Exchange Transfusion Via Port-a-cath

[mianlica]

I recently had a sickle cell patient that needed an exchange transfusion. We draw off 300cc of blood, give a NS bolus, then draw another 300cc of blood and then transfuse 2 units of PRBC's.

Because this patient's access is so poor he has a port. We attempted to draw the blood off his port and after about 280cc of the first cycle, the port clotted. We successfully restored the port using urokinase, but after only 100cc of the next cycle the port clotted again. During both cycles I flushed after every 50cc or so. Does anyone have any ideas to make this more successful next time or is it even appropriate to do this procedure with a port?

Thanks in advance for any suggestions!

[BarbPick]

My first certification came from the Infusion Nursing Society, I am designated "CRNI". INS can be a good source of information, the INS standards of practice is a good book to have around. Having said that,

I have found that implanted ports take on a life of their own. What is happening is called a reverse ball effect. (What is she talking about????) When a port is clotted, and medication is used like urokeinase(glad you had some, there is a national shortage) all it does is poke a hole in the clot. You are able to flush, pushing the clot outwards. The Fluid goes in. When you then try to aspirate fluid, it will behave for a while, but the suction will pull more of the solid clot back over the lumen of the implanted tubing and will completely cut off anymore back flow. It is officially "clotted" again, you can flush but you can't aspirate. You can run but you can't hide, you have to access a vein. If I can be of any more help, PM me.

I can share an interesting factoid of how to tell if a port is really working or not, meaning you can't get a blood return. I said there was a declotting medication shortage, one way to tell if the post is safe and in the right place is giving a huge dose of IV decadron. Why decadron you ask? It's side effect. If you give up to 20 mg of IV decadron IVP and the patient screams, you know the port is working. The side effect is making male and female genitalia burn like fire. AAAAAAHHHHHHHH!!!!!!! yup, it is open, we can use it.

Barbara