no blood return port a cath

[carabear1028]

does anyone have any tricks for getting a blood return on a patient ? After a port study confirmed placement of port and patient can smell and taste saline flushes i still can not get a blood return, suggestions are most welcome:)

[SoldierNurse22, BSN, RN]

It depends on the protocols and policies of your ward.

On my floor, we were trained and authorized to do all of the following:

1. Have the patient change position. Have them turn their head toward the port, away from the port, cough, stand up, etc.

2. Power flush (10cc syringe).

3. Heparin lock for 30 minutes. Recheck blood return.

4. Request (additional) imaging study for placement.

5. Request TPA to break up a potential clot.

[carabear1028]

Great thats very helpful thank you

[NurseRies, BSN, RN]

When the line will push but not pull, it's usually because the port is against the vein wall or it is partially clotted. In heavy people, their weight alone can put pressure on the vessel which occludes blood return and positioning can be key. Could try laying flat, moving neck, or putting pressure around the area. I have seen sand bags do the trick, although most hospitals don't allow this sort of thing, but if it's just for a minute, try a heavy saline bag. Some people seem to always have issues with blood return! I think it just has to do with vascular health.

[IVRUS, BSN, RN]

The main reason why a line has a persistent withdraw occlusion (PWO), is not because the catheter is up against the vessel wall, but rather fibrin build-up at the catheter's tip. Now, there are times when nrsg interventions will yield you the return that you are looking for, but, the majority of reasons for a PWO, is the mixture of formed blood elements, immunoglobulins, etc, which cover the opening when withdraw occurs. If nursing interventions do not work, do get an order for Cathflo (Alteplase) and instill, and allow to dwell to restore patency. The person giving the Cathflo, should be knowledgeable and be competent in its administration. Also remember that Heparin flush WON'T clear an occlusion, it only decreases fibrin's buildup.

[Asystole RN]

What side of the chest was this port placed on? Was the catheter a supraclavicular or subclavicular approach? Where did the tip of the catheter reside?

90% of the time poor blood return is due to fibrin build-up BUT the catheter tip can be residing on or near a vessel wall. These are usually apparent when you readjust the patients position, such as having them sit forward or lean to a side, and then are able to withdraw blood. Left sided approaches tend to place the catheter tip within the left brachiocephalic vessel and many times the tip will lay on the vessel. Right sided approaches tend to have the catheter free floating since the approach to the superior vena cava is more direct.