If a implanted port is in the left chest is it ok to start a peripheral IV in the Left for

Guest374845 · Dec 6, 2018

Absolutely. I've seen ports with alternate placements, like in the groin and even in a patient's forearm - ones where you'd obviously avoid distal placement - but the ones in the chest are generally tunneled up over the clavicle, into the IJ and down SVC right above the right atrium. You can even place an IV distal to a PICC with good judgement.

akulahawkRN, ADN, RN, EMT-P · Dec 6, 2018

Short answer is: yes. Implanted chest ports are usually "just" tunneled to the IJ on the side where they're placed. Think of it as basically an IJ central line where the entire system is under the skin. As long as you avoid the area where the tubing is, a peripheral line can be placed pretty much anywhere.

Home Health Columnist / Guide · Dec 6, 2018

Yes, PIV can be inserted in arm same side of body as port is located; but why is a peripheral IV being inserted instead of using the port--purpose port for infusion needs!.

applewhitern, BSN, RN · Dec 6, 2018

Yes, PIV can be inserted in arm same side of body as port is located; but why is a peripheral IV being inserted instead of using the port--purpose port for infusion needs!.

My son's port was to be used for chemotherapy only, period. The cancer center always stuck him when drawing blood, they never used the port for anything other than chemo infusion. He always got a peripheral IV for everything else. They get infected too easily! He had 3 total.

iluvivt, BSN, RN · Dec 6, 2018

My son's port was to be used for chemotherapy only, period. The cancer center always stuck him when drawing blood, they never used the port for anything other than chemo infusion. He always got a peripheral IV for everything else. They get infected too easily! He had 3 total.

Ports actually have the lowest infection rate of all CVADs.They, of course, are still subject to infection especially if the patient is immunocompromied. If it is a single lumen port and medications are incompatible then it is very common to have both a port and a PIV.

DowntheRiver · Dec 6, 2018

My son's port was to be used for chemotherapy only, period. The cancer center always stuck him when drawing blood, they never used the port for anything other than chemo infusion. He always got a peripheral IV for everything else. They get infected too easily! He had 3 total.

It's been months since we last discussed this and I'm still blown away by this. I work for a top ten cancer center and we most definitely use ports for blood.

I recently took a PRN job where I start IVs on relatively healthy patients. I have been putting in 16s & 18s whereas with my cancer patients I'm usually putting in 22s but not uncommon to put in 24s. Some of the patients it is like trying to get blood out of a rock, I'm so serious.

Yes, ports do get infected, but very rarely. Excellent sterile technique and routine flushing 4-6 weeks keeps them working beautifully.

Daisy4RN · Dec 6, 2018

Yes, but why would you want a PIV if the pt has a port. I worked in Onc and we always used the port whenever possible to save the pt from many unnecessary

sticks thus pain. The only reason not to would be a suspected infection (and in the 10 years I worked Onc only saw 1 infection) or no nurse to access the port (not trained). But as always know your facilities P/P.

DowntheRiver · Dec 6, 2018

Yes, but why would you want a PIV if the pt has a port. I worked in Onc and we always used the port whenever possible to save the pt from many unnecessary
sticks thus pain. The only reason not to would be a suspected infection (and in the 10 years I worked Onc only saw 1 infection) or no nurse to access the port (not trained). But as always know your facilities P/P.

Instances were we start IV and don't use port:

1. Port was placed outside of our hospital and we can't confirm it is a power port for a scan

2. Port does not give blood return. Absolutely nothing goes in the port other than TPA or dye for a portogram. No chemo, no fluids, no scans, no nothing unless we get a blood return.

3. Medicine incompatibility (very rare).

4. Anesthesiologists tend to not use the port. Unsure what our actual P/P is about that so I will look it up.

5. Infection and/or clot.

6. Last, but not least, patient request. Strange, but it does happen.

Daisy4RN · Dec 6, 2018

Instances were we start IV and don't use port:
1. Port was placed outside of our hospital and we can't confirm it is a power port for a scan
2. Port does not give blood return. Absolutely nothing goes in the port other than TPA or dye for a portogram. No chemo, no fluids, no scans, no nothing unless we get a blood return.
3. Medicine incompatibility (very rare).
4. Anesthesiologists tend to not use the port. Unsure what our actual P/P is about that so I will look it up.
5. Infection and/or clot.
6. Last, but not least, patient request. Strange, but it does happen.

Yes, you are correct!

I was just thinking how many times we would get our Onc pt's from ED without anyone even trying to access (or contacting Onc nurses etc), even though placed in the same facility etc. It was frustrating for the patient to be stuck so many times unnecessarily, but I also understand ED can be very busy (so they just do what they know).

Daisy4RN · Dec 6, 2018

My son's port was to be used for chemotherapy only, period. The cancer center always stuck him when drawing blood, they never used the port for anything other than chemo infusion. He always got a peripheral IV for everything else. They get infected too easily! He had 3 total.

So sorry for your son!

zoidberg, BSN, RN · Dec 8, 2018

If a working port is present, it is best practice to use it. PIV's cause a ton of BSI's. If you have a functioning port and insert OR use an existing PIV which leads to a complication (infiltration with complication, nerve damage from infiltration near a nerve, etc), you can be held negligant. If a patient refuses use of their port, you better document that on the notes when you chart your PIV...