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,
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.
Surely you must do sterile procedures in the ER all the time, though. Do you never put in foleys? Never do an LP? Never place a central line?
Patients with ports generally have complex medical conditions that require frequent IV treatments. The port is there to maintain reliable IV access. The ports not going to always be there, and the patient is stuck with the same veins for the rest of their life. Why further traumatize peripheral veins when they have a port right there? If you clean the access site adequately and get a dressing over it (at my hospital, everything you need is in one kit together) it's not going to get infected. The infection is FAR more likely to come from the hub not being adequately cleaned with alcohol or dirty tubing being connected than from the accessing of it itself.
We rarely use ports in my unit. Even if a patient has a port one one side, they always have a central line on the other. I've maybe accessed an IVAD twice in the last year. But I can still say with confidence that it's an easy procedure. The hardest part is getting the backing off the tegaderm.
blondy2061h, MSN, RN
1 Article; 4,094 Posts
Surely you must do sterile procedures in the ER all the time, though. Do you never put in foleys? Never do an LP? Never place a central line?
Patients with ports generally have complex medical conditions that require frequent IV treatments. The port is there to maintain reliable IV access. The ports not going to always be there, and the patient is stuck with the same veins for the rest of their life. Why further traumatize peripheral veins when they have a port right there? If you clean the access site adequately and get a dressing over it (at my hospital, everything you need is in one kit together) it's not going to get infected. The infection is FAR more likely to come from the hub not being adequately cleaned with alcohol or dirty tubing being connected than from the accessing of it itself.
We rarely use ports in my unit. Even if a patient has a port one one side, they always have a central line on the other. I've maybe accessed an IVAD twice in the last year. But I can still say with confidence that it's an easy procedure. The hardest part is getting the backing off the tegaderm.