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therapies to prepare 1 - The central venous access: what is it??

After the flurry of tests to figure out everything on your lymphoma is another important thing to do: put a central venous access. What's that?? Is your best friend to do many tests and treatments ... but I only discover over time, and you will love the beginning especially if you were riddled like a sieve to make withdrawals and have spent the first few treatments with your arms still why not vein went out!

The central venous access is a tube that is put up, as the name implies, into a vein "central": that is not we see one of the veins in his arms, legs or neck, but a nice big vein that goes directly to the heart. A large vein so that its walls are pretty thick and it goes so much blood, so the drug can not damage it as it happens with the poor small peripheral veins. Usually you choose the subclavian vein, right or left as appropriate. The cannula may instead be of different kinds. Story here the most common types, which are three (may be that the name change in other parts of Italy, but I do not think), and then I will explain what happens when you put a central venous cannula. I want to clarify, if someone read the "medical field", I do not want that in my description be scientifically precise: that's why there are lots of other sources. I want to explain to those who put the cannula what to expect when I bring, what will end up on her, and the pros and cons of various things.

CANNULA TYPE Hohn

The name seems difficult? Wait for the next! ^___^
It reads simply "on", and is simply a tube that sticks out from a small hole in the skin ... unlike other catheters, however, is soft silicone, and can be used three to six months, then must be changed. In favor of this cannula is the fact that just finished the treatment takes off immediately, even on the same day. It also allows you to infuse the liquid quickly, it can be used, for example, to do the CT scan with contrast (eg the Porth no).
But the fact that "check" from the skin, you must treat it carefully, because the skin can become infected, and when you reset the immune therapies that infections can become dangerous. Also, always check it out when you want to take a shower must cover with a waterproof adhesive, and is always a bit 'a mess.
Generally the cannula that "check" from the skin is fixed with the points. There are those who tolerate them well, but also points can become infected or otherwise be annoying. That is increasingly being used a other means of "fixing", the State-lock (this is the trade name, in other places is called in a different way) which is a sticky plaque that must be changed every two to three weeks. A pleasure, if like me you have items that are infected but do not ignite. If the center does not care where you are using it to try to ask. It is a completely different life. As I said with
Hohn pay attention to the infection, but also to the fact that you can easily plug and then: always keep the medication that make you never leave the hospital and discovered the insertion point (rather than to let some dressing more to change at home, you never know), take care that the cap does not escape, because otherwise Bacteria can enter the tube and from there into the blood when it is used, it must remember that heparin (ie put in the heparin, which is an anticoagulant and prevents the caps) each week, and if you have a fever and skin red at the point of connection or you lost the cap to do this doctors and nurses.
I, being anesthesiologist (in general, these catheters are placed by anesthesiologists ... we are the experts of the bites! ^___^), Have been asked to put on the type of cannula, and the ABVD had chosen Hohn. Since I knew how to "hold" on me has lasted more than six months ... but I was a bit vex ' for points, and the inability to wash it right! Luckily it was a hot summer ... ^___^
For the reasons I mentioned, Hohn is typically used for those who must make short term therapies, or who has to put a cannula "provisional" before moving to Porth, we will see now.

PORT-A-CATH

I told you that the names were weird ... This is so strange that normally is only called "port". It is also a tube that is put into the subclavian vein, but instead of sticking out from the skin, ends up in a small "reservoir" dish that is placed under the skin, with a small cut two to three centimeters. To use it you need to pierce the skin with a needle that reaches the particular serbatoietto, which has a "cover" that can be rubber clothes many times.
Disadvantages: whether to put it is to remove it is necessary to make a cut (it's a little "work" if you want) and remains a scar (even though my scars are much worse dell'Hohn points cut in the Port ...); laundry must at all times (if you really sensitive, you can make at least one hour before a pack with a anesthetic cream called EMLA, and leave it there, is also used to make withdrawals from the kids ... I personally do not give so much trouble because I feel when the hole but then immediately goes bad), no one can infuse fluids at high speed or high-pressure, so things are looking for some other veins (eg CT scan with contrast, or the removal of stem cells, however, that I hope you do not have do), and if you have a few like me ... it becomes problematic part of the hunt to the vein! Sit back and relax and be patient if you punched several times, they are doing their best but it is a difficult game ... ^___^
Advantages: Once healed the little cut the skin is intact, so there is no risk of infection and you can have a shower when you want (even with the benefit of those around you! ^___^); addition to not require Dressings "external" heparin is less frequently (just once a month), can last two to three years ... we all hope it does not serve so long, but you never know!
I think he realized that I also tried the port, which I have right now: as I said above, my best friend for treatment, and thank you for putting it ... every time I make an infusion, and every time I shower! (Including swimming in the pool and spa ... ^___^)
For more information about the port: http://www.portadvantage.com/language/Italian/patient/about_implanted_ports.html

GROSHONG

thought I was strange names were they? But no! ^___^
Groshong (Pronounced "grosciong") is not really the name of the whole tube, but only one type of tip, which is a valve and prevents the blood to flow into the cannula, which in theory should not be heparinized. But generally it is called a type of cannula, such as Hohn, "check" out of the skin, but because the cannula is threaded under the skin and make it "tick 'a bit far from the point of insertion is more unlikely to come off accidentally, can be used as long dell'Hohn also typically has more "big" and then you can do even faster infusions. Luckily I
least Groshong I have avoided, so I can not tell much more ... My Groshong Port has a bit, but I'm not talking about it as well because you confuse.

Last hint: in some departments of oncology (do not know if the hematology) are used for those who were once called "atrial cannulae long": they are really long cannulas that are inserted in the arm and reach even the famous large veins I mentioned above (all flow into the veins there). They are very practical, but even these do not "hold" big speed and big pressure. I do not care where they are in are used.

In conclusion: I have "felt" personally Hohn and Port, in case anyone had something to ask about it ... ^____^

(Images from http://www.med.unipi.it/endochir/nutriz_parenterale.htm; http://www.portadvantage.com/language/Italian/patient/about_implanted_ports . html)