Nurses refusing to draw pre-chemo labs through mediport b/c of infection risk?

[CharmedJ7]

I was talking to one of my inpatients today and she has a power port and told me that when she was getting her chemo tx, the nurses would now draw the pre-chemo labs off the port because of increased infection risk. To me this sounds like utter nonsense. Perhaps accessing the port solely for that purpose would increase risk, but assumedly she needs to be accessed anyway for chemo... The only thing I can think is the logic was that if the counts were not acceptable for tx then there was no reason to access the port at all, but this seems to me overly paranoid/not a good enough reason unless there was strong reason to suspect the person would not be able to receive tx. At the facility I was at during preceptorship anyone with a central line was accessed and labs drawn and chemo administered, no peripheral anything - isn't that one of the draws of ports? I just felt bad for her, I took a blood cx from her port as part of a pan cx and she said it was the first time anyone had drawn from it, and the surgeons had all told her that she would love it because it would save her sticks. And I tell people that all the time too...

Tell me - is it common to do this? It seems to me like a very strange (I'll even say bad) policy.

[SolaireSolstice, BSN, RN]

Not common for my unit. We access all ports if the patient has one, and use it exclusively unless it won't draw or if the lab HAS to be peripheral. However, many nurses who are unfamilar with ports simply ignore the presence of one. We get many patients up from other units with peripheral IVs, bandaids in various spots where blood draws were done, and an unaccessed port.

[mama_d, BSN, RN]

Unless there is a good reason not to, we usually access our ports on my floor. A "good reason" would be along the lines of pt presented with neutropenic fever, there are mental status changes and we suspect sepsis, etc.

However, I work on the oncology floor and accessing a port is no big deal for us. The other floors will actually call us to come and access ports if they have an order for it b/c no one else is comfortable doing so. Even the ED tends to ignore them...I had a pt come up not long ago with a femoral line and unaccessed port.

So no, unless there is a specific reason to suspect an infectious process is going on, or the pt is only expected to stay overnight and has good veins, our docs let us access the ports. It's one of the benefits to having them, so unless pt condition precludes it, why not get the order for it?

[Daliadreamer]

That doesn't make sense, poor patient! I LOVE when patient's have ports, because it allows them to save themselves from needlesticks for their comfort. Unless she had an infection from that port, or had one in the past, I don't see why anyone would NOT use the port! It seems like other RN's on your unit need to be educated on ports.

Unless this particular nurse doesn't usually follow infection control measures, there was no reason for her not to use the port.

[CharmedJ7]

Yeah, the weirdest thing is, it isn't even my unit (which is surg onc, but still we don't see too too many ports), it was the outpatient chemo center!!!

[iluvivt, BSN, RN]

Yes..it is OK to perform blood sampling from a Venous Access Port..it has the lowest infection rate ,along with PICCs of all CVCs. I have to tell you though there has been talk at many conventions with SHEA,APIC and IDSA that are suggesting that we consider not drawing from imtermediate -type and long -term VADs to reduce the infection risk. WHAT DO THEY SUGGEST....yes you guessed it..use the VAD for medication administration only and peripheral sticks for routine labs and to only use the VAD if you can not get blood from a traditional venous stick. I just can not see this as a viable option in the current HC setting. I think it is much better that we all learn how to properly scrub leur activated devices and caps and follow aseptic technique and take flushing of VADS seriousely.....b/c I can see all those agencies leading us down that pathway with the new push for a zero tolerance for catheter related bloodstream infections.

[steelydanfan]

The pt. has that port in for a VERY good reason, because they have had numeous sticks and we are TRYING TO alleviate sticks in a pt. with no access!

Use the port, utilize best practices in sterile technique and stop torturing your pt.s!

[KyPinkRN]

I'm in the ED and if a pt has a port more often then not we access it... depending on whether we think they are going to be admitted. However, most pt's who are sick enough to need a port do get admitted when they come to the ED. The only time when I have seen central access avoided is if blood cultures are ordered and the port/line itself is suspected as the source of the infection.

[steelydanfan]

Yes..it is OK to perform blood sampling from a Venous Access Port..it has the lowest infection rate ,along with PICCs of all CVCs. I have to tell you though there has been talk at many conventions with SHEA,APIC and IDSA that are suggesting that we consider not drawing from imtermediate -type and long -term VADs to reduce the infection risk. WHAT DO THEY SUGGEST....yes you guessed it..use the VAD for medication administration only and peripheral sticks for routine labs and to only use the VAD if you can not get blood from a traditional venous stick. I just can not see this as a viable option in the current HC setting. I think it is much better that we all learn how to properly scrub leur activated devices and caps and follow aseptic technique and take flushing of VADS seriousely.....b/c I can see all those agencies leading us down that pathway with the new push for a zero tolerance for catheter related bloodstream infections.

Since all central line draws are done by RN's, I see no point in singling out Mediports from PICCs. This thinking is just crazy to me, and if I were a pt. with a VAD; I would be making one hell of a stink.

[iluvivt, BSN, RN]

No...it is all central lines they are suggesting to avoid blood draws on..unless absolutely necessary. I am not saying I agree with this....I DO NOT...I am just reporting that suggestions is being tossed around by these agencies and associations.

[CharmedJ7]

I'm not sure I entirely understand the mechanism of infection risk from drawing from a VAD. I mean, with mediport there's the accessing itself which, if done w/o sterile technique runs the risk of infecting the port since you're puncturing the skin, your skin is colonized with staph and that etc etc. But for a PICC line? You clean the port thoroughly with EtOH or chlorhexidine, open a sterile package and draw the blood, then flush with sterile saline solution.... where's this huge infection risk?