Order for Port-a-Cath lab draws?

[jdsp87]

Do you need a doctor's order in order to draw blood for labs from a patient's port-a-cath? None of the nurse's on my shift, including the charge RN, could give a me a definite answer.

On one hand, it would make sense since the port-a-cath is a central line and, like a PICC line, it would require the expertise of a doctor to determine if it is OK to draw labs from.

But then again, another nurse pointed out that the purpose of the port-a-cath is to make it easier for the patient: why would you stick the patient when access is right in front of you.

I really want to hear all your opinions! =)

[FlyingScot, RN]

All I need is an order for the labs. If a patient has a VAD I am free to use it with the exception of a dialysis catheter that does not have the middle port. I imagine it varies from facility to facility. Check your P&P book.

[applewhitern, BSN, RN]

My son had a "port-a-cath" for chemotherapy. He would not allow anyone to use it, expect during his chemo sessions. When he would go into the clinic for his chemo, the lab techs/nurses there would always draw his blood from his arm. They were always warning him about the risk of infection. He ultimately did have 2 that got infected, so he had a total of 3 in all. (He passed away.) They are very expensive to have placed, and insurance doesn't cover every penny of it. I guess it really depends on "why" they have a port to begin with~ For routine blood draws, I try to avoid the ports; for fluids, etc., I will use the port. I use the port for blood draws if it has already been "accessed" for fluids, but I don't access it simply to draw blood, as eventually the skin breaks down over it, from multiple sticks.

[FlyingScot, RN]

I use the port for blood draws if it has already been "accessed" for fluids, but I don't access it simply to draw blood, as eventually the skin breaks down over it, from multiple sticks.

I'm sorry for the loss of your son Applewhite and the difficulties he had to endure. I need to respectfully disagree with the idea of the skin breaking down. I have several patients who have had their ports for >10 years and get labs drawn every 2-3 weeks. The skin over their ports is completely intact with no sign of breakdown whatsoever. That's not to say that it doesn't happen but it's really quite uncommon without some underlying condition. One of the things we assess for before having a port placed is the quality and condition of the skin. Many of our elderly patients have that "paper" skin that tears easily. They are not good candidates for ports and usually have a PICC or Groshong placed. The dressings can be an issue but we don't run the risk of the port site opening up. We also, most commonly, place dual ports which allows for rotation of sites which we keep careful record of. As for infection, absolute adherence to best practice and scrupulous skin disinfection really reduces the risk.

[applewhitern, BSN, RN]

Yes, FlyingScot, I think the fact that he was on chemo had a lot to do with the risk of infection, skin breakdown, etc. Plus, he was aware that every nurse did not follow strict infection control, he learned to monitor that himself!

[FlyingScot, RN]

I would have killed the first nurse that didn't follow best practice!!!!! I totally drill into my patient's heads the proper way to do things and they are like pitbull's with the info. They've stopped other nurses mid-procedure when they know the site isn't being prepped properly and told them "if you don't scrub for 30 seconds you aren't touching my port". The same goes for hubs on PICC lines. I tell them that they are the first line of defense in fighting infection and they take it very seriously. It's resulted in write-ups of some staff and much better adherence to policy and a very low rate of infection as well.

[Asystole RN]

Although implanted ports are an available alternative means of vascular access you should have a physicians order to perform an initial access. The physician may have had particular plans for the use or may not agree that accessing the port is worth the risk at that given time for the particular treatment.

Generally though, patients in the acute care setting can usually have their access ports accessed freely, the issue usually comes up with intermittent blood draws.

[jennilynn]

In my facility, Vascular Access RNs or RNs that are authorized by our educator access it, then we can use it.

[iluvivt, BSN, RN]

Yes it is acceptable practice to draw blood for sampling from a venous access port. We get an order to use the port and initiate the port protocol and make sure the flushes and final flush is ordered. The trend in venous care is VENOUS PRESERVATION so when you can use any CVC for a blood draw you should. There are some circumstances when this may not be optimal though such as when using the line anticoagulants and drawing clot studies, certain drug levels and when the medication being administered should not be interrupted. Of course the port should be taken care of in a scrupulous manner and I do instruct my port patients that they should not allow anyone to access it without the proper scrub to the site and that is done in a sterile fashion and that NCs are scrubbed for at least 15 seconds, Also after drawing blood make sure you perform a really good flush and do not leave any blood stuck in the y site of the non-coring needle tubing. A port is a long term line and it is not an easy in and easy out as other CVCs such as PICC and percutaneous placed CVCs, though every CVC should be treated with the same high quality nursing care and maintenance. I do not agree that MDs are always in a position to decide how blood should be drawn. The often do not know how challenging it can be to obain blood for sampling and it is the responsibility of the RN to communicate any issues. Ports and PICCs have traditionally had the lowest infection rates of all types of CVCs.

[classicdame, MSN, EdD]

every place I have worked left the access up to the phlebotomist. If I was acting as the phlembotomist then I would go for the central line.

[FlyingScot, RN]

every place I have worked left the access up to the phlebotomist. If I was acting as the phlembotomist then I would go for the central line.

Where do phlebotomists access Medi-Ports? I've never know a phlebo who was allowed to touch one.

[tokmom, BSN, RN]

We have to be certified to access and need an MD order to use. Some pt's flat out refuse because they don't trust their port won't be messed up with frequent draws. Others want it accessed right away.