Caring for a Three Legged Dog or Cat
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I was wondering if anyone else has had to deal with the problem of too much scar tissue on veins from IVs which have made the veins too fragile for IV chemotherapy?
Percy has been on chemo for a while, and we are on our third chemo protocol. At his last two treatments, the doctors have recommended that we consider inserting a venous access port. Because he has had so many IV treatments, Percy's veins are starting to become too scarred and too fragile. I really, really do not want to put him through another surgery (it is inserted surgically into the jugular vein) and I'm worried about whether he could accidentally knock something like that out of place, but the current protocol seems to be helping, so I'm trying to decide between putting him through another invasive procedure versus stopping a treatment that seems to be helping (at our last xray, Percy's lung mets were not visible!). Has anyone else had any experience with a venous access port? If so, did you have any complications?
Alternatively, has anyone had IV chemo done thru veins such as those in the ear or tail? I was told that those were possible, but not preferred, alternates if they could not use the leg veins. Using those sites would usually require sedation.
It is common for dogs to get scarring from repeat chemo or IV treatments involving a catheter. To make it worse our tripawds are short 1 leg so you only have 3 main leg veins to use (cephalic veins in front and saphenous veins in back). Many times I have had to use smaller accessory veins such as the inner back leg or a branch of the cephalic over the wrist. Using a smaller diameter and shorter catheter can often help.
What type of chemo is your dog getting? If it is Adriamycin (doxorubricin) then a catheter should definitely be used. If your dog is getting carboplatin I often will use a butterfly catheter which is really just a short needle attached to IV tubing for easier vein access and a quick (10 minute) infusion. I have used a jugular catheter to administer chemo to short stubby legged dogs like Scotties and Basset Hounds without incident but I have never surgically implanted a jugular access port. These are commonly used for people and the main challenge is maintaining sterility and keeping the catheter patent.
I have never used ear or tail veins either.
Pam
Hi Pam,
Thanks a lot for your reply and for the information. Percy is getting a combination of vinorelbine and carboplatin for hemangiosarcoma. He gets vinorelbine in week 1, vinorelbine in week 2, carboplatin in week 3, then three weeks off. Then we start over again.
You mentioned that one of the main challenges for the access port is maintaining sterility. Would there be danger of infection still once the incision heals? They said that the entire port would be under the skin. So they would still have to puncture the skin to administer chemo, but would do it at the port rather than on his legs. Would something like that be at risk of being dislodged if he scratched or rolled the wrong way?
If I decide not to get the port put in, they said that they may need to sedate Percy to give him IV at alternate sites. Are there risks associated with being sedated too often or interactions between the chemo and sedation drugs?
Thanks!
AJ
The port would be under the skin but the site must be kept clean while the incision heals since the port goes directly into the jugular vein. Keeping it covered and dry should be adequate.
Mild sedation to use alternate sites would be quite safe. I have never used vinorelbine so I do not know if it would be okay to use a butterfly catheter with that one.
Pam
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