accessing a port for just one blood draw

[Ted D]

Would this be worth it? I know that's what the ports are for, but just seemslike unnecessary heparinizing and increased chance of infection over a peripheral stick?

[KelRN215, BSN, RN]

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

I'll access that port before subjecting a child to peripheral lab draw any day of the week. In 7 years of pediatrics, I think I've met 2 children (one was a teenager) who preferred peripheral sticks over port accesses. I have patients who sit still, laugh, clap when they get their port accessed but if you try to do a peripheral stick, it's a 6 person job- 5 to old (head, each arm and each leg) and one to do the stick. Accessing the port is easier and takes less time for me every single time.

[imintrouble, BSN, RN]

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.

My post obviously hit a nerve with you and you personalized it.

I'm sorry for the illness that required you to have a port.

All you saw was "callous", and you interpreted what I posted as ...I

don't know.

I was honest. Next time I'll keep the controversial responses to myself.

I'd still not access a port for one lab draw, unless the patient requested it.

[imintrouble, BSN, RN]

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.

What exactly does "I'm just stunned mean", because I interpret all kinds of negative comments.

[imintrouble, BSN, RN]

What I responded to on my first post was:

One lab draw.

One. Not several one tube draws. Not one a day. Not IVFs, not peripheral sticks. JUST ONE DRAW.

Do I feel callous that I'd do that? Yes.

I wish I didn't have to find ways to save time, but I do.

[OCNRN63, RN]

My post obviously hit a nerve with you and you personalized it.

I'm sorry for the illness that required you to have a port.

All you saw was "callous", and you interpreted what I posted as ...I

don't know.

I was honest. Next time I'll keep the controversial responses to myself.

I'd still not access a port for one lab draw, unless the patient requested it.

I did personalize it. I personalized it for patients who have an easy means of access, yet have to endure a more difficult, painful stick because it's the nurse's preference, and they reel too intimidated to insist that the nurse use the port. I worked with cancer and infusion patients, so yes, it did touch a nerve with me. It didn't have anything to do with my illness. I just can't wrap my mind around not doing what's best for the patient because you don't feel like it. Heck, all this handwashing we do is a major time-suck, but we do it anyway. Why? Because it's what's best for the patient.

What happens if the next day the patient needs a lab draw, and you're not the nurse? Now the patient may have yet another nurse with your philosophy that "It's just one lab, and I'm too busy to draw from the port." Maybe two days later you're back, and the patient needs labs again, and you once again decide "It's just one lab."

If you are adept at port draws, it really shouldn't take that much longer to do them v a peripheral stick. How many seconds does it take to get heparin and saline, and scan them? How many seconds to put on a mask and cleanse the site? How many seconds to stick the tubes in the vacutainer? How many seconds to flush the port and deaccess the Huber, then place a band-aid? The most time consuming aspect would be taking it to the lab, if you don't have a PCT/aide to take it there for you. At most, the draw shouldn't take longer than 5 min.

I copied and pasted the words you used to describe yourself. Don't cry foul when you see them repeated back to you.

We don't see eye to eye on this, nor will we.

[OCNRN63, RN]

What's the difference between one tube v several? A stick is a stick. Time mgmt. shouldn't come at the expense of the patient. If it was your mother of father as the patient, how receptive would you be of a nurse trying to do a peripheral stick to save time? I know if it were one of my parents, I'd be asking some questions of a nurse who tried to do a peripheral stick when there was a perfectly good port.

That's my final say on the matter.

[FlyingScot, RN]

What exactly does "I'm just stunned mean", because I interpret all kinds of negative comments.

It means I can't believe a nurse would actually publicly and unapologetically admit to putting her "needs" before her patient's.

[wheeliesurfer]

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.

As a current PAS Port patient I noted that you would secure the huber rather than remove it immediately after the lab draw. This would indeed SAVE TIME later if the lab came back abnormal and needed to be re-drawn or further tests drawn and/or fluids, abx, etc. ordered for tx. Leaving the port accessed until DC isn't a bad idea in an acute care setting and in the long run saves you, the nurses after you and the patient a lot of time and needle sticks (esp. for those of us who have REALLY bad veins!)

[imintrouble, BSN, RN]

It means I can't believe a nurse would actually publicly and unapologetically admit to putting her "needs" before her patient's.

I was being honest.

This nurse doesn't have time to do everything I have to do in a twelve hour shift. If other nurses are honest they'll admit to the same.

Since I work nights, labs are drawn first thing in the AM, about 5AM. Those who work nights would recognize what happens about this time every AM. I'll not explain, as it seems I've entered the Twilight Zone where all nurses wear halos.

Yes, I want to go home when my shift is over.

Yes, I want to be able to drive the one hour commute time before I fall asleep.

Yes, sometimes my "needs" are more important to me than the patient's ONE AM LAB DRAW.

Yes, I'm human.

[~PedsRN~, BSN, RN]

I'll access that port before subjecting a child to peripheral lab draw any day of the week. In 7 years of pediatrics, I think I've met 2 children (one was a teenager) who preferred peripheral sticks over port accesses. I have patients who sit still, laugh, clap when they get their port accessed but if you try to do a peripheral stick, it's a 6 person job- 5 to old (head, each arm and each leg) and one to do the stick. Accessing the port is easier and takes less time for me every single time.

Man, I have several teens that still moan and cry and demand emla for their ports. LoL! Of course they do the same for peripherals as well. ?

[psu_213, BSN, RN]

This would indeed SAVE TIME later if the lab came back abnormal and needed to be re-drawn or further tests drawn and/or fluids, abx, etc. ordered for tx.

Our hospital is attached to our hospital's cancer center so we see a lot of oncology pt's, many with ports, many in the middle of chemo regimens. If a lab…one lab…is ordered on a patient, it is ordered for a reason--i.e. the doctor has some degree of suspicion that the result may be abnormal. If that is the case, the likely will need IV access and/or further lab draws. If the patient requests a peripheral stick (some have) I will do that. Otherwise I will access the port, draw the lab, and leave the port accessed in the event that the one lab is abnormal.

[wooh, BSN, RN]

If the patient requests a peripheral stick (some have) I will do that. Otherwise I will access the port, draw the lab, and leave the port accessed in the event that the one lab is abnormal.

Yup. And if it's a morning lab, I'll probably get the patient to let us access it the night before (because who wants to go through all that at 5am?) so that come morning, it's just a quick get the lab instead of accessing and getting the lab.