to do was replace the needle and redo the dressing over top of it.  With PICC’s I’ve accidently gotten my line caught and given it a good tug which then resulted in me having to go into the hospital, having them re-position it and then do an x-ray to make sure it’s in the right place again.

4) The last pro and probably most important for me, you can still do things while on IV meds.  I'll admit that when I was younger, I would actually play in full hockey games with a PICC line in my arm, under my pads.  Now, while there were never any complications that resulted from this, that may have been more just good luck.  With the Port I can just pull the needle and dressing and then just redo it after whatever activity I wanted to do to try and keep myself fit.  I have no limitations even though I'm on IV meds.

Now here are the cons as I see them:

1)You do have to have minor surgery to have it installed and as a CFer, general anesthetic is not an option, that means you're awake for the procedure.  Now for me I've had a half-dozen hernia surgeries while awake among other small surgeries and procedures, so this didn't really bother me much and yes it hurt a little bit more afterwards than having your average PICC line installed, but not by that much.

2)You have to access and flush the line once a month when you are not doing IV antibiotics.  That means one needle poke a month and while I've heard from some people eventually the skin covering the dome will go numb and it won't hurt anymore, for me this is still not the case.  It does still feels like I'm stabbing myself with a needle in the chest.

3) As with anything there can be complications, my first dome's tube failed after two years due to a random defect.  I still chose to have it replaced even though I’m only on IV antibiotics once or twice a year and have had the new one for two years and a half years now without problem.  Also, because the dome is permanently under your skin, you run the risk of it getting dislodged and needing to have it replaced.  For those who know me, they know I bump into things all the time. Also, as I said earlier, I have two 11 month old girls so there are lots of opportunities for this to happen.  Luckily for me, so far it hasn't.

4) The superficial element.  When you have a PICC and you’re done your IV meds the docs just take it out (or if you’re me, you take it out yourself … not usually recommended, but I was young and impetuous at the time).  With the dome, it’s always there depending on where and how they insert it, it can be fairly prominent.  I decided I just didn’t care anymore and was fed up with PICC’s.

5)Lastly, and this sort of stems from the last point, it can lead to some awkwardness sometimes.  I had my port installed before I met my wife.  Understandably, without going into too much detail, inevitably there came that first time when she noticed it and wondered what that weird lump on my chest was.  Now, luckily for me, my wife was awesome about it and didn't make me feel awkward or self-conscious about it at all.  But of course it is yet another thing for us to perhaps feel self-conscious about.

So all in all, I am very happy with my port and don’t regret it at all.  Hopefully this’ll help people decide that either a dome isn’t worth it, or that, like me, the upside outweighs the downs.