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

[TazziRN]

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?

[CoffeeRTC, BSN, RN]

Yikes! In my rinky dink LTC facility we access ports when needed. Most of the time when pts have a port they have been thru so much medical procedures and turn into experts of their illness....I listen to those (and of course all my other) pts. If we can do this in my LTC facility.....they absolutley should be able to.

[Noryn]

In our ER we did access ports and we were a smaller hospital with no oncology floor. I dont think it is necessarily a bad thing they didnt access it though. Usually accessing a port is much easier so there was some reason they didnt want to access it. I doubt it was laziness (although it could be). If they didnt feel comfortable accessing it, then I would rather them not try. Too many times I have seen nurses to ashamed to say they did not know how to do something and instead did it anyway and DID IT WRONG. I have even knew a nurse to try and access a pacemaker they thought was a port.

They really should bring someone in though to teach them how to access ports.

I have another question--it has been so long since I have been in acute care or emergency nursing but how well can you give blood through a port that has been accessed by a Huber needle? I dont think I have ever seen 18 gauge Hubers although from what I understand if you give it slow enough you can give blood through a smaller gauge.

If we were in a situation where she was going to need blood or fluids fast I may consider trying to put a larger bore IV in. Again though I need help it has been too long since I have seen Huber needles--I thought the ones we used were 21 gauge.

[Undecided7]

We have to have an MD order- ER or not. Of course, the ER doctor can give the order but some won't- they would rather wait until the pt. was up on the floor with a primary doctor. Also, some tests cannot be done through a port and some meds are not compatable and must be given in separate IV's. The nurses may not work with them a lot and be uncomfortable risking the port. Sometimes it's just easier to say you don't know something or you can't do it rather than deal with an anxious and persistant patient or family member at the time. In an ER- there usually isn't time to debate the issue and ultimately it's up to the doctor (unless you have standard orders which also count). I think had the patient been admitted to the hospital, the port situation would have been addressed then.

[tridil2000, MSN, RN]

i've accessed ports for years in the er and just recently a memo came around that we aren't allowed to touch them now bc they are to soley be used for chemo.

the thing is pts are TOLD they can get their bloodwork etc done using it once they consent to this, so they present with the notion that the port will be used for labs etc. most of these pts have poor veins anyway.

for me, i'll start now with doing 1 stick, and if i can not get it, i'm using the port. otherwise, imo, the pt was falsely mislead about the port's use when consenting to it.

[ReinventingMyselfAgain, MSN, RN]

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."

Allright, i need to know which hospital this was. You can PM me if you don't want to divulge which one (or the town will do). If this is a MSK satallite facility, there better be someone in that facility that can do it. A nurse, resident, educator, manager, anyone (well anyone trained). In peds onc, we are called all over the hosp (including the peds ED- depending on who's working) to access ports. The ED could have called the supervisor, and he/she should have called the units to find someone.

[beautifulb]

I thought that the reason for ports was to provide easy access for medications and needless needle sticks. I would be quite upset if I had a port and I was being stuck numerous amounts of times because "noone" knew how to access.

[ReinventingMyselfAgain, MSN, RN]

Sometimes (not all the time, and not all docs are interested), they want peripheral cultures to rule out a line infection vs. a systemic sepsis. But, it takes a lot of convincing for a pt to agree to this. After all, the port is supposed to be used to avoid multiple punctures.

[spectral_ev]

i was recently working in a nursing home where some nurses knew how to access a port and some didn't. it's not that anyone could not follow the procedure step by step, it's that sometimes the nurse would get the huber needle in with a good blood return on one try, painlessly, sometimes it took two tries and hurt, sometimes the nurse would try twice, not get a blood return, and wait until a more experienced nurse was available. we had the option to wait since these were not emergency sticks. if you only do it every few months you don't have a touch. myself i tried twice without success, don't know why i couldn't get a blood return since i'm sure i was in the port. another nurse was able to get it in. i would be very interested in any techniques that would make it easier for patient and nurse.

one think not everyone does is to put lidocaine cream on the site first, i think they should do that whenever possible.

[Blee O'Myacin, BSN, RN]

All of our patients are allowed to receive blood products and have labs drawn off their accessed port. I've gone down to the ER to access ports before - most of the time they can do it, but it was busy, the nurse who called was a pool nurse that came to help us out on more than one occasion, so it was no trouble to go down and pop that needle in.

As a nurse, I love it because I don't have to torture my patients with frequent sticks. They are bone marrow transplant patients, so by the time we get them, you are lucky to get that peripheral blood culture from the poor, tired, over abused antecubital, let alone anything larger than a 22G!

As a patient, I refused unnecessary sticks and talked seasoned nurses, a few nursing students and a eager med student through accessing my port. I never had a problem with people flat out refusing to use the port - even if there was some initial hesitation to do something out of the range of comfort.

Blee

[veegeern, BSN, RN]

In our ER we did access ports and we were a smaller hospital with no oncology floor. I dont think it is necessarily a bad thing they didnt access it though. Usually accessing a port is much easier so there was some reason they didnt want to access it. I doubt it was laziness (although it could be). If they didnt feel comfortable accessing it, then I would rather them not try. Too many times I have seen nurses to ashamed to say they did not know how to do something and instead did it anyway and DID IT WRONG. I have even knew a nurse to try and access a pacemaker they thought was a port.

They really should bring someone in though to teach them how to access ports.

I have another question--it has been so long since I have been in acute care or emergency nursing but how well can you give blood through a port that has been accessed by a Huber needle? I dont think I have ever seen 18 gauge Hubers although from what I understand if you give it slow enough you can give blood through a smaller gauge.

If we were in a situation where she was going to need blood or fluids fast I may consider trying to put a larger bore IV in. Again though I need help it has been too long since I have seen Huber needles--I thought the ones we used were 21 gauge.

Our Hubers are all 20 gauge. We give outpatient blood transfusions through them all the time for cancer patients and others with chronic conditions. Our protocol is to administer blood over 2-3 hours, and it works fine on a pump.

[NephroBSN, BSN, RN]

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."

Sorry I wasn't as clear as I meant to be.

What I meant is most nurses "think" a port is for chemo only and won't access it.

Sorry for the confusion.

I agree someone should be available to access it ..What about the house supervisior?

[TazziRN, RN]

Wow......LOTS of responses! Okay, I'm gonna try to remember all the ones I want to answer/comment to.

I don't know exactly where the satellite facility is, Cuz lives in Glen Oak, so somewhere in between there and the main facility.

She WAS admitted, but was an ER hold because of bed status. She spent her two days in the hospital in the ER.

I work in Podunkville.....no onc floor, 6-bed ER, 4-bed ICU, LTC in the building....we have all kinds of pts with ports, not just onc. The floor nurses often call us to access them because they don't see ports as often as we do, but there's always somebody who knows how.

I will ask pts if they want me to access their ports or try a periph. THEY know their bodies and I would be a fool not to listen to them.

She was not there for a infection problem, she was there for a nosebleed. No reason to suspect line contamination.

Since in the ER we rarely have the time to let EMLA cream work, I inject epidermal lido before accessing.

Thanks for all the responses, everyone!!