Complication with accessing a porta cath

[RN-BSN2006]

My patient has a new porta cath placed 3 weeks ago for vanc infusions. The order is to change huber needle every 3 days. I attempted to access porta cath and I get a beautiful blood return, however, when I flush the site begins to rise significantly. I have been unable to access this. Patient was sent to radiology for a study. He was told he had a hematoma and was sent home with a new access in place. Could the issue I had be due to my technique or a complication with his port??

[liveyourlife747]

Doesn't sound like it was your fault. You probably hit the hematoma and got blood return from that.

[RN-BSN2006]

Thanks for ur response. I guess I'm confused because after I attempted to access it they were able to place one. When I removed the one they placed I had the exact same issue as before. I'm at my end wits with the situation.

[NBMom1225]

Was the Huber needle you were using the right length? I've seen various lengths ranging from 1/2 inch to 2 inches. When you inserted the Huber, did you 'feel' the needle hit the base of the port?

I'm curious about the order to change the Huber every 3 days, I've worked oncology at a couple facilities and policy has always been to change the Huber every 7 days or as needed...though I am only familiar with mediports, perhaps they're different than porta caths?

I'll take accessing a mediport over getting a peripheral IV any day, my IV skills aren't the best after dealing with mediports for my first few years as a nurse...no longer in oncology now, co-workers on my current floor are a bit intimidated by the occasional mediport we'll get, so we trade: I'll access their port, they get my peripheral, lol :)

[RN-BSN2006]

Lol:)I have tried from 3/4 in to 1 1/2 inch and they have resulted in the same complication. I was only able to access this once since he's had it. Yes I couldn't believe the order for q 3 days. I even called to verify this as well because every PAC I've ever had has been for q 7 days. I'm a home health nurse. My associates have both tried to access him as well and have gotten the same result as me. We are all at our ends wits with this. I just can't figure out why the radiology dept was able to access it and then when I tried I had the same problem as before.

[NBMom1225]

Perhaps it's a positional issue...radiology most likely had him laying flat on his back, have you/your associates been accessing it with him sitting, or laying flat?

[Anna Flaxis, BSN, RN]

Can you describe how your are finding your landmarks and what you are feeling when you access? Are you going straight in or do you "rock" the needle (like some people do, but you're not supposed to)?

[iluvivt, BSN, RN]

I need to know a few things and I can then give you a few suggestions. So far it sounds like you are just having an issue with accessing the septal chamber of the port with the non-coring needle. You should NEVER use a 1/2 inch needle length to access a chest port,that length can only be used fro a peripherally placed port b/c on all port designs and sizes you barely get through the septum and it can easily pop out and infiltrate or extravasate. I have some tips for you but want to be more specific and if it is that tricky to access I would implore the MD to change the order to reaccess q 7 days as that is the current standard of care. This will also extend the life of the port and decrease her risk for a potential drug leakage pathway.

1. What side is the port on?

2. Does it have a low profile?

3. Can you easily palpate the septum or is it hard to do so b/c of breast tissue or rotation of the port?

4, How long has it been in place now,did you say it was a new port?

5 where is the port pocket exactly in relation to the clavicle?

6 What gauge needle have you been using?