I'm currently giving Remicade infusions in a clinic setting and work alone (no other nurses). I have experience working with ports but my current patients usually have relatively good veins and get peripheral IV's. I have a new pt who had to get a port d/t inability to consistently have venous access. Her first port did not have blood return so another port was placed. The second port again had no blood return even after TPA instillation so a flow study was completed over 3 months ago. After the study, the port had blood return but the following infusion there was none. The patient refused the infusion without having blood return despite the study showing correct location, etc. The physician has spoken to the pt and the pt is now up for having the infusion but my question is how often should the flow studies be completed to show that no negative changes have occurred with the port? The one completed was way over 3 months ago (by this time) and since I can not get blood return, how will I even know if it is in the correct location? I understand that Remicade is not a vesicant but I'm not sure how comfortable I am with giving the infusion if I don't have recent information. Am I being overly cautious with this? Any and all information would be greatly appreciated. thanks
Mar 10, '17
Standards of practice say that a clinician MUST obtain a blood return, which is the color and consistency of whole blood from every IV catheter or you have a NON-functioning IV catheter and it should NOT be used to administer any medication until the problem is resolved.
Mar 10, '17
Hi IVRUS, that's what I've always said and what I've always followed but the physician/surgeon completely disagrees and says it's useable. Since there are no other nurses, I alone must advocate for me and the pt. I just wanted to make sure I'm justified in "digging in my heels" with this issue or if there was some other protocols if flow studies have shown correct placement (and how long those flow studies are good for). Thanks for the input!
Mar 10, '17
Hey Blu... What you've "always" thought is completely correct!!! Dig in your heels, and cite that this IS Infusion Nurses Society (INS) standards and if you were called into a court of law, your license would be questioned, not the MD.
Flow studies are good to make sure the line is open, but if it is, why aren't you obtaining a brisk blood return? I would hook on a 5 or 3 cc syringe as both of these exert less aspiration pressure with withdraw and slowly, pull back after you ensure patency of flushing with your 10cc syringe. ALso do a direct connect (minus the needleless connector)
And, what happened when Cathflo was instilled?
Mar 14, '17
Thanks for the tip! When I instilled the Cathflo the first time and waited the appropriate amount of time, blood return was still absent. When I went to instill it the second time per the protocol, the pt became very nervous and refused. We have been through this so many times, I'm afraid that without heparin or infusions of some sort, it has perhaps clotted or has a sheath formation (which is what the flow study showed previously but the radiologist was able to get blood return at the time).