Accessing Ports

OCNRN63, RN · Aug 7, 2014

Does your facility have an IV team? You could ask to follow one of the IV nurses for a day or two to get practice and experience. If you don't have an IV team, do you have an oncology unit where you could get some experience?

I believe ONS has a CEU on VADs. You should check them out.

FlyingScot, RN · Aug 7, 2014

If your hospital has an infusion center or oncology lab they would be an excellent resource for you. I train people all of the time.

Caffeine_IV · Aug 7, 2014

Thanks to you both for the reply.

We do have an IV team and I asked the manager of the team during orientation about a follow along for practice and was told they didn't offer that anymore because it ended up being a waste of time.

I'd love to work with a cancer center nurse for half a day just accessing ports if they would allow it.

During orientation I start 3 ports without any issue but they were all on prominent ports so the regular nurse signed me off on it.

blondy2061h, MSN, RN · Aug 8, 2014

Palpate, palpate, palpate. That's the key. Before you do anything else feel the heck out of it. Try and grasp it between your fingers. Get a feel for how mobile it is and if it's tilted at all. That's the best tip I can get you. It will get better the more you do.

OCNRN63, RN · Aug 8, 2014

Mine is difficult to access because it's deep, somewhat tilted , and mobile. I'm very picky about who accesses it. I had someone really botch it, and I had bruising and soreness for about two weeks.

Caffeine_IV · Aug 8, 2014

Mine is difficult to access because it's deep, somewhat tilted , and mobile. I'm very picky about who accesses it. I had someone really botch it, and I had bruising and soreness for about two weeks.

Those like yours that you describe are the very ones that give me trouble. Do they use a 1 inch needle? We only carry 3/4 inch and sometimes I think that could be an issue but maybe not. Thankfully I haven't caused any bruising to my knowledge.

CarryThatWeight, BSN · Aug 8, 2014

I've had trouble as well with deep or tilted ports. I agree with the advice to palpate. It's tempting to rush, especially when you're busy, but recently I took the time to really feel a port and it paid off. Also, when they are still fresh from being implanted, swelling makes it more difficult to feel where to go. 1 inch needles can be helpful for deep or swollen ones.

blondy2061h, MSN, RN · Aug 8, 2014

Also try and get a feel for the shape of it. Occasionally you might get a triangle one. Have you seen and handled one that wasn't implanted? That helped me to get an idea of how much of a "target" I had to work with and how much border I'm feeling for.

SierraBravo · Aug 12, 2014

Pretty much what everyone else said. I work in oncology and many of our patients have IVAD's. The key for the ones that are not as prominent is, as someone said above, to palpate the port. If it's a power port, make sure you can feel the 3 small dots. Once you find the dots, aim for the middle of the port. Also, using your index finger and thumb to anchor the port prior to needle access is a good idea. By anchoring the port, you can make the skin taught which can sometimes make the port more prominent. Using a 3/4" needle in an obese patient or a deep port is ambitious, but if that's all you have then you have to work with it.

blondy2061h, MSN, RN · Aug 12, 2014

When you do put the needle in, do it in one swift motion. Don't hesitate once you decide to put it in- commit!

FlyingScot, RN · Aug 12, 2014

When you do put the needle in, do it in one swift motion. Don't hesitate once you decide to put it in- commit!

I totally agree with this. Although it seems going slowly would be less painful it just drags out the pain. I don't make a production of inserting the needle. Seriously, I worked once with a nurse that would count to three and then literally shout " BIG BREATH IN". It made me anxious and I wasn't the one getting stuck. I prefer to distract them with my titillating conversation. I don't tell them when I'm going in. Most of the time they don't even feel it. My best advice is to take the time to palpate the borders of the port so you know where to go. Secure the port with as many fingers as you can and go for it. The worst port I ever had to access required a 1.5 inch monster needle. You had to push it down to stabilize it then pray like heck you didn't miss (I didn't). This patient had her lung dropped 3 TIMES by misses!!!!! Talk about a swamp a$$ moment. Made my butt pucker every single time.