Hi everybody! + Mediport access question

Tweety, BSN, RN · Nov 26, 2007

Good luck in finding an answer. I'm going to move from Introductions to General Nursing since you are asking a specific question. Welcome!

NurseyBaby'05, BSN, RN · Nov 26, 2007

I'm a new Oncology/MedSurg Nurse, I passed my boards this past June & I find that I have frequently have questions that I want or need to ask but do not always feel comfortable asking my coworkers. I work with a lot of nurses who have 20+ years of experience & 3/4th of them don't greet new nurses with open arms; it's like boot camp, my boss told me. Anyhow, my first question is this, "the tubing connectors (that are replaced every 5-7 days along with the huber needles, the ones with Maxplus positive displacement devices) have clamps, do you need to clamp the line even though there is a positive displacement device, like a Maxplus or does it interfer w/ the Maxplus' prevention of blood reflux into the lumen? I tried finding the info out on the internet but had no luck, can someone please answer my question. Thanks everyone!

In theory, the lines should not require clamping, but anecdotally they seem to work better if the clamp is shut when not in use. The less you have to Cathflow a line when you need labs STAT, the better. You may wind up waiting awhile for blood and the pt may have to be stuck. (If he can be, many times a port is implanted b/c peripheral access is so poor.) Clamping the line is certainly not going to hurt it.

As for your co-workers, ask anyway. If they get cranky, tell them you're not trying to pee in their Wheaties, you just want to know. Just be careful and aware of how you come across. A lot of students/new grads have to get showing what they know or can (over)analyze out of their systems. Another thing to remember with rough around the edges co-workers is timing. Ask something like your question when they're not in the middle of something and preferably in private. Then they might feel less put on-the-spot. If it's something you need an answer to right away, like say how long does my pt need to drink po contrast before his CT he's getting today, don't let them run you off. Ask anyway and insist (nicely, that is) on an answer.

jhlynngirl · Dec 8, 2007

Hello. I am also a hem/onc nurse. Your message sounds a little scary to me. My professional opinion is this, suck it up and ank for help before you hurt one of your patients. The internet is probably one of the worst places to seek out "good" info, and I certainly hope you are not blindly putting what you read into practice without running it by someone first.

Always clamp when messing with the line because of the pressure changes in the lumen of the catheter.

EmmaG, RN · Dec 8, 2007

Positive Displacement Caps must have the tubing or syringe disconnected prior to clamping. The removal of tubing or a syringe from these devices creates a small fluid bolus that exits the end of the catheter inside the patient. Thus the "positive displacement"- this is a one time occurence based on the action of removing a luer locked tip from the cap. This does not create ongoing pressure. If you CLAMP before you remove the luer locked item, you negate the positive displacement from the catheter and you lose the benefit. Some devices have "stick down" issues with the piston itself and can leak if they are clamped before the syringe is disconnected. Thus, once again knowing what type of device is important but you also need to know how to use it. If you clamp an extension with a positive displacement cap after you remove your syringe you also do not create any pressure but you do prevent issues noted in other postings such as air bolus and exsangination. This is why clamping can be a good idea for any extension, but must be done according to the manufacturer's directions for use related to the cap and catheter that is being used.

http://www.iv-therapy.net/node/231

I clamp according to the type of device, because I've had caps and lines come disconnected.

Daytonite, BSN, RN · Dec 9, 2007

we were told not to clamp them. in fact, one of our iv nurses used to remove the clamp from these lines so no one would clamp the line. i don't know that was the best thing to do.

i have a list of iv therapy links on post #6 of this thread that was mostly set up for the nursing students. you might find some useful information there. hard to find internet info on piccs and ports.

https://allnurses.com/forums/f205/any-good-iv-therapy-nursing-procedure-web-sites-127657.html. however, if you ever see the company rep for any of these lines or devices hit them up for any information they can give you on these lines. they usually have gobs of printed info including research articles but you have to ask them for it.

TazziRN, RN · Dec 9, 2007

hello. i am also a hem/onc nurse. your message sounds a little scary to me. my professional opinion is this, suck it up and ank for help before you hurt one of your patients. the internet is probably one of the worst places to seek out "good" info, and i certainly hope you are not blindly putting what you read into practice without running it by someone first.
always clamp when messing with the line because of the pressure changes in the lumen of the catheter.

one of the things about all nurses is the help we give each other. she is not asking how to access the port, she's asking about the tubing and clamps. if you take some time to read old posts you will see that questions are encouraged and help is given.

Toquay · Dec 9, 2007

I would ask to see if my unit or hospital had a specific policy on mediport procedure and follow that. It does seem to me that the manufacturer has a clamp on the huber tubing for a reason, maybe changing the port etc. I would think purposely removing the clamp would be altering the device and could cause problems later if anything were to go wrong, like cap coming off and pt having portal for infection. If the hospital does advocate removing the clamp they should look into devies that don't have them. Very good question and I would be curious of the outcome. Sometimes the devices have literature as well or you can request some from the manufacturer to support your views to the powers that be.

Toq

PICC VIC RN · Apr 6, 2010

When ever you have a catheter that has a clamp you should always use it. Having a positive cap is going to help some in case someone forgets to clamp it however it can't over come the high thoracic pressures when patients coughs, sneezes, bares down etc and thus you will have blood entering the catheter. The Maxplus is a great product I personally teach for the company and is excellent for all kinds of catheters especially the nonclamp catheters such as the Navilyst PASV piccs. ETC.. So YES if you have a clamp always clamp....Priming the Maxplus cap the correctly is crucial in order to benifit from the positive displacement mechanism or feature it has.

Good luck in your career. Never be afraid of asking even if the nurses make faces, cause when you ask it's on them to answer or not, they can never say you never asked. Hope this helps.