Crackling sound when flushing port

[alzrn]

Have any of you ever heard a port make crackling sounds when it was flushed?

This port is only a month old, was accessed in the OR, used for the first time that night. Crackling sounds were noticed with the first flush at home.

The port is accessed with a 1/2in 22g needle. Can we be hearing tiny air bubbles that might be making the crackling sound? You can also hear the fluid flow as you flush it. So maybe the port is just very close to the surface?

We get excellent blood return and no resistance with flushing or infusions. I've been told not to worry about the crackling. I'm still curious as to what could be causing it and if anyone else has ever heard it before in their patients.

Thanks!

[IVRUS, BSN, RN]

Well, I am glad that you are getting a blood return, however, I am still concerned about the functionality of the port. Is the catheter completely intact to the port body? I would ask for a trip to the hospital and request a dye study. Not a CXR.

Liability wise, I don't think you have any other recourse. Your patient is entrusted to your care and if something unusual is occurring, I would not use the port, without getting a dye study which will either identify the cause, or negate your fears.

[alzrn]

How do I get an order for a dye study? Does the surgeon usually order this?

The doctors seem unconcerned because the port seems to be functioning so well otherwise. They are convinced that we are simply hearing it being flushed. Other nurses I have spoken with have never heard this crackling sound in a patient with a port.

I was thinking of calling the port manufacturer (AngioDynamics) to see if I might be able to talk with a clinical specialist. Maybe they have heard of this occurring with some of their ports (it's a low profile Smart Port)? I'm curious to see what they will have to say.

The crackling sound does not occur with every flush and every infusion. We are careful to push out the air and prime all flushes so it seems to occur only every now and then. That's what initially what made me wonder if it could be tiny air bubbles that caused the noises.

Thanks

[IVRUS, BSN, RN]

The port body, being sutured into a subQ pocket, should not provide you with ANY sounds if it is functioning okay, IMO. The pt can go in to the hospital and get a dye study done in radiology.

[alzrn]

Thank you IVRUS.

The crackling sound is alarming to me. Prior to this, I had never heard a port make any sound before. I'm surprised that my fellow RN's and the doctor's are so ...complacent, unconcerned, and not even curious as to why this is happening even though they admit that they have never encountered it before either.

Patient has no pain with infusions, incision and port site looks good. Is currently self infusing at home TID (per doctor's orders...). That has made me question whether or not to trust my gut instinct here. If something is going on though, I don't want to wait around until the patient has terrible pain or irreversible symptoms. I would rather have a problem caught early so that the catheter might be repaired or port replaced if necessary. Before harm is done.

I'll contact the surgeon to see if he'll be willing to order the dye study.

[sdeal]

That is absolutely not normal! I'm with IVRUS, dye study, don't use PAC until results available. Obviously the risks associated with a defective device depend on what you are infusing. But if harm does occur it will fall back on you! First and foremost, protect your patient, also, protect yourself! "The doctor said so" isn't a valid excuse! Good luck!