De-accessing a port woes?

Asystole RN · Feb 27, 2015

I hate that feeling of not knowing if you did something or not.

Don't worry about not locking with heparin, if you did in fact forget as long as you flushed well and deaccessed without negative pressure. I have had many patients with ports who could not/did not take have heparin flushes in their ports. It is not that uncommon of a thing.

IVRUS, BSN, RN · Feb 27, 2015

Guys, I am stressing myself over something I can't do anything about and pretty much due to a nagging feeling. I'm hard on myself and this could be in my head, maybe which is why I am lying in bed awake at almost 4a.
To the point, I discharged a patient at change of shift last night, deaccessed his port, which was the first time I've ever done that (been an RN for almost 3 yrs). I spoke to my charge and we went over the steps. I ordered the heparin flush per our protocol. I remember flushing with NS first and I know I pulled the heparin flush from the Pyxis and documented on it, but for the life of me I have been agonizing, thinking I may have missed the heparin when I deaccessed the port. During my dc education, I let them know to continue getting the port flushed monthly yadda yadda. But I can't shake this feeling. Could be in my head but that's no comfort. And I can't do anything now about it if I did forget it. I don't even know why I'm posting but any advice/encouragement would be helpful. And needless to say I will DEFINITELY make sure I heparinize next time.
Side note: I just precepted someone last week and let them know you are still constantly learning in this field and you will never know everything. Boy, is that the truth or what!

Also remember that EVEN if it does occlude, Cathflo will usually lyse the fibrin/clot and restore patency. This however, does not negate the responsibility of your employer to have assessed your competency BEFORE you perform procedures. He/She should be assessing all RN and LPN's given their scope of practice in the state they reside. You want your competency assessed and documented so that when surveyors come into the facility, they have your information on file, and can observe/document that you are competent and have followed policy.

RN does equate to capable, but that doesn't necessarily mean competent.

Libby1987 · Feb 27, 2015

Hopefully the light of day will clarify your memory. I've had those second guesses, usually when I've been multi tasking mentally..Can you recall wasting it or seeing it laying it there unused?

I hate that middle of the night anxiety and I'm sure we've all had it.

EmeryRN · Feb 28, 2015

Hopefully the light of day will clarify your memory. I've had those second guesses, usually when I've been multi tasking mentally..Can you recall wasting it or seeing it laying it there unused?
I hate that middle of the night anxiety and I'm sure we've all had it.

I have that anxiety even if I have a really good day, thinking I must have missed or forgotten something and that's why I thought I went smoothly haha. I remember scanning it but that's about it. All a blur bc it was at shift change and I was multitasking. Arg! It's frustrating and the not knowing is annoying. But thanks all for the support.

CryssieD · Feb 28, 2015

Don't stress so much--what's done is done! Learn from it, that's all you can do at this point. Anyway, I've flushed small (pedi) ports without heparin and never known one to clot off--the main thing is locking with positive pressure to prevent backflow of blood. Even if it does clot, it can probably be cleared with thrombolytic.

SierraBravo · Feb 28, 2015

Don't stress so much--what's done is done! Learn from it, that's all you can do at this point. Anyway, I've flushed small (pedi) ports without heparin and never known one to clot off--the main thing is locking with positive pressure to prevent backflow of blood. Even if it does clot, it can probably be cleared with thrombolytic.

I work with central lines every day and I can count on 1 hand the number of nurses I have seen clamp a line while flushing (positive pressure technique). Our facility does not use positive fluid displacement needleless caps. If people flushed central lines correctly then perhaps the need for alteplase would decrease because there might be fewer clots.