Patient with a Port

NurseKitten, MSN, RN · Jul 11, 2009

Ask your surgeon or anesthesiologist to write an order that if the anesthetist is not familiar with how to access your port, someone from IV Therapy or Oncology come start the line and be available to help troubleshoot any issues.

I know how to do it, because of my years in dialysis, but many of my SRNA classmates don't have that background.

It doesn't mean they're a poor CRNA, just that they haven't been exposed to it.

SuzieQ1959 · Jul 11, 2009

They did end up paging Oncology to come do it ... The nurse that came up was so sweet. She seemed a little PO'd that they paged her, and that they didn't know how to use it.

Doris Anne · Jul 11, 2009

I guess the nurse are not familiar it yet. I myself dont encounter that stuff so i would not do it by myself unless their is someone could guide/teach me.

miss81, BSN, RN · Jul 11, 2009

Well, our OR nurses would use it. If they were not comfortable they would call a nurse from the surgery unit to access it before the patient leaves for the OR and have some saline running slowly or have it heplocked, but accessed! I guess they don't have that skills as not everyone is familiar with accessing ports, but that seems strange since the ports are placed in the OR and must be accessed before you are discharged from the hospital (at least at my hospital). There have been times that the oncology nurses have come to help a new nurse access a port but that's what you have to do sometimes when you are not familiar with a skill and next time you will be! Ports are great and I think it was a good decision for you to have it placed. Good luck with your next encounter at the hospital, glad you stuck up for your rights...

catshowlady · Jul 11, 2009

I would guess (and it's only a guess) that they are unfamiliar with how to properly access & use it. I know that when I was in nursing school, we talked about special lines like Groshongs and ports, but I don't even remember seeing them in lab. We got to see, but not realistically use, triple lumen central venous catheters, but that was it.

I was really lucky to be exposed to a port insertion by a very experienced RN during my orientation period after I was a new nurse. I still don't access them often, and I have to pull my hospital's policy and review it prior to doing it.

I know if I am not sure about something, I don't do that skill without help. I would be afraid, in your example, of damaging the port or otherwise harming you. Heparin is used to lock most ports if more than a few hours will pass before the next use. Heparin is considered a very high risk medication, so that adds a dimension of risk that you could be harmed by a nurse who doesn't know how to use the port properly.

If the nurses seem reluctant, I don't think it is out of line to suggest that they see if an infusion or other experienced nurse can help.

rngolfer53 · Jul 11, 2009

My name is Sue.
I have a question for all you nurses. Especially anestesia (sp?) nurses. I am in poor health, I am Type-1 diabetic, anemic, and have chronic blood clots, due to limited mobility from rheumatoid arthritis, I have 2 artificial elbows as a result. I've developed arthritis as a child. So from years of health issues, my veins are totally shot. My hematologist recommended that I have a Port-a-cath implanted in my chest. So i did. NOW why the heck won't any of the nurses use it !?! Whenever I go for iron treatments for my anemia, the oncology / hematology nurses always use it.
I went in for a D&C last week, and I had to fight to get them to use it. They all stood around like they had never seen one before. I know it requires a special needle, flush, yada-yada. However the nurse that checked me in GAVE them the needle, they taped it to the chart! I know a phlebotomist can't use it, but shouldn't an anesthetist be able to use one??? I gave the nurse a hard time about getting a line in me, cause I am an impossible stick, and I just don't want to be jabbed over and over, afterall, thats why I have the port. After the trouble I had getting the port in, I went into Ketoacidosis post op.
I just wonder what the reason is, nurses never want to use it? Is it really that dangerous to use????
Hopefully I didn't sound like just another ***** of a patient,
Still not feeling well.

I'm sure this was frustrating for you.

Nurses' skills and experience are largely dictated by the particular unit they work on. If they don't see ports often, they're probably not going to be confident of safely accessing them. But they should get someone who is familiar with them, and then get the unit to set up an in-service so the next Pt can be promptly treated.

The rule of "First, do no harm" should always be on a nurse's mind. :twocents:

blondy2061h, MSN, RN · Jul 11, 2009

I work in oncology, so obviously we use them. It drives me nuts if one of our patients gets admitted from an ER and the port isn't accessed and they have a peripheral. What the heck, it's there for a reason.

DoeRN · Jul 11, 2009

In the hospital that I work at you have to be port certified to access them which I am. Not all nurses work with and would have no clue how to access them, how to keep them sterile while doing so. In some units they are rare. There is a special technique you have to use to access them. And no it is not as easy as sticking a needle in them. I like them it makes our lives easier and especially the patient. They always tell me how they love that they have a port-a-cath because they don't have to be stuck everyday.

Oh and blondy20161h it drives me crazy too. The ER nurse are port certified and lately it has been hit or miss. It takes LESS time to access a port than it does to start a peripheral. Go figure. I can see if EMS started it but my goodness you need to get labs and sometimes you can or can not get a blood return from a peripheral.

zamboni · Jul 11, 2009

I work in oncology, so obviously we use them. It drives me nuts if one of our patients gets admitted from an ER and the port isn't accessed and they have a peripheral. What the heck, it's there for a reason.

I'm ED, and I'll explain why I don't always access the port.

The ED is a filthy place. The nurses are filthy. This is just because of the number of patients that role through a shift. Even when we clean, in my mind it's still gross. We don't have housekeeping come in every time we turn over a room, we do it in a few minutes typically. Yeah, I do have high standards for keeping my rooms clean, but it's still a five minute-wipe down the mattress/counters/call light-and throw a clean sheet down-kinda clean. The trash may have trash from previous patients, as does the linen cart in the room. I've had contact with 30 or so patients straight in from the world, carrying God only knows what...hand washing can only do so much.

Now, accessing a port is a sterile procedure. An infected port is a nightmare for a patient (and most patients with ports are compromised anyway). Yes, we do maintain sterile technique when we access, but the environment itself is less than optimal. If I can throw in a quick PIV without causing stress to the patient, I'll leave the port for the nurses upstairs in their clean rooms that access several ports on a daily basis (I access ports maybe 2-3 times a month). I won't torture a patient with multi sticks, and I'm not scared of accessing a port (I actually kinda enjoy the procedure). But I prefer not to fool with it if I have any other quick, easy options, and the patient is ok with it. I'll explain my rationale when I give report, and every floor nurse I've handed off to appreciates it.

zamboni · Jul 11, 2009

Oh and blondy20161h it drives me crazy too. The ER nurse are port certified and lately it has been hit or miss. It takes LESS time to access a port than it does to start a peripheral. Go figure. I can see if EMS started it but my goodness you need to get labs and sometimes you can or can not get a blood return from a peripheral.

Heh...not me. I can have a patient with decent veins lock-and-labbed in the time it takes me to just get the port supplies all pulled together. Port supplies are scattered in two different supply rooms (don't ask!). PIV trays are right there. I do many PIVs a shift, where as I do maybe 2-3 ports a month. I can do PIVs in my sleep vs having to stop and roll through the port procedure in my head before I start.

PAERRN20 · Jul 12, 2009

Haven't read all the replies...but I'll add my :twocents: anyways. As an ER nurse I start many PIV's in a day. I can even get those who have the bad veins. I personally feel way more comfortable starting an IV. That said, I do access a port if the patient has one. I think it comes for nurses being more comfortable with standard PIV access.