Things can't just be easy....

This morning found JT up at Maine Med for his three month/pre-chemo MRI. JT was in good spirits until it was time to have his medi-port accessed. Despite Emla numbing cream he’s still extremely sensitive about the area and hates the needle (not that I can blame him). In any event, the needle went in while his mom, a nurse and I restrained him. It was shortly thereafter that we realized that flushes were going in (as they should) but there wasn’t a return. Not so good. But “no return” wasn’t a reason to delay JT’s inevitable date with the mega magnet. So, after a little Propofol JT was off to la-la land and went to get his head examined.

Meanwhile, Jennifer and I grabbed a pager – mind you the pagers are exactly like the ones you’d get waiting for your table at the Olive Garden – and went up to the café to grab a little breakfast. While returning to MRI we ran into MCCP’s Nurse Practitioner and described JT’s lack of return. Knowing that JT needs to go to the Clinic next Monday for blood work (read: they need to pull blood out of the port!) it was rather critical that the damned thing work. So, the NP, Chris, made sure that JT’s needle stayed in post-MRI and had us moved up to a room at Barbara Bush Hospital where they could try and work out what was clogging up the works.

While there are, I’m certain, many different reasons for a port to fail to give a return there are a few reasons for “no return” that I’ve heard more times than not. To explain even one adequately I need to briefly describe (with apologies to any healthcare professional reading this) the basic workings of his medi-port. The medi-port tube (or catheter) is woven into one of JT’s veins on his upper chest. When a needle goes into the access point, his medications travel down the tube and into his blood stream. The conventional wisdom is that when JT is accessed you press the plunger of the syringe the meds travel into him and if you were to pull the plunger out blood would travel up the tube, out the access point and you would see it enter the syringe. The act of pulling on the syringe plunger would suck out or “return” blood via the port. Thus, the term “blood return”.

Now, why wouldn’t you be able to get something simple as a return every time JT’s accessed? Good question. One theory of what’s going on is called tubesuckingthewallistis. Okay, I made that up. But it pretty much describes the phenomenon. Imagine putting a straw into your lemonade. It works well until you put the straw so far down that it rests squarely on the bottom of the glass. Then you can’t suck up lemonade. Imagine JT’s catheter doing the same exact thing. Except the end of his catheter is hitting up against the structure wall of where it ends.

Hold on….Nurses entering the room…..
Fast forward two hours….

JT and I just got back from Fluoroscopy. Now that, my friends, is cool. Real-time x-ray images of moving structures in the body. JT just laid there while the doctor injected contrasting dye into his medi-port. I got to sit there and see his port working right on TV. Wicked cool. What they found was JT has a little fibrin sheath (affectionately known as a fibrin “booger”) at the end of his medi-port catheter. In essence, a little strand of a clot hanging off the end of the tube. As junk is injected through the port it breezes right by the booger. But as soon as one tries to pull fluid back up the catheter, the booger sucks into the end of the catheter and blocks it up. I suppose my previous example should have been “pulpy” lemonade. Yep, there you have it….James has pulp stuck in his catheter.

There are tricks to beating this and so far the one dose of booger eating medicine (Urokinase) hasn’t worked. Tomorrow we’ll head to Maine Children’s and try again (and maybe again).

Talk to you later,
dct