Port-a-cath question - page 2
by Curious1alwys 15,615 Views | 20 Comments
I guess I have really only seen port-a-cath's placed on the chest, not accessed. I was precepting another nurse the other day and we had a patient that had a port-a-cath already accessed with a huber needle in place (I have never... Read More
- 0May 23, '12 by ~*Stargazer*~I'm sorry, but the more I read your questions, the more concerned I am about nurses at your facility doing anything with central lines! I don't mean to sound itchy with a "b", but I'm concerned about patient safety in a facility that has nurses expected to perform procedures that they have little to no training in, with no policies and procedures in place.Last edit by ~*Stargazer*~ on May 23, '12
- 0May 24, '12 by ~*Stargazer*~I came back to this thread because I really don't want to sound discouraging to the OP. It's good that you're asking questions and want to do the right thing.
Institutional policies are usually based on practice standards, such as those by the INS (Infusion Nurses Society). The INS publishes their standards of practice. The INS standards of practice publication is available for purchase on the INS website.
- 0May 24, '12 by Curious1alwysThank you Ashley. Everything you said makes sense.
I just started, first day, and I work for an agency not the group home. I will ask next time about official policies and procedures. She showed me books and books but I didn't find anything specific. (Now I know why all new grads want to first work for big hospitals-you can go into the computer and find everything you need!)
It's a group home so not sure they do anything with sterile gloves. We did mask however. So I think I have the first part down....flush 10-20 cc, pull sample, flush 5 cc hep, flush 10 cc NS, all push pause. As far as hub caps, this line is being accessed every AM for a blood draw, sometimes more frequent within 24 hrs. The line is definitely being opened as we are pulling off the hub and putting a new one on. Even the hub was equipment I hadn't seen and we had a very tough time getting the hub off for some reason. So I need to investigate equipment, look for P&P. I'll look through my nursing textbooks for written material as well.
As far as concern for where I work, I can't make that call yet. I understand your concern, however. I've only been there one day and I need to see more of what is going on, ask more questions. Of course, I'll re-evaluate. As a new grad, I am happy to even have a job, especially one that works with my schedule!
Thank you all for your help!
- 0May 24, '12 by ShantheRNI'm still confused about why the cap (assuming you mean cap in that last post instead of hub?) needs to be changed every time you access the line. Definitely check your P&P asap!
Oh and.....for lab draws it should be flush/check blood return, waste, draw sample, flush, and hep flush. If there aren't any fluids going, the last thing you want going into the line is heparin
- 2May 24, '12 by ~*Stargazer*~Quote from Curious1alwysOkay, your flushing procedure is incorrect.It's a group home so not sure they do anything with sterile gloves. We did mask however. So I think I have the first part down....flush 10-20 cc, pull sample, flush 5 cc hep, flush 10 cc NS, all push pause. As far as hub caps, this line is being accessed every AM for a blood draw, sometimes more frequent within 24 hrs. The line is definitely being opened as we are pulling off the hub and putting a new one on. Even the hub was equipment I hadn't seen and we had a very tough time getting the hub off for some reason.
Confirm blood return.
Flush with 10cc NS.
Flush with 20cc NS.
Flush with heparinized NS, 5cc or per policy.
The rationale for wasting between your flush and your draw is that when you flush, there will still be NS in the catheter and the dwell (part of the port), and this will dilute your sample, altering the results.
You flush with 20cc NS after blood draws to remove blood components from the inside of the lumen that want to build up and cause occlusion and/or provide a hospitable environment for bacterial colonization. Flushing with the heparin last means that the heparin will be inside the dwell and the lumen of the line. If you do your heparin, then your NS, then you're just flushing out the heparin with NS, which makes it completely pointless to use heparin.
Also, just a terminology issue: The "hub" refers to the end of the line, which you attach the injection caps to. You should not be changing the hub.
You can draw blood through the caps, but if you do so, the caps should be changed. The rationale is that blood components can remain inside the cap, providing a hospitable environment for bacterial colonization.
- 0May 25, '12 by Curious1alwysOk, thank you so I think I get it now.
Sorry for the incorrect usage of the terminology. I meant caps as far as what is changed, not hubs. I realize now the caps are being changed with every blood draw because there are no fluids running.
Thank you for the info on the flushing, this is what I will do. Blood can be drawn from the caps. So the whole procedure can be "clean" but what about the last step when you go to change the cap out? Is it OK to be clean then too or should you be sterile with a mask and sterile gloves?
Also, in between all the flushing and sampling, are you swabbing the port with alcohol?
- 0May 25, '12 by ShantheRNThese are the parts that will vary by facility. At my hospital, cap changes are always sterile technique. It seems clean technique is used at the adult hospitals around here. You don't need to swab the cap between syringe changes as long as everything stays sterile, as in.....the tips of your syringes don't touch anything but the previously cleaned cap, and your cap doesn't come into contact with anything else.
And no need to apologize about the terminology stuff. I'd just gotten home from work and my brain was too tired to figure it out lol I just wanted to make sure I understood. Hope this helps!
- 2May 26, '12 by sauconyrunnerJumping in here just to encourage you to actually find the policy for your company, rather than simply relying on all the very good advice you got here.
The reason I encourage you to do this is because if something does happen- a patient gets a bad blood stream infection, after you access the port, and you are asked to say how you accessed the port etc. You will not want to say, "I found the procedure from a post on AllNurses on line." You see how that would sound? Plus you need to follow your agencies policy and procedure so that you are covered by the Agencies Malpractice insurance.