vap access: can you still use even if no blood return?

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    To chemo certified nurses:
    I am getting conflicting information & I want to clarify what is the best practice for an port that does not give any blood return. I have received a pt from ER, where the pt's vap was accessed by the ER nurse & I was informed that I can use that port & that it's good even though there is no blood return. However, the irony is that she started an iv to infuse blood. Then, the next day, the night nurse decided to de-access her port because she said that when there is no blood return, the port should not even be accessed & that one can not be sure if the line is in the right place. so, she decided to start another iv because the previous iv was in the ac, where it caused iv pump to beep every time pt bends her arm. When the husband saw this in the am, he was mad & insisted that the port is good to be used according to the oncologist. He was not willing to listen to the rationale & blames nursing. I got the husband wrath & spoke to my charge nurse & she says that from her experience, the port can still be used even if you don't get blood return. She spoke the night nurse who de-accessed the port & the night nurse replied that she has a specialty in vascular access & she does not care what the husband think because she has heard about scenarios where there were negative outcomes when port was used when there was no blood return. What should be the proper protocol? Should the ER nurse discontinued the access once she found out that there is no blood return?

    Confused ICU nurse
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    I work in a chemo unit in Australia and our hospital protocol is that if a port doesn't bleed after fluid loads and urokinase, then we have to get dye studies done to prove the device is patent. Sometimes this has shown a fibrin sheath but there has also been occassions where the port has separated from the catheter or the catheter has been defective in some way. if it's a fibrin sheath, it's up to the doctors to document this in the chart and that they are happy for the port to be used. Obviously you need to monitor the site for swelling or pain (assuming the pt can tell you this). Where it gets interesting is giving vesicant drugs through a non bleeding device as the consequences if it extravasates can be devastating. We won't use a non bleeding device in this instance and will cannulate the pt instead. It's just too risky.


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