Help Me Understand IV Port and How This Happened

[jetsy62]

First off, I want to say that I am a pre-nursing student starting school fall of this year and love this site. My grandmother is in the hospital with end stage COPD after developing pneumonia. She has an IV port in her left arm to receive her medication. Monday and Tuesday when they came in to give her the steriod she complained "that is cold and making me wet" when my mom and my aunt were there. To be honest, we all just kind of thought it was her illness since she has been coherent at times and other times not. Well yesterday this happened again with my aunt in the room. The nurse got a concerned look on his face and said he had to go get help. It turns out the IV was not actually in my grandmother. It was laying on top of her skin under the white tape. So, she has not been getting her medication of course and she was in fact getting wet. I guess that explains the damp sheet the one day. It is fixed now but I don't understand how this happened. In the three days this was apparently out, I would think someone would have noticed. But maybe not. I will say the hospital has been very busy and I know the nurses are being forced to work longer shifts and extra shifts but I think someone should have noticed this. I guess I will learn once I get to school how difficult it is to determine if an IV is in or not but from what is being explained to me if someone had looked under the white medical tape it was obvious. Just looking for an explanation. It is over and done with but I still wonder how this happened. They just said it is something that happens every now and then. I can't help but to think someone should have discovered this before three days passed.

[psu_213, BSN, RN]

A question: was the white medical tape over the actual insertion site? If so, it would have been impossible to actually 'see' that the IV was out; however, there are other ways to tell if the IV is still in the vein.

I don't know what the nurses who were using the IV (well, I guess it really wasn't an IV then) did or did not do to check for position/patency, but in general this should not have happened. I was not there though, so I don't know what mitigating factors existed. For example, the first time the IV could have been in the vein, and your grandmother could have been sensing coldness and wetness during the normal flush of the IV; and the wet spot on the sheet could have just been saline that was pushed out of the flush when purging air from it.

[ChristineN, BSN, RN]

By port do you mean your grandmother had a Mediport (a permanently implanted port for IV access that is under the skin)? Or did she just have a peripherally inserted IV? If it is a Mediport, sometimes patients and family members are unsure of the size and guage of needle normally used to access the mediport which can result in the nurse guessing the needle size that she thinks might work, which can result in a needle too big/too small being attempted. If this is the case it should have been obvious when it was accessed as the mediport would not have flushed OR would not have given back blood.

If your grandma has a peripheral inserted IV in her arm, the catheter on the IV can come out of the vein and onto the sking with movement, extended periods of being in, etc. It is normally obvious that it is not in place as the dressing around the IV will look wet when you flush it, a sign of leakage.

You stated your grandma is confused on and off. Is it possible Grandma might have pulled at her IV at some point and that is why it was not in place?

[Mulan]

Maybe you should ask the nurse manager how this happened.

[KelRN215, BSN, RN]

I, like Christine, immediately thought you meant an implanted port when you said IV port. It sounds like you are more referring to a peripheral IV. Those things can fall out quite easily and confused patients often pull them out. A saline flush feels cold when it goes into the IV. If the tape was over the insertion site and you couldn't see the catheter, I could kind of see how it could fall out and not be immediately realized... but I can't really see how it could be like that for days. Presumably the IV was being flushed several times a day and if it wasn't in the vein, the tape would get wet which would usually lead to it becoming non-adhesive.

[SwansonRN]

Sorry about your grandma

Simply put, it was overlooked. There's no saying how long the IV had been dislodged, maybe it had only been a few hours or a few days. IVs are made of a bendy flexible catheter that can be pretty easily displaced from the vein. When you're a nurse I hope you remember this, this way you'll always be great at assessing IVs and whether or not they are working properly. Best of luck to you in school and I wish your family member the best.

[jetsy62]

No explanation given really and I am just glad is was found and is fixed. I think they know it should not have happened because almost every nurse that has been in since has mentioned it and they check it well when they flush it and when they give the medicine. And from what you are all saying, it is not a port but a peripheral IV. So sorry for my mistake. I hope to take this as a learning moment to help me when I am actually in nursing school. Mee Maw was saying to the nurses, and us, that they were making her wet when they came in to do something to her regarding the IV. Guess she was right. I think we all were dismissing it because at the time she was not always coherent. I hope I remember to never dismiss something a patient is saying even if they seem to be saying something that does not seem correct. Thank you all for the responses.

[JustBeachyNurse, LPN]

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