Infusaports...

iluvivt, BSN, RN · Aug 24, 2012

First you need to interview the pt if they can. Find out how long the port has been in place....have they always been able to get a blood return....have they had any problems with the port..try to find out if is is a power port....do they know the length of non-coring needle generally used (most do not but you can still determine what you will use by your assessment).

Next perform a really good assessment...feel the port...see if is is stable and and not rotated.....is it a single or dual lumen...does it have a low,med, or high profile and how deep is it..how does the skin look around it...when was the last time a CXR was done and look at the report or film....determine the needle length you will use. I rarely use a 22 gauge b/c the blood return is too sluggish

These are a few things you can do that will help you with access...get help to hold skin traction..this will help the port remain stable.....this is often needed for women with larger breasts.......just before you make the puncture feel again with your sterile gloved finger for the softer feeling septum.....go into the septum at a right angle with a firm push...if you miss regroup and have another non-coring needle ready should you need it....a patient will tell you often if it does not "feel right"..listen to them they are usually right....always check for a blood return..and if you do not get one and you think you are still in the portal septum you must not use it and you need to take remedial action and that depends upon the problem. Positioning for me is also crucial to success..I have a higher success rate if the patient is on a bed or is leaning back as opposed to sitting up or in a chair.

mappers · Aug 26, 2012

I'm right handed. In larger patients, I use the first two fingers of my sterile-gloved left hand and I'll palpate for the top and the bottom of the port (And the side if it's a power port maybe even with my third finger). Once I feel like I really have a good feel of the edges, then I hold it in place with the two fingers, then put the needle in with my right hand.

Normally I go right in. There have been times though that I've been too far to one side, so I gently pull back, not taking the needle out of the skin and re-position the needle.

Of course there was that one time I tried to access a pacemaker. We realized after a CXR that the port was on right side. This was for a simple port flush. In my defense the patient held up the left side of his shirt. Even he forgot which side his port was on....

KelRN215, BSN, RN · Aug 28, 2012

I'm right handed. In larger patients, I use the first two fingers of my sterile-gloved left hand and I'll palpate for the top and the bottom of the port (And the side if it's a power port maybe even with my third finger). Once I feel like I really have a good feel of the edges, then I hold it in place with the two fingers, then put the needle in with my right hand.
Normally I go right in. There have been times though that I've been too far to one side, so I gently pull back, not taking the needle out of the skin and re-position the needle.
Of course there was that one time I tried to access a pacemaker. We realized after a CXR that the port was on right side. This was for a simple port flush. In my defense the patient held up the left side of his shirt. Even he forgot which side his port was on....

I do it the same way that mappers describes. I find feeling the port gives you a better gauge than just seeing it... and I work in pediatrics where some of the kids are so skinny from their treatment that the port sticks right out. I am by no means an expert on port-accessing (had a kid today who I couldn't get because he was moving too much) but I'm getting better at it. It does get better with more experience.