ER Nurses- Do You Access Mediports?

[blondy2061h, MSN, RN]

I work in a hospital that doesn't have it's own ER. As a result, our patients are often filtered through other ERs, and we get patients from a variety of different hospitals. Working in oncology, some of our patients have Mediports, and almost all have central access of some form.

Some hospitals seem to routinely access the Mediport (or use their central line), while others won't touch it and start a peripheral IV.

How do you feel about accessing Mediports in the ED? What if it's a central line with the lumens right there ready for use?

[ChristineN, BSN, RN]

I don't work in the ER, but I know at my hospital (level 1 ped trauma center), the ER nurses can call IV team to access a pt if they know the pt has a Mediport. Normally they're pretty good about getting them accessed in the ER, and I've never seen the ER put a peripheral in a pt with a central line.

[Babs0512]

'When I worked in the ER, we were only allowed to assess mediports if we had been "certified". Most of us were. There were many patients who were apparently told not to use their mediports for anything but chemo, this surprised me, so we often ended up putting IV's in anyway.

Blessings

[blondy2061h, MSN, RN]

There were many patients who were apparently told not to use their mediports for anything but chemo, this surprised me, so we often ended up putting IV's in anyway.

Hmm, I've never seen that done. When a patient gets any kind of central access put in, the doctor has to check off a form saying what it's "approved" for- blood draws, TPN, transfusions, chemo, CVP monitor, etc. I've never seen a doctor not check off everything. Maybe in your area some are? I guess I could see some people getting "possesive" over their patients' ports, but it kinda sucks for the patient.

[lpnstudentin2010, LPN]

If I had a port, I would want it used for everything I needed. I can not imagine having an iv started (i am a VERY hard stick and needle phobic) if I had one

[THAT Nurse., MSN, RN, APRN]

Mediport, is that the same as a port-a-cath? (Located under the skin generally in the upper chest)

[Pepperlady]

I know that in our facility we cannot access any central access device (port-a-cath, tunnelled line etc) from another facility without an x-ray to establish correct placement.

If someone presents to the ER and they have one our docs just order an xray first for confirmation.

[november17, ASN, RN]

.....

[iluvivt, BSN, RN]

This should be determined by facility policy. However, if you choose to use it the RN will be held accountable to the standard of care for that particular device. For example,if a patient comes in with a PICC line you must verify tip placement (either by CXR or check for most recent CXR if available) and patient does not have any s/sx of PICC-related complications. Same goes for a tunneled CVC,such as a Broviac,Hickman or Groshong. You will usually see patients come in with ports,tunnelled catheters,HD and apheresis catheters. You generally want to aviod using the HD and apheresis catheters. Accessing a port is a sterile procedure and requires the use of a non-coring needle so some hospitals require a special certification before allowing a nurse to perform this procedure.

[YellowBoneRN]

This should be determined by facility policy. However, if you choose to use it the RN will be held accountable to the standard of care for that particular device. For example,if a patient comes in with a PICC line you must verify tip placement (either by CXR or check for most recent CXR if available) and patient does not have any s/sx of PICC-related complications. Same goes for a tunneled CVC,such as a Broviac,Hickman or Groshong. You will usually see patients come in with ports,tunnelled catheters,HD and apheresis catheters. You generally want to aviod using the HD and apheresis catheters. Accessing a port is a sterile procedure and requires the use of a non-coring needle so some hospitals require a special certification before allowing a nurse to perform this procedure.

Does anyone know of a special class you can take "outside of your facility" to become certified in accessing special ports. I would like to have additional training in a classroom setting about it.

Leave me a message in my box here on this site.

[MajorDomo]

Short answer Yes

Longer answer is that if the primary nurse has never accessed one, they go to the charge or other nurse and asks the "Have you ever..." question. Usually, someone in the department has enough experience with them to comfortably access them, as most ER nurses come from a variety of other fields (Peds Hem/Onc in my case).

It is the same with most other unusual implanted items (peritoneal dialysis, PICCs, wound vacs, ect..)

MajorDomo

[blondy2061h, MSN, RN]

Mediport, is that the same as a port-a-cath? (Located under the skin generally in the upper chest)

Yes, also called an IVAD.