Recently we have been discussing in our office what to do about implamtable port that have no blood return and the administration of chemo. The port has been checked over (ie dye studies, TPA'd...) and are proper position and placement. Do you give chemo through it??? We have a patient that has never had a blood return on several of her ports. Hasn't been a problem until recently we restarted her Navelbine (she has been receiving Herceptin for several years through this port, she has metastatic disease). What are the recommendations from other areas??
Thanks deb, RN
Jan 23, '03
If you have sludge in the port, impeding blood return, you already have major infection risk. Similar problem with fibrin. Have you ever seen ports when they have been removed. There is an unreal amount of crap in there.
I know it annoys the heck out MDs/Surgeons but the ONS regulations are based on testing and evidence for prevention of injury/infection. Ports/Groshongs/PICCs/Broviacs/etc. need to be changed if there is evidence of impairment. And lack of blood return/ that cannot be easily fixed is evidence of impairment.
Also, frequently, there are surgeons, whose ports "never' have blood return. If there is no return - s/he has not done a very good job. If they finally are forced to do it right (and after enough redos, and MDs that get tired of their pts needing to have ports redone, and stop sending the pts to these surgeons, they will have to improve their technique - It is sad that we have to force this issue. but that is the only way to do the best for our patients.
Also the rad reports should have the exact placement of the line (such as tip in the superior vena cava, etc.) If the stated placement is not proper for that specific VAD, it should not be used. The line "The tip is in the bloodstream" or "Placement confirmed" is not acceptable. The tip MUST be at the specific place for that type of VAD or it should not be used.
There are other VADs than ports, also. If ports are a specific problem, then maybe MDs should order different VAD. Also, make sure the VADs are being heparinized.
Yes, MDs get ticked when we refuse to put chemo thru a port without a return. But if it is policy, and management backs Nursing (and if they don't, well there are better jobs out there), they will learn to do the right thing. It is sad that we have to train MDs to do the right thing but we owe it to our pts and their health.
Last edit by caroladybelle on Jan 24, '03