portacath access

[amyk_ncsu]

Does anyone know if students can access implanted port catheters? I realize that policies may vary between facilities, but my patient tomorrow has one, and I am unsure of whether or not I will be allowed to access the device.

Thanks!

[queenjean]

Is your patient in a hospital? If so, typically those are accessed once upon admission, and the access remains throughout the hospitalization. So it will look like any other IV access. You wouldn't actually be reaccessing it every time you needed to give an IV med.

So, if as a student you can do stuff with central lines, you should be able to give meds through the portacath access.

If you are working in an outpatient setting, the client may not have his/her portacath accessed. In our facility, only nurses who have specialized training can do this (IV therapy, ICU, and ER nurses). I suspect the "specialized training" involves a 45 minute inservice; it's not rocket science. Just ask your nurse tomorrow what your facility policy is on the unaccessed portacaths, if that is the situation.

[amyk_ncsu]

Thanks! Its a 10 month old kid, and he doesn't have any continuous fluids running, and no PIV, but several antibiotics are ordered, so you can see why I was trying to figure this out. Could he have a type of PRN adapter attached that allows frequent intermittent access so we dont have to stick him 4+ times a day?

[queenjean]

I would imagine it would be accessed. I can't believe you would have to run abx and not have it continually accessed.

When I have had pts who had a portacath but no continuous fluids, their site has always remained accessed; it's just locked (I can't remember if it is saline or hep--I haven't had one in a long time). At our facility anyhow, the lock looks like a locked peripheral IV on the chest. So you would still be able to run intermittent abx, pushes, etc without having to actually access the port. Also, you should be able to draw blood from the accessed, locked port, saving him sticks.

Does this make sense?

[amyk_ncsu]

Completely, thank you! In reasearching how to do this, I found a lot of info on how to access it, but nothing really about it being able to have a prn adaptor. I didn't know that an adaptor was possible, I mistakenly thought you had to access it with the hueber needle every time you wanted to use it.

I also emailed my instructor, and she believes that it is adapted as well, so I should be good to go. I think they are hep locked with 5mL of 100u strength heparin since it is a central line. Thats what I'm preparing for at least.

Thank you soooo much for your help! :)

[Daytonite, BSN, RN]

no one should be accessing the port-a-cath of a little kid unless they have been checked off on the procedure of how to do it. these kids usually have the skin over the port prepped with some kind of topical anesthetic before being stuck. the needle sticks to these ports hurt like the dickens.

if the child is getting antibiotics the port is probably already accessed and has an extension line attached to it that is heparinized. in effect, the port is accessed and heparin locked. the huber needle is then changed by someone weekly per hospital protocol.

when i worked on an iv team no one--no one--changed the needles on these ports or inserted new huber needles into them except people on the iv team who had been trained in how to do it. it is a strictly sterile procedure and very different from a peripheral iv stick.

[AuntieRN]

Wow at our hospital the admitting nurse does the accessing once the doctor has written an order stating we can access the port, we do not have an IV team though. If there are not continuous fluids running our policy is 3ml of heparin flushed bid.

Now I dont know what the policy is on children as I don't work peds.

[APBT mom, LPN, RN]

Just make sure that it is something that you're allowed to do in the program. Had a student a couple of years back that accessed one and was kicked out of the program.

[amyk_ncsu]

Don't worry, I'm not going to be unsafe. I am currently under the impression that it is already accessed and prn adapted, so my questions are answered. I was just confused on the term "accessed." I didn't realize that it was something that could be adapted, as I had never worked with one. We learned all about the different kinds of central lines, but noone really told us that there are such things as prn adapters for implanted ports.

Thanks for all your help guys!