accessing a port for just one blood draw

[Ted D]

Would this be worth it? I know that's what the ports are for, but just seemslike unnecessary heparinizing and increased chance of infection over a peripheral stick?

[sistrmoon, BSN, RN]

I've worked inpatient oncology for 7 years. I have literally never had this situation. But we are told that every access and every dressing change is a serious infection risk for that patient. I'm pretty sure we would be discouraged from doing this. We always access and leave access in. Except I have one patient right now who hates having his port accessed or drawn from and wants a peripheral draw and IV every time. Last night he again "deaccessed" himself. The only time he allows accessing is for chemo and wants to immediately be deaccessed again.

As for heparin, we use only saline flushes while accessed then heparin lock when deaccessing.

[OCNRN63, RN]

Man, I have several teens that still moan and cry and demand emla for their ports. LoL! Of course they do the same for peripherals as well. 

I almost always put EMLA on my port before I get labs/get it flushed. One stick from someone who is not a good sticker, and you learn really fast to get that site numbed up.

[RadRN1]

Does anyone have any evidence/research that suggests we should not access a PORT for a one time lab draw due to CLABSI risk? I see a lot of people mentioning infection risk, but can't find anything in my search to subsantiate not using a PORT, even if just accessing for single use.

[Asystole RN]

Does anyone have any evidence/research that suggests we should not access a PORT for a one time lab draw due to CLABSI risk? I see a lot of people mentioning infection risk, but can't find anything in my search to subsantiate not using a PORT, even if just accessing for single use.

Frequent lab draws are a rationale for placing a port and I have had many patients with ports just for that reason.

There is no compelling evidence that I am aware of, nor standard of practice, that suggests drawing from ports for a lab would be inappropriate.

My only concern would center around the clinician, as long as the clinician was educated and experienced in the proper procedures and policies regarding port access and blood draws I can see no reason why not.

[Asystole RN]

Man, I have several teens that still moan and cry and demand emla for their ports. LoL! Of course they do the same for peripherals as well. 

Not as funny when you are on the other side.

Being a child shouldn't hurt and I do not think it is unreasonable for us to strive to make every procedure as painless as possible as long as we have the tools available.

Your convenience

[Double-Helix, BSN, RN]

Does anyone have any evidence/research that suggests we should not access a PORT for a one time lab draw due to CLABSI risk? I see a lot of people mentioning infection risk, but can't find anything in my search to subsantiate not using a PORT, even if just accessing for single use.

We know that having a central line increases the patient's chances of getting an infection. Every time the port is accessed with a needle, every time the line is accessed with a syringe, there's a chance of introducing bacteria. The same is true with an IV placement, but the difference is that one is a CENTRAL line and the other peripheral. You won't find research about the infection rates from one access, because you would have to be able to PROVE that the infection came from that particular access, which is nearly impossible to do.

Infection is a factor, so if the patient doesn't have a preference, I would chose a peripheral blood draw for that reason. But since it is likely a small risk if proper technique is used, the patient's preference is really the most important factor. Some patients prefer to have a peripheral stick. Others prefer the port. This is true in children and adults. If the patient wants the blood draw to come from the port, that's what should be done. If the patient prefers a peripheral draw or has no preference, there' nothing wrong with making that choice.

[NurseStorm, BSN, RN]

I agree with Double-Helix, BSN, re: risk for infection of a central line.

If it were a child who was a chemo patient with terrible veins and needed blood work, of course I would access the port. If it was a very young child and just the one test and a finger poke would work, many parents may prefer the quick finger poke to trying to hold a young child for a sterile port access procedure.

If it were an adult, who is currently doing well, not requiring blood work frequently, has good veins and any other health conditions are not currently affecting peripheral access, and does not have a preference I would get the lab to draw peripherally.

Adult chemo pt with frequent blood work/infusions or /adult pt with very poor peripheral access and a port: I would access the port.

Basically, depending on the specific scenario I would use my judgement along with the patient's preference to decide what is appropriate for the situation. I don't think it should always be a port access no matter what for any situation if they have a port necessarily. What if they have had the port for 8 years but have been healthy since, do not have frequent blood work, have great peripheral veins, and do not mind a peripheral access? I think that would be appropriate.

And I don't think it's callous to question the time it takes to access a port and the importance and attentiveness one must pay to sterile technique and the risk if that is not followed. Previous poster is right, unfortunately we do have to prioritize at times, and the 5-10 minutes accessing the port for 1 blood draw, vs the 0 minutes while the lab draws peripherally may make a pretty big difference..

I understand if it someone undergoing chemo/someone with horrendous veins and has a port, etc that one should be accessing the port but I don't think this is a situation you can just proclaim "you should use the port no matter what, anytime"

(Also just for interest sake, in my hospital general floor nurses are not port certified. Many of the pediatric staff on my unit (including myself :) ) are port certified and the ambulatory care nurses/oncology nurses are, but nurses that work medical, surgical, ER, etc. are not.)