Why are some portacaths have no blood returns but flushing well? Is it safe to use?

Our policy is that a portacath that doesn't have blood return needs a flow study done on it before it can be used for chemo.

First,always get a brief history of the port. How long has it been in place. When was it last accessed? Have there been any problems with it? Has it always had a blood return?


After you have accessed it and it flushes easily and YOU CAN NOT get a blood return...........perform all those remedial actions you were talking about...some are re=accessing with a larger gauge needle.....re-positioning the patient arm out...having patient turn head and cough...etc. After all that and you can not get a blood return and there are no other s/sx of any port-related complications you most likely have a PWO (persistent withdrawal occlusion) This is simply where you are able to instill,but not withdraw and is caused by a fibrin build up as in a fibrin tail or sleeve. In this case,I would administer Tpa. This will usually restore the blood return. Also view the most recent CXR or call the radiologist or an IV nurse to view it (some are certified to do so). Out team recently caught a problem with a left chest placement port that was butted up against the upper SVC with a PWO,that had to be removed.


If the TPA does not fix the problem the patient will need a dye study to r/o or treat a problem or recommend removal



So the answer is NO NO NO ,do not use it until you get a blood return. Do not forget to document that as well. If you administer anything,through that and it is not in the vein.....you and you alone will be held responsible. So practice safely. If you have to administer something that can not wait,while you are troubleshooting the problem...you can always start a PIV.

I just graduated nursing school, so bear with me if this is off the wall---but I was just thinking that another consideration might be that it has been misplaced within the body, in which case you wouldn't want to use it.

Yes of course it can and thus the importance of viewing the most recent CXR and getting the dye study I was talking about. There was a sad case several years ago where Adriamycin plus some other medications were being given through a port without a documented blood return. Did it have one or not......it was never documented. As it turns out the tip was in the pleural space ....finally after one week the IV nurse on a routine needle change noticed some unusual chest tube drainage (not the usual blood color,though red). It was the Adriamycin......ultimately the patient did die b/c of this. So there is the answer as I have stated above ,,,do not use it without a blood return.

We obtain a dye study and as long as all is well with it then we get an order to use the port.