I have recently been "recruited" by my hospital to perform fills. I have a modification of the technique performed by Dr Kuri in TJ.

I'm interested in other techniques some of you have experienced.

Please share with me.

thanx

My surgeon places a pillow below my lower back, then has me do a crunch to locate the port for injection. Following the injection he has me drink some water to see if it stays down I guess and how it feels.

My surgeon places a pillow below my lower back, then has me do a crunch to locate the port for injection. Following the injection he has me drink some Water to see if it stays down I guess and how it feels.

I made sure my surgeon would personally be doing all my fills. I don't want anyone else doing them. Perhaps this is just me....

The doctor or a nurse practitioner put a pillow behind my back I arch over it and they use a large needle and inject the fluid I personally like the surgeon better he doesn't bruise me but you get who you get. Its easy and quick unless your port flipps like mine did a year ago.

Does your filler do a barium swallow first? Use betadine, alcohol, or other agent to clean your skin.? Use fluoro to find the port? Use lidocaine to numb the skin. Use a three way stopcock on the needle to fine tune the fill? Use barium and fluoro to determine if the ideal amount of fill was performed?

thanx jones

From Raven's Husband, Paul:

Assuming you have experience with accessing various types of ports, it's easily done in about 1-2 minutes. If you can't feel the port outline to determine exactly where the diaphragm is, consider US guided access as an option to fishing around blindly in hopes of locating the diaphragm.

Supplies:

-20ga Huber needle with short tubing extention. 1"-2"+ needle length depending on depth of tissue over port.

-10ml syringe.

-18ga needle to draw saline.

-18ga needle to draw 2% Lidocaine w/ epi.

-25-27ga needle to inject Lidocaine into tissue overlying port.

-Sterile saline (Or contrast media, if necessary for visualization via fluoroscopy or CT. Check port manufacturer's data to confirm compatibility.).

-Alcohol prep pads.

-Betadine prep pads (Unless allergic, then substitute as needed).

-1-2 gauze pads.

-Bandaid.

-Spill safe container of Water for patient to drink from.

-Non sterile exam gloves.

-Sterile gloves if desired.

1. Patient positioned supine w/ 1-2 pillows under his/ her back.

2. Draw up roughly 1-3ml (Or as much/ little needed) of saline with 10ml syringe and 18ga needle then remove needle. Attach syringe to Huber needle w/ extention, flush and clamp the tubing. Note volume of saline remaining in syringe.

3. Locate the port. Spend as much time as needed to get comfortable with port location and attitude.

4. Prep site with Betadine/ Alcohol, wipe with sterile gauze for better visualization.

5. Infiltrate Lidocaine to tissue directly over the diaphragm. Less is better, too much and you'll have trouble feeling the port. 1-2ml is probably enough.

6. Reprep the site as needed, inject Huber needle through anesthetized skin and tissue to the center of the diaphragm. It takes a bit of firm pressure to penetrate the diaphragm. Don't worry, the port body is plenty strong enough to prevent overpenetration.

7. Release the tubing clamp and aspirate until resistance is felt. Again, note volume in syringe. If unable to aspirate at all, you're either not in the right spot or the port & band are completely empty.

8. Inject desired amount. Clamp tubing and note volume injected. Have patient drink a small amount of water while still supine. If patient's esophagus is now obstructed and unable to swallow any Fluid, aspirate enough until no longer obstructed before removing the needle.

9. Remove Huber needle, clean up the site, place Bandaid. Repeat swallow test in upright position with at least 120ml of water (4oz) to "Proof" the patentcy of the esophagus.

10. Discharge patient to home with 24hr phone# access to your service for emergencies related to this fill.

Lay on my back. Surgeon pulls my shirt up and feels around until he's found the port, and marks it somehow -- I'm not sure what with, I don't watch. Get swabbed with isopropyl, then get poked. He can usually drop the needle straight into my port. One time he hard a hard time finding the port in which case he had me do a partial sit-up and hold it while he felt for the port. Popped the needle in, knew he had missed the port, so left the needle in and felt around until he found it, then popped the needle in.

I request no lidocaine, so once he's made the mark and comes back with the syringe he fills me, then the nurse qipes with betadine, repeats if I'm still bleeding, and pops on a band-aid.

Probably not the detail you're looking for, but it's all I know.

I don't know much either because I don't look and it happens so quickly.

I step in office, pull up shirt, he sticks his head under my boob (that's why I can't see what's going on), takes about 40-45 sec., says "step across hall", I go across for floro, watch it go down, and that's that. I've never felt a stick or had a pain or a problem. And it works.

Fluoroscope is the only way to go. I had 3 fills by one Doctor who refused to do under Fluoroscope. I never felt full so I stop going to him. When I was discharged I was told by my surgeon never to have fill done unless under Floro. It was very difficult to find a Doctor that would do Floro near Memphis. After a lot of research I found Dr. Houston, Nashville TN. Wonderful Doctor with a to the point attitude. After having test done he found that I had a enlarged esophagus. This was most likely caused from not cut food into a small size and not eating food well before it went down.You see food had no where to go and would not come back up. I am now on liquid for the next 3 weeks and then blended food until i need next fill..... The reason I am tell you all of this is because if I had not been so determined to find a Doctor to do this under fluoroscope. I could have ruptured my esophagus and could have died if I had not got to the hospital in time....So guess who is the best Lap-band surgeon in the south...Dr Hugh Houston, Nashville TN.......

I had the hiccups all the time and my Doctor had me do an upper GI and was that my esophagus was dialated so he unfilled my for three month and I just got refilled today. I am now feeling restriction again and now I have to pay attetion to how I am eating once again. I did gain weight, about 8 pounds. I want to lose about 30 pounds more. This has been the best decision I have ever made.

I'd like to find a doctor (preferably hot and male) that does his fills by blowing into your mouth to fill the band. I know I know, some may say that this won't work right? Well it sure would be fun to try!!!

Roflol! that must be the princess n the p modified technique! I bet you would want more than one fill every 4 weeks!!!

O.K. I think we changed the course of this thread. It started out so informative and scientific. sorry :confused:

terry

I'd like to find a doctor (preferably hot and male) that does his fills by blowing into your mouth to fill the band. I know I know, some may say that this won't work right? Well it sure would be fun to try!!!

My hubbies post was technical but I like yours so much more! My fill doc, my hubbie, is hot and a male (go figure) but I'm not sharing him.....yet.

Another Q: when do we get to count a pound lost? When it still hovers in the .4 range or when it is off the scale for say, 2-3 days? I got on the scale this morning and have lost another 1+ pounds! I don't know if that's because I was dehydrated or due to my bowel movement but hey, I want to count it on my ticker! I'm drinking beer with salt tonight so it will probably be back tomorrow.

I've only had one. Lay on the table and lift my feet slightly - a baby crunch. No anesthetic. Slight prick and it was over. Release the feet.

I asked him about a numbing shot. He says he doesn't like them because they hurt more than the fill needle. Having had numbing shots before, I agree with him.

My fills are done without numbing shots, and under flouro. Takes less than a minute, and no pain.

He requests nothing to eat or drink for two hours before the fill. My Dr. had me lay back on the table, fully clothed, just having my shirt raised. He palpitated my stomach for the port, he couldn't find it, had me put a pillow in the small of my back to stretch my abdomen out, palpitated it some more, still couldn't find it. He told me not to worry, that he places a low profile port quite deep and he often can't feel it. So then he prepped me with an antiseptic wipe, no numbing shot (they hurt more than the fill needle, I agree) and went in directly over the small round scar he says is the scar from where they anchor the port, he always knows if the port hasn't moved from where it was stitched it's always directly under this spot. Sure enough he says, it's exactly where it should be, no worries. When he first goes in with the needle he taps down gently with it until he encounters the port, then he pushes down into the port harder. Then depresses the plunger on the needle to add the fill. He pulls the needle out quickly, follows with another wipe and a bandaid. He has me sit up, and drink water to assess my level of restriction. He does not use flouro, and feels from his experience he finds no advantage in it. He has used flouro in the past, but found his success rate with adjustments has been the same with or without flouro. He explained that even if flouro shows perfect levels of restriction, patients react so differently to adjustments - some with swelling that goes down and restriction leaves within the next few days up to a couple of weeks. Some the opposite, no restriction at first, and then all off a sudden in a few days or as much as a week or two later restriction kicks in. He has me drink about a styrofoam cup filled to the brim, and then refilled half way of the water. To assess that I'm not too tight. First fill he had put in 4.5cc's in the large VG band - I had the water - didn't go down easy, so he had me lay back and took .5cc's back out, tried the water again, and no problem. Second fill of .5 cc;s water went down fine. I've had just the two fills, one week apart. The restriction on the first fill was there for two days (so I had restriction right off the bat - so even without flouro he hit the nail on the head) unfortunately some of that was from swelling, and three days later, restriction gone. With the second fill I've reached good restriction again, not too tight, not too lose, just right. My further follow up fills will be done by another Dr other than my surgeon, but one that has been trained by my own Dr. via INAMED Health and authorized by INAMED (whom I assume you'll be recieving training/authorization from yourself.) I think there are some slight differences, usually around whether they use a numbing shot and/or flouro, but the majority of adjustments seem to be done very similarly. The best to you in your practice.