Patient had port placed by surgeon on 6/29, she was seen in oncologists office for Adriamycin administration on 7/2. Port accessed without difficulty, excellent blood retrun, ran by gravity at a good flow rate. Received 400cc of fluid prior to Adria administration. No swelling, no complaint of discomfort. Adriamycin IV push begun, after a couple of cc's patient complained of slight burning above port site. Assessed again still excellent blood return. Resumed Adria administration IVP tolerated most of it but then complained of discomfort in neck and left arm. Port was on left chest wall. There was still good blood return, still no swelling, still good flow by gravity. It was decided to stop administration of meds via port, peripheral line placed and therapy completed that route. Patient was sent for dye study on 7/3. IR reported back that there was a small leak noted at the port/catheter connection. Surgeon removed port on 7/4. She stated surroundong tissue was not noted to be inflamed, she irrigated site and when she flushed the port afterwards she didnot find any leakage.
The question is what should we be expecting. We do not know how much Adria leaked into the area surrounding the port. As of 7/5 the patient was not complaining of any discomfort, denies redness at the site. I have seen the pictures of Adria extravasation from needle dislodgemnt, I know what can happen, but since this may be a deeper extravasation, what can we do? Would a CAT sacn determine tissue damage? We have also been informed that the surgeon should not have irrgated the area. Any advice would be appeciated.