Help! No blood from port??

lftiger · May 14, 2009

Sounds like it needs de-clotting, but it may be just positional....try repositioning the patient either side to side or flat to fowler's.

Hope this helps =)

melissahunter2 · May 14, 2009

I thought about the positioning (after I left). Maybe I will try to go back tomorrow and try a different position. Thanks!!

iluvivt, BSN, RN · May 14, 2009

The first thing I would do is to make certain it is not a 22 gauge needle...get at least a 20 gauge...I can not tell you how many x I have accessed with a 22 gauge and got a sluggish or no blood return and the switched to a larger gauge needle and was able to get one. Next make sure you are accessing parallel to the portal septum and stay near rh middle of it.....then after you have accessed immediately perform a pulsatile push pause flush...with that syringe attached immediately pull back for your blood return.....then have pull that arm out to the side....or lie flat and pull that arm out..try several different position changes....still no blood return after all of this....what you have is a PWO.....which is a persistant withdrawl occlusion......and the only way to treat that is with Tpa.. you are correct the standard of care is to access and flush that port at least monthly...try to get the order changed and let the MD know what the standard is...perhaps the patient will need less Tpa that way...he may have a fibrin sleeve or tail on the distal end of the catheter

melissahunter2 · May 17, 2009

I am going to try the 20g tomorrow and with different position changes. I had left a message with the surgeons nurse and she later called me back stating the doc said there was nothing he could do other than change the port and we could just use it for meds. It flushes easily, but makes me uncomfortable without the blood return. If I dont get it tomorrow, would you suggest to the doc about TPA????

iluvivt, BSN, RN · May 18, 2009

YES!!!!! absolutely........you need to treat it with Tpa....the usual dose is 2 mg mixed with 2.2 ml sterile water...instill SW gently and rotate gently never shake....and instill entire amount....I usually ask the MD for a MR x 1 dose or on ports will ask for 3-4 mg........ports have a higher priming volume that PICCs and other percutaneous CVCs ,usually 2 -2.5 ml...so I want to make sure I get enough to cover the volume of the port and attached catheter...Ok..then instill...and wait at least 1/2 hour before checking...you can check every 1/2 hour if you like...what I would do on a home care patient is to instill...wait a bit to ensure there is no reaction..then leave....go have some lunch or something come back in 1.5- 2 hours......ports seem to do better when you leave the Tpa in the max dwell time.TheN attach a 10 ml syringe discard about 5-8 ml...flush with double normal saline and whatever Heparin you are using usually works like a charm....if not repeat the dose.....tell the MD it is the standard of care to treat these PWO b/c not only must you try to get a fully functioning VAD (port in this case) research has linked fibrin and blood left clotted in all types of CVCs to a higher risk of infection...Please be aware that Tpa (activase has an extremely low risk for allergic reaction and that is why when urokinase was no longer available the we scrambled for a solution to catheter occlusion and chose Activase over streptokinase...as streptokinase has a much higher risk for allergic reaction PLEASE MAKE SURE YOU BRING A VIAL OF STERILE WATER...IT DOES NOT COME IN THE PACKAGE AND DRUG SHOULD BE KEPT IN REFRIDE UNTIL USE,,,,MAY BE USED UP TO 8 HOUR AFTER RECONSTITUTION...AND YES SAFE TO GIVE TO A HOME CARE PATIENT...HAVE DONE IT MANY AMNY TIMES