Help me with a portacath question

[nsgnva]

I work in LTC. Several years ago a resident of mine went in the hospital for portacath placement. I went to visit her so I could observe the ICU nurses accessing and flushing, because if this resident ever needed flush/meds, I'd need to know how. The ICU nurse showed me how to access, withdraw blood to check placement, then she proceeded to administer the IV meds.When the resident returned to my facility, she never had any IV's or IV meds ordered, but required monthly flushes to keep the portacath patent.Since I was the primary nurse for this resident, it would be my responsibility to flush it every month. I trained and worked in a hospital that did not allow LPN's to work with portacaths. So I went to an RN and asked her what to do. She said our facility allowed LPN's to do this and she would be happy to give me hands on training. With this accomplished, I have flushed the portacath every month for over 2yrs. Well, I recently had problems with it and could not get a blood return, nor could I get the flush to go in. I reported this to my unit manager, and tried again the next day. Still no go! So I reported it to her again.She advised me to put a note in the MD rounds book, which I did. The MD on rounds said to make an appt. with the surgeon who put it in and see about getting it removed....seeing as how all she has received through it, for 2 years, was flushes. So I set up the appt. In the meantime, my unit had a change of managers. The new manager asked me what the appt. was all about, so I explained to her all that had transpired the past few months. She talked to me like I was an idiot. I have been a nurse longer than she has been alive, but excuse me for not having trained in portacaths until 2 years ago! She said "You NEVER aspirate blood to check for placement. There is no where for the portacath to go. It doesn't migrate anywhere, or infiltrate, so there is no need to draw back on it to look for blood in the line" Who is right? The ICU nurse at the hospital who showed me how to do it, the RN who gave me hands on training, or the new LPN manager???

[nsgnva]

It sounds like you were doing things correctly. You most ceratinly do aspirate for blood. There can be infiltration if there is a compromise in the device. If there is very forceful coughing or vomiting, the port can flip and not be accessible. This is rare but can occur. I have a couple of articles at work I can point you to as a reference. Be careful about what you do as an LPN. In my state only RN's can access these types of devices. I would hate to have the facility use you to do something that you should not. You are certainly capable, but don't accept unneccessary liability. I am sorry your boss is such a jerk! It sounds like she needs to look up some references or just take her foot out of her mouth.

Thank You! I've always been concerned in LTC with some of the things they tell the LPN's they can do. It's always "it's a facility decision" or "the state lets you do anything under the supervision of an RN" (even if we have only 1 RN in the bldg and nowhere around), etc. I just sent an email to our state board of health professionals for answers.

[HmarieD]

Check your state's Nurse Practice Act. Facility policy is one thing, but if you are restricted from performing a task in the NPA, you absolutely cannot do it regardless of agency policy. You should be able to find it online.