Difficulty Accessing A Port

[REDDICKD]

My patient recently had a Bard Power Port placed. I access/de-access the port weekly. She had never had a port before. She continues to complain about pain when I access and de-acess the port. She admits to being a needle phobic. We used emla cream once and she has refused it since then. She did not mention if it was effective (it was placed at least 1 hr. before I arrived). I have also used the diversion techniques recommended. Taking a deep breath while accessing and de-accessing which seemed to work in the beginning.

I had never worked with this particular VAD (Power Port Advantage )before. I will admit when accessing the port it does not "feel the same" as other ports I have accessed. It is not that nice, quick sharp stick, yet there is no problem with flushing or blood drawing.

Does anyone have any suggestions?

Thanks

I have contacted the Bard Rep. (without much luck)

[sweetlilwolf]

So there's no issues with flushing or blood return.... And what do you mean doesn't feel the same? Have you tried and ice pack for 5 mins prior to insertion? Is it a new port? Swollen? Bruised etc? Anyone else say it doesn't feel right?

[nutella, MSN, RN]

Sometimes it can "feel off" when you are used to a specific kind of port. Also, depending on the needle and length it can "feel" differently. If you get a good blood return and flushes without problems but you are still worried that there is something "wrong" with the VAD itself have another nurse access it or watch you access it and give feedback. I have noticed that with those new VAD the membrane is very "bouncy" kind of but the needle slides in just fine.

It does hurt to access a VAD and some patients are more sensitive than others, sometimes perhaps there are nerves in the area. Sometimes it is better to have a patient lie down to access the port, especially in a female pat with some more pronounced upper chest area. That way it is easier to really get a good right angle. In addition if a patient is phobic and they are reclined they can turn the head to the other side and focus on something else.

But it is important to be realistic in that accessing a port still means pain because the needle penetrates the skin. EMLA cream can help some if applied 1 hour before and covered with a tegaderm.

I once had a patient who was all about icing the skin but too much icing can cause skin damage.

Funny enough - I just thought the other day that back when all VAD used to be large and sticking out some it was easy to access them. Now that they are very small in comparison and also sometimes appear in unusual places it can be different.

I also find that when a patient looses some weight the VAD is more "wiggly" and needs to be secured very well with access and lying down helps a lot.

[KelRN215, BSN, RN]

Power ports don't feel the same as standard ports. They are triangle shaped and have those palpation bumps.

How old is the patient? If the port is newly placed the site may still be a little tender.

[roser13, ASN, RN]

My husband says that the emla cream takes a full 2 hours to work. While I have a hard time believing that, he's the boss in port matters. Why does your patient refuse it?

[blondy2061h, MSN, RN]

Why has she refused EMLA since? Was the EMLA applied with an occlusive dressing over it? I've had some patients prefer a freezing spray instead.

When I access ports I have the patient lay back and close their eyes if they're willing to. I prep everything, grasp the port with my left hand, and with my right hand I line up the needle just barely resting on the center of the port where I want it to go, then, when I and the patient am ready, I swing it in giving it a constant, even pressure. It's almost like the motion a teeter totter makes. It's very smooth and steady- not really "stabbing." I've had patients tell me this hurts less.

How much experience with ports do you have?

[REDDICKD]

Thank you for your reply. The port was placed about 3 mos. ago. No bruises, edema or any signs of infection. Another nurse accessed it once and thought the port "felt new". I will ask the pt. about icing the area.

[REDDICKD]

Thank you so much. Truthfully I am use to those big old ports. The pt. is terminal. As strange as it may seem "simple things" is all she has control over for e.g. EMLA, icing, arriving on time etc. Yes, the spouse who is an RN did apply the EMLA cream and tegaderm at least an hour before I came. No yeah or nay just a refusal to use it again. Both the spouse and I have learned "no" is no. I will definitely ask about changing position, that may be a go. Yes, this port feels bouncy. I do secure it well but I will pay particular attention to this. Once again I appreciate your advice.

[sweetlilwolf]

3 month old is shouldn't be hurting much anymore it should be getting less painful.... Does it just move around? Could alway ask the provider for a X-ray or call IR to verify it also. Kinda odd regarding the refusal of emla.... Maybe she would let the needle stay in longer? Not sure the policy at your company we can leave the needles in some patients love it some hate it....

I'd agree with blondy also

[sweetlilwolf]

Also ports are getting smaller and smaller it's crazy! I work in oncology infusion currently so almost all our patients have ports or piccs we use them same day as they are placed.... And some are the size of a larger dime.... Is crazy

[REDDICKD]

The pt. is in her late 50's. I called Bard about "the bumps" or lack of. The rep. said they are not always so prominent....go figure. That seems to be the case with this pt. Fortunately I use it solely for drawing blood (4+ vials of blood). Thank you for the information.

[sweetlilwolf]

Oh okay... If it's just used for a blood draw maybe the patient would prefer you just use a butterfly needle....