Obinituzimab and Port

[DrLV]

Do you recommend a port with Obinituzimab infusions?

[Jm954 Administrator]

no, I wouldn’t have thought so as it’s only once every four weeks (unless you have literally no peripheral veins).

[Poodle2 in reply to Jm954]

Agree with Jackie. Unless you have really bad veins, you should be fine. There are only 9 infusions if I remember it correctly and apart from the first month they are once in 4 weeks.

[DMary]

I was happy to still have my port from 3 years on a trial when I had my 2nd line treatment of obinatuzimab (6 total 4 weeks apart), but wouldn't have had one for only that short of a time. Best wishes for a strong response.

[Gradyboy]

Like others have said if you have good veins you don't need one. I had no issues with iv.

[Abby-pup]

I was told, at first, it was not necessary. Then I saw the Infusion nurse who strongly insisted that I get a port. It's not just the infusion, it was the additional load of all the blood tests once I started on Ventoclax. I'd suggest you check with the infusion staff.

[Rico49]

I just completed 8th infusion.Unless you have really poor veins, a port is no necessary IMO.

[Skyshark]

Good veins doesn't stop them being fragile. Good veins are just easy to find. Fragile veins collapse or burst on contact, then they can't get blood to prove patency - "dry stick". Also with good veins they can still roll out of way or be tough to puncture.

It's not the 9 cannula for 8 doses of Obin.

It's the 30 (or 40 in my case) something blood tests in first 9 weeks of "high risk TLS" VenO and getting a Dx of fragile veins after the first 12 resulted in 6 "dry stick", 18 punctures and 12 bruises. The doctor and all the nurses said I have good veins but they "don't like it up them". It being the cold hard steel of a venipuncture needle.

Low risk TLS have far fewer blood tests.

[Big_Dee]

Hello DrLV

Depends on your veins. I did B+R without port and had a lot of damage to my veins and attempts to insert needle, took a year to recover. I am one year into V&O with port and really like it. Ports are not however without their own problems like infections and blocked ports. My platelets were very low during port operation and took longer to stop bleeding than time to insert port. I have not had any port infections but have had two blocked ports. I have port flushed once a month when I get blood draw. If port blockage cannot be cleared, then port will have to be removed otherwise left in for any additional treatments. Blessings.

[Kam73]

My husband has nice healthy veins before B+R treatment. He wanted a port and since we were so new to CLL we went with the doctor’s advice. What a horrible decision. That was 10 years ago and his veins are IMO ruined. Multiple sticks for routine bloodwork. In an emergency situation in the ER they could not get a vein for either blood draw or IV. A port would have much better.

[jillybird13]

I didn’t have one for the first two infusions. But I was black and blue from the infusions and blood tests . Had a picc line fitted and so glad I did . I’ve had so many blood tests and am still on weekly blood tests and will be after my Venetoclax finishes next week . Just until my neutrophil count goes up .

[Lambo1]

There are different kinds of ports. What do folks think is the best for O&V treatment?

[Skyshark in reply to Lambo1]

A PICC line is inserted in the upper arm, takes about half an hour with ultrasound guidance, local anaesthetic at the port site, then there's a x-ray to check it's in the right place (can be wrong length or even go up the neck instead of to heart). The port is external, secured by a tag (like "buttoneer" clothing tags) and there is a dressing that has to be changed every week, it's high maintenance. Awkward for showering, it needs a silicone sleeve to keep it dry. It can be a source of infection and result in sepsis. Because of this I only had it for 8 weeks, installed day before 2nd infusion, had it removed after the cycle 3 infusion. Nurses were not happy, they wanted it to stay until last of infusions. There is a time limit of how long it can be kept, about a year.

Central port is in the chest and subcutaneous. These can be kept for a long time, apparently what DMary has. The limitation is the number of times it can used - about 300 punctures per port and dual ports are available. You can swim with these (only if you could before fitting!). Fitting is more involved, minor surgery to place it under the skin. A local anaesthetic and sterile wipe should be used before inserting a needle through the skin into the port, then for infusions a dressing is applied to secure the needle and line. I think these are only used when there is an expectation of very frequent or long term use.

There are no nerves in veins so it's only the exit though the skin that you are ever aware of.

[Lambo1 in reply to Skyshark]

Thanks, Skyshark.

[JustAGuy]

I will likely have my first treatment soon, O+V, and have wondered about this myself. I’m not sure what is meant by a port, when I’ve had IVs there is a catheter installed in an arm vein and a connector where they can inject medicine, take blood draws and connect IV drips to. I was in ER for a day and a half and the whole whole that “thing” was in my arm and only removed when they discharged me. Is that what’s meant by a port?

[Skyshark in reply to JustAGuy]

A cannula is a type of port, it has a short line in the vein, about the length of a needle. Usually placed in lower arm, wrist or back of hand. They are not allowed to let you leave hospital with a cannula. It's not common for cannula to be used for blood draws other than during drug trials where frequent blood tests are done on the day a drug is given but Scottish NHS has a SOP.

A PICC port (line) is a longer tube, about 45cm, 18in. The tip of the tube is located near the heart. The port emerges in the upper arm and is quite like a cannula except for it's anchor that retains it. A PICC line stays in, so it avoids repeated cannulas. It can also be used for blood draws instead of yet more needles.

If blood tests are good, taken at first attempt and you are happy with cannula then that's fine.

[bennevisplace]

Absolutely, if you can persuade the nurse to pour you one. Personally I prefer a dry sherry, but anything to pass the time... 😉