Mediport access prob. HELP

[jlynn3324]

I am new to the site. Hello! I am a home health nurse of two years and am currently taking care of a chemo patient. She is getting continuous TPN through her mediport. We change the huber needle weekly and draw lab's at that time. I have accessed approx. 20 mediports and have been the only one to access this patients mediport since she started TPN around June 1st. Yesterday I replaced her huber needle, as usual, using a 22G 3/4 huber in the exact same place it was accessed previously. I also obtained lab as follows: I flushed port with 10 cc NS, then aspirated 10cc of waste blood and threw away and then aspirated another 10cc for my lab. I then flushed with another 10cc followed by heparin. I then hooked this patient back up to TPN and when I left all was fine. I get the lab back from the hospital and her WBC was 1.4 and platelet is 6. I call MD who has patient come to hosptial for platelets the next day (on regurally scheduled chemo day). I get a call from the family today saying the MD drew lab again today and the above levels were normal. MD stated that I had put the huber needle in the subclavian cavity and drew the labs from there and that was why the labs were not normal. I do not understand this because, I KNOW I accessed in the same place as previous accessed and the port flused easily with good blood return. How could I have got approx 20cc of blood if I went into the subclavian cavity? I have accessed this port many times with no problems. I am really afraid to access this port again and really upset. Please help!

[ga girl]

i know you said you aspirated and threw out the first 10cc- you are for sure right? if you are, i wonder if there was just a lab error with your bloodwork done at the hospital??? curious as to what anyone else thinks... i can understand your frustration :)

[me5115]

When I first started at my job, I was sure I drew a waste tube on a pt. A similiar thing happened and all of her blood counts came back low. We were getting ready to blood band her and I thought Im going to redraw jic. Well the second tube came back wnl.

What I think I did was when I was pulling back my saline flush, I wasted only enough to make my flush red, so I thought it was a full waste. The patient, family, and I were all talking and I was distracted.

It sounds to me like you didnt get the full waste. I dont understand what the doctor said, it doesnt really make sense.

Dont be afraid of ports. Its sounds like your placement was fine.

I swore I drew my full waste too....remember to to look at the pt. My pt didnt look like her counts were that low.

good luck.

[iluvivt, BSN, RN]

It sounds like you submitted the waste for lab analysis. Always make a habit of putting the discard syringe in a special location or if in the home setting ,just immediately put it into your sharps container. It does not sound like you made an inadequate discard. When discarding you want to discard about 2-3x the priming volume of the line,so 10ml on a port is enough since ports have a priming volume of 2.5 ml. I do not believe the MD understood the problem here. Even if you accessed the subclavian vein (which I doubt with a 3/4 inch needle) you would have obtained venous blood which would have been acceptable. Do not be worried about further access of this port....view your discard and make sure it is dark venous blood...keep discarding until it looks dark for a couple of mls.......put discard in the sharps container.....draw speciman....and transfer to tubes. Also remember to draw in a nice steady fashion so as not to destroy the cells and have the intracellular contents spill out