Needed: Tips to access a port a cath painlessly

[eyzsogreen]

I have been working in oncology for 2 years now and access power ports (port a caths/medi ports) on a daily basis. I am able to access the ports successfully with positive blood return aspirated, usually with no difficulty. However, recently many of my patients complain about the pain from the Huber needle stick (even after using EMLA numbing cream and/or spray). Also, many of them state that my coworker does not hurt them when she accesses their ports. They cannot tell me what she does differently and I have asked her to watch me but she won't. (I have been a nurse for 14 years and worked ER mostly. So, I had previous experience, although limited.) I do make sure the chlorhexidine cleanser is dry before I stick, and I stabilize the port with my non dominant hand. Please any other tips would be appreciated. I do NOT want to hurt my poor cancer patients!!

[JKL33]

- Are the patients applying the EMLA prior to the encounter or are you applying it? If the latter, you could double check whether it's on the skin for the amount of time they are used to.

- Make sure you're using mostly wrist motion and not pressing down into the chest with your arm/hand (using uncomfortable/unnecessary pressure) - this is pretty common when people don't stabilize the dominant/needle-holding hand.

- Are there other dynamics with this other nurse who refuses to proctor you on this? What is your relationship like? I hate to suggest it, but any chance she is sabotaging you by bad-mouthing you to patients? Or...in fairness, does she just have longer-established rapports with the patients and they are skeptical of a newer person?

[Wuzzie]

Do you insert slowly or commit to the stick and just do it. The faster you do it the less it hurts. I use a darting motion with my wrist making sure not to hook the needle. I also don't count or tell them to take a deep breath. Instead I distract them with conversation (usually a little irreverent) get them laughing and it's done before they know it.

Your co-worker is a jerk. I never decline assisting my peers when they ask for help improving their skills. And even though I have an established rapport with our patients I always talk up my coworkers with them.

[Daisy4RN]

Good advise from above posters. Do you have a different coworker or educator that would be willing to watch you and offer advice? I also think that nurse who refuses to help you is a jerk!

[iluvivt, BSN, RN]

All good suggestions above.Make sure you are applying enough Emla or equivalent and it needs to stay on a least one hour prior to the puncture.More importantly is how you perform the access. You should not touch the the needle to the skin and then push down but rather stabilize the port with your non=dominate hand and insert at a 90 degree angle using what I call a controlled fast poke or jab.You can use wrist action if that helps you to do a controlled fast poke that that starts a few cm above the portal septum.Does that make sense? Also, make sure you have your patient in a good position to access because it make a diiference. I prefer pt on a bed or gurney with shoulders flat on the bed with HOB no higher than 30 degrees.I will do it in a chair if the septum is easily palpable and

and the patient can lean back with shoulders to back of chair. In the 2016 INS guidelines they had a very specific recommendation about where to access...will find it and post it.The other thing you may want to consider is the needle gauge and product you are using.I find the Bard power loc to be a bit dull so if I have to use it I compensate by increasing the speed by which I perform the puncture.Have you changed products? What are using.Use the smallest gauge that will allow to administer the prescribed therapies.Also remember that the skin over the septum will become desensitized the more it is used.Just remember that even though many things we do cause pain or discomfort the minor pain involved in a port access is minimal compared to all the benefits the patient will be receiving from their IV therapies.

[AnnieOaklyRN, BSN, RN, EMT-P]

I work on an iv team ans we infiltrate the area with lidocaine prior to accessing ports if the patient wants it, instead of elma.

[Wuzzie]

I'm not a huge fan of EMLA purely from the psychological aspect of it. I've had patients freak out when their port needed to be accessed unexpectedly and there wasn't time for EMLA. Most patients don't need it but if they want to use it it's no skin off my nose. Another technique I've learned is if you stretch the skin a little immediately prior to insertion of the needle it seems to blunt the pain response. I really don't know the science of it but I wonder if the stretch receptors in the skin at the site are triggered and it slows the pain impulse to the brain.

[iluvivt, BSN, RN]

I rarely use any topical anesthetic because to be honest rarely do my patients conplaim of that much pain.I just dart them in fast at a 90 degree angle unless I have the rare side port entry or a very deep one.We had an old very high profile port that had been placed about 12 years prior and it was literally under the patients breast .I took a friend to access that one and had her do it too and we had to borrow an inch and a half non=coring needle from a sister hopspital.

[IVRUS, BSN, RN]

I rarely use any topical anesthetic because to be honest rarely do my patients conplaim of that much pain.I just dart them in fast at a 90 degree angle unless I have the rare side port entry or a very deep one.We had an old very high profile port that had been placed about 12 years prior and it was literally under the patients breast .I took a friend to access that one and had her do it too and we had to borrow an inch and a half non=coring needle from a sister hopspital.

Hey ILUVIVT... Good to see you on! I just deplore those ones placed deep in a woman's breast tissue... Auughhh!! But I just wanted to say that along with the quick entry through the skin and into the septum of the port, what I found that works well to decrease pain for the patient is this: When using your non-dominant hand to hold the port steady, also use your thumb and forefinger to spread the skin taunt as you enter with your dominant hand. This decreases the painful sensations too.

[Wuzzie]

Hey ILUVIVT... Good to see you on! I just deplore those ones placed deep in a woman's breast tissue... Auughhh!! But I just wanted to say that along with the quick entry through the skin and into the septum of the port, what I found that works well to decrease pain for the patient is this: When using your non-dominant hand to hold the port steady, also use your thumb and forefinger to spread the skin taunt as you enter with your dominant hand. This decreases the painful sensations too.

I mentioned that earlier. I'm still trying to figure out what the physiologic reason for it is. Do you know?

[VioletKaliLPN, LPN]

I access and flush my own port q4weeks. It has never hurt, but I am a quick stick. I commit and just go for it!!