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Problems in rinsing the port (central i.v.-line)

Question
Hello,
I am suffering from CF and have an implantable port-system for infusions of antibiotics for 2 years. At the last two rinsing-procedures of the port (the last even at my CF doctor) I suffered from nausea and strong shortness of breath just after the rinsing-procedure (about 1 minute after). After 5-8 minutes, everything was over and normal.

My CF doctor did an auscultation during the shortness of breath period, but could not find anything in listing to the lung (no bronchospasm, pneumothoracs…). On the x-ray done afterwards, showing the port, everything looked pretty fine. The skin around the port is unchanged, too, I do not have any pain or feelings of pressure.
My physician does not have an idea at the moment, single suspicion: allergy to heparin. But I am getting it for years together with the i.v.-therapies and until now, there has not been anything.
Do you have an idea what the problem is do or do you have heard of anything similar or experienced anything similar?
Many thanks for your answer,
Answer
Dear questioner,
we care for some CF-patients having a port-system and know the described phenomenon with nausea and shortness of breath after rinsing the port. Fortunately, you recovered quickly!
The described problem can have several causes:

1. an allergic reaction to heparin or to additives of heparin:
Until now, you have tolerated the heparin solution always well as you wrote. However, an allergy can develop in rare cases also after many years of administration. Nausea and shortness of breath match with an allergic immediate reaction. Unfortunately, you did not mention, how the situation of the circulation was (e.g. blood pressure, pulse frequency). The nausea could be a sign of a decreased blood pressure, the shortness of breath of an allergic reaction of the lung.
The clarification of an allergic reaction is not so simple. One can do a skin test with the latest used soultion for rinsing the port, in order to see, if you react to heparin, respectively to the containing additives, i.e. if you are sensitized.
In case no reaction does occur, the next step would be to give a minimal test-dose via the port. If this will be tolerated well, the full dose can be administered. The test dose and the administration of the normal port-rinsing-dose should be done under monitoring of pulse, oxygen saturation, breathing and blood pressure.
In case an allergic reaction does occur at these different steps, a so-called desensitizing is possible, this functions like a hypo-sensitizing therapy like e.g. with a pollen allergy. It has been reported sucessfully about this in the medical literature.

2. A thromboembolism out of the port-system:
In artificial materials like a port catheter a thrombus can form easily, which can then at the rinsing procedure of the port, be transported into the bloodstream and can then cause problems in other vessels, e.g. in those of the lung (thromboembolism). You wrote, that the x-ray of the lung with picture of the port has been inconspicious. However, by this a possible thrombus can not be excluded. Sometimes they develop at the end of the catheter and are detectable indirectly, if the contrast-dye is given during the x-ray investigation via the port-system.
Have you been investigated already regarding an increased, inherited risk of thrombosis (APC-resistance, factor-V-deficiency, mutation of the prothrombin gene, etc.)?
I hope that you will tolerate the rinsing of the port next time well again....
Yours sincerely and best wishes,
Dr. S. van Koniingsbruggen
24.11.2008