accessing a port for just one blood draw

FlyingScot, RN · Jul 16, 2014

I was honest. One lab draw. A moment of honesty just cracked my nice nurse face.
Sometimes I don't have time. Sometimes the guy in the next room who's about to die comes first. Sometimes I simply can't fit one more thing into the 2 hr I have to do everything. Sometimes I want to do it the easy way.
As I replied to the other poster, I've never refused a patient who wants to use the port for blood draws. But if I have a choice, the lab's going to do it peripherally.
If that really stuns you, you haven't been a nurse very long.
Either that, or you work with saints.

If 28 years of experience (I need to update my profile) constitutes not being a nurse for very long then, ummm, okay and no I don't work with saints nor am I one but I've never made a decision on how I care for a patient based on my convenience. I currently run the ONLY lab for a huge university-based medical center that accesses ports/piccs/cvcs/pivs. My average patient census is 40+ in an eight hour day so I understand busy. I'm glad you never refuse a patient but I have to ask you this, if a nurse were to admit that they chose the easy way out not the best way for one of your parents how would you feel?

OCNRN63, RN · Jul 16, 2014

I know, I know. I said I know.
But saying I have time, and it's all about the patient, puts you in the same category as the manager who expects me to do two jobs in the same amt of time, and deliver cookies and coffee too.
YES, sometimes I want to be callous. Even though I've never refused to access a port when the patient requested it. Will I access if I have a choice? No. Most of us wouldn't for one lab draw.
The OP scenario did not include chemo and bad veins. People have ports for reasons other than CA

It's not the same thing at all. Really? Accessing a port is as frivolous as fetching coffee and cookies? Wow. Just...wow. Honestly, I wouldn't want you to access my port, since it's obviously such a burden on you. Why don't you just fob it off on IV team or a co-worker who has more skill with ports. It shouldn't take you much longer to draw from a port than an arm, so obviously you're not as comfortable with them. There's nothing wrong with that, just don't make your patients suffer because you lack the patience/expertise.

It doesn't matter what the patient's dx is. People get crappy veins from abx infusions.

If a guy in the next room is going to die, you're not going to be drawing blood anyway. What you said stunned me too, and I've been a nurse for almost 30 years and have never worked with saints.

OCNRN63, RN · Jul 16, 2014

If 28 years of experience (I need to update my profile) constitutes not being a nurse for very long then, ummm, okay and no I don't work with saints nor am I one but I've never made a decision on how I care for a patient based on my convenience. I currently run the ONLY lab for a huge university-based medical center that accesses ports/piccs/cvcs/pivs. My average patient census is 40+ in an eight hour day so I understand busy. I'm glad you never refuse a patient but I have to ask you this, if a nurse were to admit that they chose the easy way out not the best way for one of your parents how would you feel?

Thanks. If I ever end up in your facility, you may feel free to plunge a 19g 1" Huber in my chest anytime.

imintrouble, BSN, RN · Jul 16, 2014

If 28 years of experience (I need to update my profile) constitutes not being a nurse for very long then, ummm, okay and no I don't work with saints nor am I one but I've never made a decision on how I care for a patient based on my convenience. I currently run the ONLY lab for a huge university-based medical center that accesses ports/piccs/cvcs/pivs. My average patient census is 40+ in an eight hour day so I understand busy. I'm glad you never refuse a patient but I have to ask you this, if a nurse were to admit that they chose the easy way out not the best way for one of your parents how would you feel?

I definitely wouldn't slam them. "Easy" and "best" don't have to be disparate.

In this very narrow situation regarding drawing blood, FOR ONE LAB, I would understand why my fellow nurse made the decision they did.

Nursing is all about prioritizing. You see "easy" as the nurse being lazy and making a substandard decision about care. ONE LAB DRAW. Do you really believe that drawing peripherally for one lab draw, instead of .....

This is how I have to access a port where I work.

I get a kit and charge the patient.

I get a mask and the patient gets a mask.

I sterilize the site.

Access the port.

Verify placement with a flush/aspirate blood.

I probably would apply the dressing, and not just remove the Huber.

Draw the blood.

Flush with Ns and Heparin.

Label and deliver the tubes to the lab. Yep, I'd have to deliver them.

For one lab.

I don't think it's unreasonable to want lab personnel to draw, while I do the job they can't do.

FlyingScot, RN · Jul 16, 2014

Thanks. If I ever end up in your facility, you may feel free to plunge a 19g 1" Huber in my chest anytime.

Just let me know when you're coming and I'll be ready. ?

imintrouble, BSN, RN · Jul 16, 2014

It's not the same thing at all. Really? Accessing a port is as frivolous as fetching coffee and cookies? Wow. Just...wow. Honestly, I wouldn't want you to access my port, since it's obviously such a burden on you. Why don't you just fob it off on IV team or a co-worker who has more skill with ports. It shouldn't take you much longer to draw from a port than an arm, so obviously you're not as comfortable with them. There's nothing wrong with that, just don't make your patients suffer because you lack the patience/expertise.

It doesn't matter what the patient's dx is. People get crappy veins from abx infusions.

If a guy in the next room is going to die, you're not going to be drawing blood anyway. What you said stunned me too, and I've been a nurse for almost 30 years and have never worked with saints.

I worked in a LTC once where a resident literally used the call light every 10 minutes day and night. No exagerration. Her room was at the end of the hall. A 50 ft hall. Fifty feet from the nursing station. We were chronically understaffed.

I asked if the resident could be moved closer to the nurses station to save the staff, as we were exhausted at the end of the shift.

Management's response was exactly what yours is here. How dare I suggest my needs were more important than the resident. How dare I complain that I wanted to save steps and time. The implication was that I was lazy and uncaring. Exactly what you are suggesting.

We don't have IV teams. If I don't have time, my co-workers don't have time.

Is it just me, or is every nurse who posted they'd draw the lab peripherally lazy and uncaring?

One lab draw. WOW. Who would have thought you could make assumptions about a nurse's character over one lab draw, and the mode of obtaining it.

~PedsRN~, BSN, RN · Jul 16, 2014

INS does not say that! I've seen your post regarding this before.. And "we" really should be giving correct information to others. Practice standard 45/practice criteria P (page S61 in the latest standard book) states: Before removal of the access needle from an implanted port &/or periodic access and flushing, the device should be locked with HEPARIN LOCK SOLUTION of 100units/ml.

Good, this is our policy right now.

OCNRN63, RN · Jul 16, 2014

I worked in a LTC once where a resident literally used the call light every 10 minutes day and night. No exagerration. Her room was at the end of the hall. A 50 ft hall. Fifty feet from the nursing station. We were chronically understaffed.
I asked if the resident could be moved closer to the nurses station to save the staff, as we were exhausted at the end of the shift.
Management's response was exactly what yours is here. How dare I suggest my needs were more important than the resident. How dare I complain that I wanted to save steps and time. The implication was that I was lazy and uncaring. Exactly what you are suggesting.
We don't have IV teams. If I don't have time, my co-workers don't have time.
Is it just me, or is every nurse who posted they'd draw the lab peripherally lazy and uncaring?
One lab draw. WOW. Who would have thought you could make assumptions about a nurse's character over one lab draw, and the mode of obtaining it.

It's just one lab draw for you, not the patient I have to get frequent labs; sometimes it's one lab, other times it's several. If everyone did what you do, my arm would be even more scarred than it already is.

I made no assumptions. You were the one who said you were being callous.

FlyingScot, RN · Jul 16, 2014

I definitely wouldn't slam them. "Easy" and "best" don't have to be disparate.
In this very narrow situation regarding drawing blood, FOR ONE LAB, I would understand why my fellow nurse made the decision they did.
Nursing is all about prioritizing. You see "easy" as the nurse being lazy and making a substandard decision about care. ONE LAB DRAW. Do you really believe that drawing peripherally for one lab draw, instead of .....
This is how I have to access a port where I work.
I get a kit and charge the patient.
I get a mask and the patient gets a mask.
I sterilize the site.
Access the port.
Verify placement with a flush/aspirate blood.
I probably would apply the dressing, and not just remove the Huber.
Draw the blood.
Flush with Ns and Heparin.
Label and deliver the tubes to the lab. Yep, I'd have to deliver them.
For one lab.
I don't think it's unreasonable to want lab personnel to draw, while I do the job they can't do.

You must have me confused with someone else because I never said you or anyone else was lazy. And as far as I can tell I didn't "slam" anyone either. You, yourself, said you were callous and made the decision based on your needs not the patient's. In fact in your first response nowhere did you mention prioritizing or critical patient needs.

You said "but darn it, it takes longer, it's more trouble for the nurse and on a busy shift why can't I be a little callous and do it the easy way".

I use ports for one tube lab draws all day long. The only time I don't is if the patient, unsolicited, sticks out his/her arm and says "just use my arm". Could I convince a port patient to just let me use their arm? Of course, but I think that's tantamount to an abuse of the trust they have in me to put their best interest first. In the end it doesn't really take that long. I can get the job done in 5 minutes or less.

Sometimes I don't get lunch. Sometimes I don't leave on time. But that's part of the game. And I'm okay with it as long as I know I gave my best to my patients. YMMV.

OCNRN63, RN · Jul 16, 2014

It's one lab for you, not the patient. For all you know, other people may be doing the same thing. If I caved in and let people stick me peripherally every time I had just one lab, my arm would have more scars than it already does.

I made no assumptions. You called yourself callous, self-centered and selfish.

I know ports are better for the patient. I know it's easier on the patient, even it's just one lab.
But darn, it takes longer, it's more trouble for the nurse, and on a really busy shift why can't I just be a little callous and do it the easy way?
I had a patient with a port admitted for OBS. Peripheral site in ER, (they didn't want to access the port either) and one lab before discharge.
Lab didn't want to draw the patient, wanted me to access the port and get the blood. Pressured me. Talked to the patient til the patient asked for a port draw.
A serious waste of my time. Ok, if that makes me self centered and selfish, I'll own it.

~PedsRN~, BSN, RN · Jul 16, 2014

Honestly, this situation can't arise often. Our port patients (not cancer kids), if they are in the hospital we access that port - because we know we are going to use it. Eventually. It's easier to access it on admission so it's there when it's needed.

wooh, BSN, RN · Jul 16, 2014

Do I do a little happy dance when a patient is willing to do what's easier for me? Heck yeah!

Can I convince a patient to do that, even when it's not best for them? Many times, yes.

Have I taken advantage of that? A few times, yes.

But I do try to avoid it. Not that the nurse's needs aren't important. I'm not a saint. I prioritize my pee breaks in line with my patient's needs. But I'm for accessing that port AND moving the always calling patient closer to the nurses station. If it helps the nurse without hurting the patient, then definitely do it. If it helps the nurse but hurts the patient, then it needs to be thought about again.

Sometimes you have to do what you have to do. But I try really hard not to fall into making that the norm for me. It's just too easy to fall down the slippery slope and do what's easier even when I do have the time to do it the better way.