Giving IV Contrast thru a Power Port with NO blood return

[SoccerMomNC]

We are having an issue with this at my hospital. I access the Power Port to use for Ct scans. Sometimes I do not get a blood return, I always ask the pt if this is normal for them. I KNOW I have accessed it correctly, am in the center of the port, etc. So we will inject without any problems. Does anyone else do this? Is anyone else having problems getting blood return from the Power Ports?

[DutchgirlRN, ASN, RN]

I've had no trouble getting a blood return on a power port. If I did not get a blood return I would not inject no matter how sure I was that I had accessed it correctly.

[melrned]

Hi - I would never give anything thru a port without a blood flow - where is that tip? is it a clot or fibrin sheath, get a flow study - and then fix the problem -- where could that drug end up if the catheter has broken, or come apart. Good luck.

[iluvivt, BSN, RN]

Are you talking about a chest port? You should never give anything through a port unless you get a blood return . The first thing I would do is re-access it. One common thing I see is nurses who select a 22 gauge as an option to decrease pain to the patient. I always access a patient in the hospital or if I need to get a brisk blood return with at least a 20 gauge and sometomes a 19 gauge (ie Blood administration). I cannot tell you how many times I de-accessed a 22 gauge with no blood return or a sluggish one and re-accessed with a larger one and then got a great blood return. Also try position changes,especially abducting the same side arm. Also try a 10-20ml pulsatile flush...leave that same syringe attached and then immediately attempt a blood return. If all troubleshooting fails and you believe you are in the portal chamber and you are able to easily instill...you probably have a withdrawl occlusion. This will require the use of Tpa to treat the fibrin build-up. After all trouble shooting and several doses of Tpa and still no blood return the pt will require more testing such as a catheterogram to verify the integrity of the line. As you may know contrast media is considered a vesicant and may cause severe tissue damage if extravasated so you should not take a no blood return finding lightly.

[ukkatie]

Hi there, I am not a nurse but a cancer patient who has just had a Power Port inserted for the administration of chemotherapy. I just wanted to say that, even though the swelling has now subsided, my oncology nurse cannot gain access and get a blood return by using a 3/4" needle and has to use a 1". This has happened more than once and now she just uses the 1". Thank you to all nurses everywhere!

[iluvivt, BSN, RN]

Yes I believe that ...you need a length that will allow you to get through the portal septum and reach the back wall of the portal chamber. Each pts body is a bit different and each pocket is unique....so an assessment needs to be done to select the most appopriate gauge and length.