Hello, I'm actually a new hospice nurse, but am getting alot of patients with implanted portacaths for pain management. I'm unfamiliar with the care of these portacaths and am a little uneasy about changing the huber needles.
They have a little hook on them, and I would appreciate any help you experienced oncology nurses could provide (a visual aid would be most helpful). Thanks for the help!:uhoh21:
Jun 18, '07
I'm not an oncology nurse, but I have worked with the port-a-caths before. The "hook" is called a huber needle. It allows you to access the port without leaving a big hole in it. Accessing the port should be a sterile procedure. When I used these ports, they had to be changed weekly. You have to flush with saline and lock with heparin after use and before d/cing the needle. (The line should have the amount of heparin needed printed on the tubing). When you access the port, you can feel the needle hit the back of the port. Do this gently, as not to poke through anything. then pull back just a little and secure the needle with a dressing. You will need to put gauze under the sides of the needle to give it a "base" that keeps it from wiggling too much. That's all I can remember off the top of my head. Any experts out there?
Jun 18, '07
Ask your manager for the policy on the steps for accessing a port, and monitoring the site (ports can infiltrate too, ya know) and general care of the port. If you are told there is no policy, then ask that one be instituted, for your protection and that of your patients. I've worked with ports for 20+ years, and could tell you how to access and monitor them, but I don't believe that depending on advice given on a message board would be a defense should you make a mistake... no offense, but this is something your agency needs to provide for you if you are expected to do your job properly.
Jun 18, '07
Ti be honest, I cannot imagine anyone accessing, using, or dc'ing a portacath wothout extensive training - not how-to instructions on a message board. This procedure needs not only to be taught by a preceptor well-versed in the use and care of central lines, but repeat demonstrations and competencies should be completed. Your liability is huge on this issue if you have not had training. If I were you, I would try to get some time in an outpt chemo unit - we do at least 30-40 port accesses daily.
Jun 18, '07
i was an iv therapist for a number of years and had a number of patient's with port-a-caths. your facility or pharmacy service should have a policy and procedure on how to change a huber needle. i've been trying to find some good pictures on internet websites for you so you can see what these huber needles look like. i haven't been working as a clinical nurse for a couple of years and i see that safety features have been developed on some of these needles to prevent accidental needle sticks. a huber needle is basically a steel needle with a beveled tip that is bent at a 90 degree angle. that's probably the "hook" you are referring to. there are some huber devices that have steel needle introducers with flexible cannulas; the steel is withdrawn once the plastic cannula is placed in the port. when you take the needle out of a port you need to stabilize the edge of the port with the fingers of your one hand (hold the edges of it down) while pulling the needle out with the other hand. to insert the huber needle you prep the skin like you would for any iv insertion. use your fingers to palpate and locate where the center of the port is without touching the skin you prepped. again, you stabilize the port and the skin with the fingers of one hand. the ports are in a subcutanous pocket so they can (and will) slide around, particularly the skin, if not stabilized when you are ready to perform the puncture. aim the beveled tip of the needle straight down (it's already pointed downward anyway) and push it down as far as it will go until you feel it hit something hard. that hard thing it hits is the back part of the metal reservoir of the implanted port. you'll see that in some of the drawings of the websites i found for you. tape the needle, place your dressing, connect your tubings and you're good to go.
if you know the manufacturer of the needle, call them or one of their sales reps and ask if they have any information they can give you on the insertion of the needle. most of the patients should have been given a patient brochure that came with the port insertion kit. their hospital chart will also contain information about the exact device that was inserted in their surgical record. bard, who makes the port-a-cath, has some educational pamphlets or videos that they may share with you. their customer service number is 1-800-545-0890. i would call and ask.
Jun 18, '07
Thanks to all for your responses. I have had extensive experience in dialysis lifesite ports with locking needle and was wondering why the hook on the huber? It does not seem to be too stable. The pharmaceutical company supplied an inservice today, so that was helpful, as well as all of your suggestions, esp websites to check out. Thanks again - it was very appreciated. If I can help any of you out with dialysis questions, let me know!!!!
Jun 21, '07
Others here have given you great responses. I just want to add that once you have successfully accessed a port, you generally will not forget the "feeling". It is just a certain feeling you get when you come againt that diaphram. You'll know it's in.
Also, I can't empasize enough, that Ports can & do infiltrate. And I have seen some Horrendous extravasations--particularly with adriamycin. Always check for blood returns, PLEASE!!
I guess that's all I wanted to add.
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