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- 1Feb 19, '10 by jamonitSeriously? NO WAY. it's a really, really bad idea. At a hospital in my state a nurse accessed a patient's portacath without blood return and hung chemo (a vesicant, mind you) and the woman had the medication eat through her chest tissue. THe port was no longer positioned correctly and leaked throughout her chest. So, no, dont do it. It's also against any and every infusion nurse guidelines.
- 1Feb 19, '10 by iluvivtGenerally speaking NO.!!!!.. You need to see a blood return to verify that you are in the portal septum. All kinds of untoward complications can occur if not used and assessed properly such as creation of a drug leakage pathway,skin erosion, portal separation.catheter damage or fracture,extravastion or infiltration into chest wall or body cavity..plus more.. So make sure you are in the portal septum and can feel a click of the non-coring needle on the back wall of the portal chamber,flush,aspirate for a blood return. There are all kinds of things you can do to try and obtain a blood return. First find out if you can the port history..has the port always given a blood return?...Has it ever needed Tpa? Does the pt have to put their arm a certain way or lie down to get a blood return? If you have a 22 gauge in the septum..consider re-accessing with a larger gauge. I do this all the time and then I easily get a blood return. ............If I have done my tricks.the next thing I do is look at the most recent CXR and usually order another or get the order..once I can see it on the CXR in the correct location I instill the Tpa if I suspect a thrombotic problem or a fibrin sheath or sleave.....If all of that fails I may ask for a cathetergram....it really depends on the whole picture....There have been a few situations. over the last 27 yrs..after we tried lots of things and did our cathetergram and everthing was peachy..and with MD approval and really good documentation we have used it...and even then I was still able to get at least some pink tinged return
- 0Feb 19, '10 by TolosThank you so much!!!! I do IV infusions on rheumatology patients. 2 to 3 of them have port-a-cath. For 21/2yrs since I took up this job, one of these Patient's port brings back only pink tinged blood and I've been able to draw blood only 2 to 3 times. I sent her to the hematology/oncology nurses who use ports daily they have same experience. They alteplased X2, no result, sent her to the surgeon who inserted it. He did a cathergram, sent a record saying everything is fine with it, no fibrin sheath, it is well placed. Pt came back told me the surgeon did not get blood return and he said that the nurse should feel the click and use it as it is without blood return or blood drawing. I refused and sent her to the chemo nurses. They accepted and said they will do her infusions as it is. Scary!!! Thank you for the confirmation that I have made the right decision.
- 0Feb 20, '10 by iluvivtYou did everything right!!!!...odds are it was placed from the left side Was it? and may have been butted up against the wall of the SVC THE brachiocephalic vein on that side is longer and takes a really sharp turn into the SVC.Left side ports tend to be more temperamental b/c of this. You did Tpa at least twice and I hope you put in enough volume....The cathflo gets mixed with 2.2 mg sterile water and you can leave it in for 2 hrs and on ports I do. After all that was done...I would feel safe using it,and documenting those events as well as the current assessment and include there are no s/sx of any port related complications observed. Yes as said we have had to do this on a few occasions