Port-a-cath question - page 2

I guess I have really only seen port-a-cath's placed on the chest, not accessed. I was precepting another nurse the other day and we had a patient that had a port-a-cath already accessed with a huber... Read More

  1. by   ShantheRN
    I'm still confused about why the cap (assuming you mean cap in that last post instead of hub?) needs to be changed every time you access the line. Definitely check your P&P asap!

    Oh and.....for lab draws it should be flush/check blood return, waste, draw sample, flush, and hep flush. If there aren't any fluids going, the last thing you want going into the line is heparin
  2. by   Anna Flaxis
    Quote from Curious1alwys
    It's a group home so not sure they do anything with sterile gloves. We did mask however. So I think I have the first part down....flush 10-20 cc, pull sample, flush 5 cc hep, flush 10 cc NS, all push pause. As far as hub caps, this line is being accessed every AM for a blood draw, sometimes more frequent within 24 hrs. The line is definitely being opened as we are pulling off the hub and putting a new one on. Even the hub was equipment I hadn't seen and we had a very tough time getting the hub off for some reason.
    Okay, your flushing procedure is incorrect.

    Confirm blood return.
    Flush with 10cc NS.
    Waste 10cc.
    Draw sample.
    Flush with 20cc NS.
    Flush with heparinized NS, 5cc or per policy.

    The rationale for wasting between your flush and your draw is that when you flush, there will still be NS in the catheter and the dwell (part of the port), and this will dilute your sample, altering the results.

    You flush with 20cc NS after blood draws to remove blood components from the inside of the lumen that want to build up and cause occlusion and/or provide a hospitable environment for bacterial colonization. Flushing with the heparin last means that the heparin will be inside the dwell and the lumen of the line. If you do your heparin, then your NS, then you're just flushing out the heparin with NS, which makes it completely pointless to use heparin.

    Also, just a terminology issue: The "hub" refers to the end of the line, which you attach the injection caps to. You should not be changing the hub.

    You can draw blood through the caps, but if you do so, the caps should be changed. The rationale is that blood components can remain inside the cap, providing a hospitable environment for bacterial colonization.
  3. by   Curious1alwys
    Ok, thank you so I think I get it now.

    Sorry for the incorrect usage of the terminology. I meant caps as far as what is changed, not hubs. I realize now the caps are being changed with every blood draw because there are no fluids running.

    Thank you for the info on the flushing, this is what I will do. Blood can be drawn from the caps. So the whole procedure can be "clean" but what about the last step when you go to change the cap out? Is it OK to be clean then too or should you be sterile with a mask and sterile gloves?

    Also, in between all the flushing and sampling, are you swabbing the port with alcohol?
  4. by   ShantheRN
    These are the parts that will vary by facility. At my hospital, cap changes are always sterile technique. It seems clean technique is used at the adult hospitals around here. You don't need to swab the cap between syringe changes as long as everything stays sterile, as in.....the tips of your syringes don't touch anything but the previously cleaned cap, and your cap doesn't come into contact with anything else.

    And no need to apologize about the terminology stuff. I'd just gotten home from work and my brain was too tired to figure it out lol I just wanted to make sure I understood. Hope this helps!
  5. by   sauconyrunner
    Jumping in here just to encourage you to actually find the policy for your company, rather than simply relying on all the very good advice you got here.

    The reason I encourage you to do this is because if something does happen- a patient gets a bad blood stream infection, after you access the port, and you are asked to say how you accessed the port etc. You will not want to say, "I found the procedure from a post on AllNurses on line." You see how that would sound? Plus you need to follow your agencies policy and procedure so that you are covered by the Agencies Malpractice insurance.
  6. by   Anna Flaxis
    Agree with the above. That's why I won't give any more information; not to be rude or unhelpful, but because patient safety and your liability are at risk. I will add to the chorus and encourage you to consult with your facility on this.
  7. by   Curious1alwys
    Thank you everyone. I understand. I am in the process of finding out if P&P'S actually exist. Seems this place is so disorganized I don't even know who to ask!
  8. by   lumbarpain
    Anytime there are new procedures in a facility, I FEEL that all nurses should get a practical on hands inservice by a seasoned Infection Control nurse on this topic who performs this procedure often. However, this isnt the case in the real world......usually a patient comes in and whammmo everyone gets a crash course.!!!! Or you learn from the previous shift nurse how she does it.... then you are a wreck questioning your own practice, having overwhelming anxiety on if you are doing the correct thing. I found this irritating and very stressful. ALWAYS review your facilities policies....and if they dont satisfy you, you should go to the DON or Nurse manager and request proper protocol to be done.
  9. by   SamTastic RN
    I agree with the need to read and know your facility policy for lab draws from ports and CVC's.
    Clean technique is fine for draws BUT, if you are going to expose the lumen of the port for any reason this becomes a sterile procedure.
    I am the ADON for a Home Health agency and have 17 years experience in Critical Care Nursing. I have done many draws, dressing changes and access / deaccess procedures in the field.
    The guidance I provide my Nurses is that 1) there is no such thing as "too clean" and 2) everything else aside, everything you do will affect some one for the rest of their life, good or bad.
    I do not draw through injection caps for a couple of reasons.
    First, the more turbulent the draw, the greater likely you are to lyse the blood cells, resulting in inaccurate lab results. Second, blood does collect and stagnate in the injection cap and could become infected, becoming systemic when the stagnated and infected blood is flushed through the cap.
    In that light, this makes every lab draw a sterile procedure as I remove and replace the cap each time.

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