Accessing ports.....can you do it?

veegeern, BSN, RN · Mar 13, 2006

I had a phone call from my cousin this morning. She is about to start her third round of chemo for non-Hodgkin's lymphoma and has a port in. She's taking her treatments at Sloan-Kettering in New York. Wednesday night she had to go to the ER because of epistaxis and was there for two days. Because of the severity of the bleeding she went to an S-K satellite hospital closer to her home. In spite of the port the ER nurses insisted on repeating sticking her peripherally for blood and IV's, and someone finally told her that there weren't any nurses there who knew how to access ports. I was shocked. I work in Podunkville and I access them quite often, not just in the ER......I sometimes get called to the floor to access them if the staff nurses don't know how. I don't expect all nurses in a facility to know how to do it, but I was shocked that NO ONE knew how. Am I wrong?

We access them quite frequently. However, we have to have an MD order to used the PC for Meds and Labs. Many times, if the port was placed for chemo, our medical MD will deny an order to use it. I've been told the reason is that some chemo therapies can only be given centrally. If someone damages the port, then that patient can no longer receive their chemo.

neneRN, BSN, RN · Mar 13, 2006

I work in ER and if a pt has a port, we access it. Would only do a peripheral stick for BC or PT/PTT, or if pt was going to have a CT with dye injected. Or, if they come in with a PIV that EMS has already started, we just use that one. Can't imagine the nurses not knowing how, though...is it a tiny ER?

meownsmile, BSN, RN · Mar 13, 2006

No you arent wrong. That nurse should have gotten the doctor in there to help access that port. Heck your cousin could probly have done it herself or at least told them how.

I dont know if i would have let them stick me continually. They would have gotten someone to access.

TazziRN, RN · Mar 13, 2006

No, not a tiny ER at all. She lives in the middle of New York City! MY place is tiny, we only have 6 beds in our ER, and I access them all the time. This is the second ER I've worked in and I've never needed an order to access a port. I can understand needing an order on the floor, but not in an ER.

She told me that when the nurse told her that, she said "I'm calling my cousin to see what she says about that!"

Tweety, BSN, RN · Mar 13, 2006

That is shocking. Surely someone somewhere in that facility could access a port. They probably were just too lazy to try and find someone.

Tell her in the furture to insist they use her port, if the nurse caring for her can't do it, they need to find someone who can.

I hope your cousin is o.k.

TweetiePieRN · Mar 13, 2006

Yep I can! But, then again I work in oncology!! Our ER does not access the ports either. I have a nurse friend who works in an ER in another hospital and they don't access them either. For goodness sakes, we have had the ICU call us in Oncology to come and access a port. I am not sure as to the rationale for this. Wouldn't it be nice if the hospital offered a quick course on it. It's not hard to learn.

caroladybelle, BSN, RN · Mar 13, 2006

No you arent wrong. That nurse should have gotten the doctor in there to help access that port.

Actually I have worked in several hospitals where the ONco nurses got called to the ER and the ICU to access ports. But ocassionally the ER staff is in a hurry, and wants the blood drawn NOW!!!! and will not wait for us to come down.

While it would be nice if the ERs had someone to access ports, I would not push a department with few experienced staff to do so. In GA, the ER for one facility was barred from doing it after two ugly incidents where someone used a regular (not a noncoring/huber) needle to draw blood from a port...basically resulting in thousands of dollars worth of damage, serious infection issues and major unnecessary bleeding/surgery.

Coming in the hospital with pancytopenia is bad enough without sticking a permanent 19 guage hole - access for infection and nonhealing opening to the major blood vessels. Peripheral sticks are preferred to that, unfortunately.

But I have to laugh - an MD access a port - I've worked at a lot of facilities, good and bad - urban and rural - and have yet to have found an MD that would attempt to access one. Most of them have poor enough sterile technique when trying access an ommaya, something that falls in their scope. I have had several (when nurses were unable to access a port that had flipped) that refused to even try. Most of the time, we have to write the flush orders, because they don't know how.

While I am sure that there are some that do, I have yet to come across them.

NephroBSN, BSN, RN · Mar 13, 2006

I had a phone call from my cousin this morning. She is about to start her third round of chemo for non-Hodgkin's lymphoma and has a port in. She's taking her treatments at Sloan-Kettering in New York. Wednesday night she had to go to the ER because of epistaxis and was there for two days. Because of the severity of the bleeding she went to an S-K satellite hospital closer to her home. In spite of the port the ER nurses insisted on repeating sticking her peripherally for blood and IV's, and someone finally told her that there weren't any nurses there who knew how to access ports. I was shocked. I work in Podunkville and I access them quite often, not just in the ER......I sometimes get called to the floor to access them if the staff nurses don't know how. I don't expect all nurses in a facility to know how to do it, but I was shocked that NO ONE knew how. Am I wrong?

One other thing that might be happening here is this. A port is used for chemo and shouldn't be accessed willy nilly. It is a life line

Dialysis patients have a CVC and are told explicitly not to let anyone but a dialysis nurse access their catheter. Same with their fistula or graft.

Heck I did acute hemodialysis in WV and while trying to put in a triple lumen the doc asked for the dialysis nurse, ME, to access the fistula so they would have a least that line for a code.. The nephrologist wouldn't access the fistula but he did watch my other patient on hemodialysis while I ran to the patients room.

Hope she is ok.

TazziRN, RN · Mar 13, 2006

Her port isn't just used for chemo. She's got poor venous access, always has, so this is used for draws also. She tried to tell the staff that.

A question I asked her was, "Did she mean no ER nurse knew how to access it, or NO ONE in the facility?"

Answer: "She told me that no one who was working that day knew how." She took that to mean in the facility. As I said, even if none of the ER nurses knew how, I wouldn't have been surprised. I am only one of two in my ER who know how. But no one in the facility??? And if she's got poor veins, it doesn't do much good for the ER staff to be too impatient to call for help when they have to poke her repeatedly.

She also got a nurse who kept slapping her arm to try to bring up a vein, even though she told them she bruises easy because of the cancer and chemo. The answer was "I know what I'm doing, I've been a nurse for a long time."

stn2003, RN · Mar 13, 2006

I am surprised that there was NO ONE in the facility that knew how : 0

Most of the nurses on my unit do not, but after obtaining an order from the doc to access the port we call our oncology floor and one of the nurses from up there is kind enough to come down and access it for us, as well as refresh our memory on how to flush the darn things. Once it is accessed, we draw off it/ use it for IVF.

Katnip, RN · Mar 13, 2006

Wow. In our ER we accessed ports all the time. Everyone was expected to have competency in it. Onco patients aren't the only folks with them. We had Sickle Cellers and patients who had other chronic conditions that required frequent access.

I can't imagine emergency nurses not required to know this.