Accessing central lines/IV starts

Specialties Home Health

Published

Specializes in NICU, Pediatrics, Home Health.

Hello, I recently starting PRN for a home health agency. I have been a nurse for 1.5 years, and all of that time has been NICU. The HH agency I am working for is very small and is just really getting started-I think we have about 5 or 6 RN's now. Anyway, a few days ago I was asked if I was willing to take a one-time patient just to give her 1 dose of meds. I said yes. Now I have found out that I am giving an IV push med, which means I either have to start an IV, or access a central port. Here's the thing, I don't even know if she has a port, because I have no access to her medical information. I've requested it but have not heard back from SPNN.

The issue is that 1) I haven't started an IV on anyone over 8 lbs in 2 years and 2) I have NEVER even accessed a port. I don't even know how to push a med through a port. I know they will supply everything I need, but I don't actually know how to use it. I already went through the online webinar to learn how to administer the medication, and I have done all the paperwork and taken the exam, but the IV/port part is what I'm unsure about. What do you guys think I should do?

Thanks!

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Specializes in Intensive care, ER.

Use sterile technique. I would look to see if YouTube has videos on accessing a port, there seems to be so much there. Feel the edges and feel for the central hub, find a visual landmark to aim for. I always flush with 10 before and 10 after. As far as starting a peripheral, the ACs are the easiest to find. Maybe you can get with your nicu educator and they can help you find resources to physically practice on a dummy? Good luck!

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Specializes in NICU, Pediatrics, Home Health.

Thanks so much for the reply. I have been finding some great videos...gotta love youtube!

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Specializes in Complex pedi to LTC/SA & now a manager.

If you are not trained do not access a port!!!! Don't use you tube ask the agency for inservice training. You can cause more harm than good. KelRN is a frequent poster that is a home health oncology nurse.

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Specializes in Pedi.

Accessing a port is something that you have no business doing on your own in the home if you have never done it before. From your OP, it sounds like you don't even know what kind of access this patient has. Is the patient an adult or a child? If the patient has a central line (like a Broviac or a Hickman) that's one thing. Surely you have seen those in the NICU. You should not accept the visit if the patient has a port-a-cath, you do not have the necessary skills to do the visit.

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Specializes in Pedi.

Also, I have to ask, what kind of manager would allow you to go to a visit for a skill you're not trained to do? Well, I actually know the answer to that question (someone who cares only about covering the visit and not getting the patient an appropriate nurse). I do not allow anyone to do port-a-cath visits unless I've assessed their skills.

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Do not access a port a cath without inservice. Some states do not allow IV starts in the home, you need to check your Scope of Practice. If you know what the med is you might be able to "guess" at what kind of line it is. If your agency does not get you an answer pronto, call infusion company or MD to get the answer.

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Specializes in Neuro ICU and Med Surg.
Accessing a port is something that you have no business doing on your own in the home if you have never done it before. From your OP, it sounds like you don't even know what kind of access this patient has. Is the patient an adult or a child? If the patient has a central line (like a Broviac or a Hickman) that's one thing. Surely you have seen those in the NICU. You should not accept the visit if the patient has a port-a-cath, you do not have the necessary skills to do the visit.

I cannot agree more.

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Specializes in Vascular Access.

As JustBeachy stated, DO NOT access an implanted port, if you do not have the education AND competency to perform this task appropriately. Never use Youtube as your education module. As others have stated, first know if it is within your scope of knowledge to perform this task. Then, if it is, go to your ED staff development person and ask for education and then have someone assess your competency in performing this procedure. One should NEVER put the patient at risk by trying to "WING" it. Also, "Port-a-cath" is a name brand of one type of implanted port. One must be aware of the type of port that they are accessing. Not all ports terminate in the venous system either. Some terminate in the hepatic artery, some in the Peritoneum. You need to know whether or not you have a venous access port.

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When I was asked to do an IV case that I felt was beyond my ability because of lack of experience, I refused the case. The agency gave me flak, but I stood my ground. What worries me about what you said in your post, is that they are not providing you with the specific information you need before making the visit. No agency should ever refuse to provide a copy of the 485, or refuse to answer any questions if they expect you to go into a home and provide safe care.

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Specializes in ICU/CCU, Home Health, Case Management.

I agree-always ask for an in person in-service from a trained nurse, NOT YOUTUBE!! Go over it several times, ask questions. I am an RN and have been to IV in-services from pharmacies and IV companies like Coram, including hands on in services in acute care. Then, do co-visits with a trained nurse, and when you are comfortable, only then accept a case you have been properly trained in. You always should have access and a copy of the Plan of Care (485). The first time or even a few times-you are within your rights to ask for an experienced nurse to go with you for co visit. It's the pt's life and your license!!

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