Port Access for IVIG: Another Option By Dan Bennett This is the third and final story in a “I was very sick as a child but had knowledge of ports, because I series featuring the three methods nobody could figure out why,” had used a port earlier when I had a of immune globulin administration. Conner said. “I went through 47 bone infection. It wasn’t that difficult IVIG administration was detailed hospitalizations before I was in high of a decision for me.” in the February-March issue while school. Doctors tended to blame my Conner, now 39, and Madison, now subcutaneous administration parents for me getting sick all the time. 9, recently switched to subcutaneous (SCIG) was profiled in the April- Then my daughters were getting sick, infusion. May issue. In this series, patients and just like with my parents, doctors “Our levels stay more consistent and physicians with varying kind of blamed me in different ways with subcutaneous,” Conner said. experiences and opinions share for their illnesses. It took an allergist to “We went to a conference in June their viewpoints with readers. No deliver the proper diagnosis; then we 2005 [where they learned about particular method of adminis- were all diagnosed.” SCIG], then decided to try subcuta- tration is recommended in this neous that October. But Abigail has series, as patients should consult kept her port. When she goes to their physicians to determine what “The port was much easier. the hospital for anything, she often is best for their individual needs. needs an IV. If she didn’t have the She didn’t feel anything. port, there would be a problem. It’s dministration of immune a safety and security thing for her, globulin using the port She could play video and for things like blood draws, it’s A method may not be the games and do other things easier. She really wants to hang on most popular of the three infusion to the port, because it’s a lot less choices, but for some people, ports with her hands.” stressful for her when she goes to work best. the hospital.” Although Kelliann Conner and Dr. Richard Schiff, Global Medical one of her two daughters recently A few tries with IVIG administration Director for Immune Therapy at switched to subcutaneous adminis- convinced Conner to try ports. Baxter Bioscience, and a leading tration (SCIG or SubQ), for the two “We put Abigail on a port pretty authority on IG infusions, says multi- years before that, ports—the long- much right away, because an IV can ple factors play a role in deciding term placement of an infusion entry be very traumatic at age 5,” Conner what administration method to use. point—served the family’s needs. said. “The port was much easier. She “Certainly the use of the port has “Our oldest daughter and I were didn’t feel anything. She could play its critics, and certainly the port has having a lot of negative side effects video games and do other things proven beneficial to many patients,” from intravenous infusion,” said with her hands. When her older sister Schiff said. “This is another example Conner, a Washington state resident. was diagnosed, she wanted to stay of how the many varying needs of “Ports were the best choice for us with IV at first, but when she saw immune globulin patients help dic- at the time.” how her sister liked the port, she tate a method.” Two years ago, Conner’s youngest asked to change, also.” Problems with veins are the most daughter, Abigail, then 5, was diag- Conner experienced problems common reasons patients use ports: nosed with an immune deficiency. with IVIG, which ultimately led her Ports go directly into a central vein, Older sister Madison, then 7, was to opt for a port. allowing easier access. However, diagnosed soon after, and then “It took the nurse 14 tries to get the central vein connection poses a Conner herself was diagnosed, the IV in me, and I knew I needed to greater risk of life-threatening infec- at age 37. try a port,” Conner said. “I already tion than a peripheral needle stick, 8 June-July 2006 www.igliving.com IG Living! so ports require extra attention to thought of that, so that shows the says, include the fact it takes a proper technique. Schiff recommends importance of consulting different surgical procedure to install and careful consideration and frequent types of doctors. That said, we are remove the port, and the resulting consultation with doctors. very happy with our primary doctor, scar can be large. “The needs of the patients can because she will back me up once I “And not all medical professionals change, and the best choice for make a decision. I’m my daughter’s can access them, meaning there could administration can change along advocate, and she respects that.” be a wait for someone on the IV team with that,” Schiff said. “This is In the long term, Kraft says, there with experience in accessing ports,” absolutely an ongoing process.” will be more challenges. McFalls said. “Also, whoever accesses Rachel Kraft, a 16-year-old Kent, “Rachel is two years away from ports needs to be trained in and carry Wash., resident, began IG treat- college, so when she goes, she will out very good sterile techniques. This ments at age 3. need to have a plan in place for her is not just a clean procedure, it is a “We began with an IV, but there treatments,” Kraft said. “One of her sterile procedure. Also, if the port gets were difficulties,” said Rachel’s mother, options is staying close to home for hit in sports, it can hurt. It really Lorri Kraft. “We put a port in and college, where she can continue her should be protected with padding that method has been wonderful treatments at the same hospital. But if playing contact sports. Not all for Rachel. She is on her second certainly there are issues that will doctors will support the desire for a port now.” come up that someday might make port, especially with the availability Lorri Kraft keeps on top of new subcutaneous a practical option.” of SCIG; some doctors will never developments, and has listened Kris McFalls, an IG specialist for a support the desire for a port.” carefully to discussion on the SCIG homecare company, is familiar with Despite frequent talk in the IG administration method. all three methods of immune globulin community that other options may “We decided against it, because administration, having two sons with be more viable, some patients and for one thing, we have established a PIDD who’ve tried them all. their families continue to opt for the routine that doesn’t take as long for “The pros of using a port include port method. the infusion as SubQ would take,” easy access, meaning there is no “We were amazed at how many Kraft said. “We were having problems need to dig around for a vein,” people are anti-port,” Kelliann Conner with the portacath four months ago, said McFalls. “They can be used for said. “They talked about things like and our doctor suggested we switch blood draws and are easy for family the risk of infection. But every to subcutaneous, but we told her we members to use. In some cases a family and every person is different. didn’t agree. I made appointments port can eliminate the need for a Watching my kids suffer every few with different surgeons, and we nurse—patients can learn to use it weeks was worse than the infusion figured out that the needle wasn’t themselves.” itself. The benefits outweighed the reaching the port. Nobody had The negatives of ports, McFalls risks for us.” Recap of Port Pros and Cons Advantages Disadvantages • Easy venous access • Involves a surgical procedure • Immediate accessibility for blood draws • May result in scarring • Simple for family members to help • Poses a risk of infection • Shorter administration time • Requires sterile technique Cleansing the port site, using sterile technique, • Necessitates frequent consultation is essential before accessing the port. with doctors IG Living! www.igliving.com June-July 2006 9.