PORT A CATH ISSUE!!

[mscelean]

MY PATIENT'S PORT WAS ACCESSED IN ER TODAY. UPON BEING ADMITTED TO MY FLOOR SHE NEEDED IV PAIN MED. WHEN DRAWING BACK I RECEIVED NO BLOOD RETURN AND WHEN ATTEMPTING TO PUSH THE SITE BEGAN TO SWELL. I D/C'd THE PORT AND BEGAN A PERIPHERAL. AN OLDER RN INSTRUCTED ME TO ALLOW THE SITE A CHANCE TO REST AND MAYBE ACCESS IT IN THE MORNING...I AM ABSOLUTELY UNSURE OF WHAT TO DO B/C THE RN WASNT VERY CONFIDENT IN HER ANSWER AND IM STILL A BABY RN. I FEEL LIKE ITS LIKE STARTING AN IV DIRECTLY WHERE IT INFILTRATED...YOU WOULDNT DO THAT SO WHAT DO I DO. GOTTA FIGURE SOMETHING OUT BY MORNING PLS HELP!

[IVRUS, BSN, RN]

MY PATIENT'S PORT WAS ACCESSED IN ER TODAY. UPON BEING ADMITTED TO MY FLOOR SHE NEEDED IV PAIN MED. WHEN DRAWING BACK I RECEIVED NO BLOOD RETURN AND WHEN ATTEMPTING TO PUSH THE SITE BEGAN TO SWELL. I D/C'd THE PORT AND BEGAN A PERIPHERAL. AN OLDER RN INSTRUCTED ME TO ALLOW THE SITE A CHANCE TO REST AND MAYBE ACCESS IT IN THE MORNING...I AM ABSOLUTELY UNSURE OF WHAT TO DO B/C THE RN WASNT VERY CONFIDENT IN HER ANSWER AND IM STILL A BABY RN. I FEEL LIKE ITS LIKE STARTING AN IV DIRECTLY WHERE IT INFILTRATED...YOU WOULDNT DO THAT SO WHAT DO I DO. GOTTA FIGURE SOMETHING OUT BY MORNING PLS HELP!

It is quite possible that the port needle become dislodged, or the needle used was too short and once saline was put into it in attempts to flush it, the saline went into the surrounding tissue instead of into the port itself. (It was saline that you were attempting to use first to ascertain patency wasn't it?) It was quite appropriate to d/c the non-coring needle, but if it was saline in the tissue, I would have reaccessed with the appropriate size non-coring needle and continued the process as long as I had a good, brisk blood return.

My concern now would be, if the port wasn't heparinized prior to removing the needle, is it now occluded?

Cathflo, to the rescue!!

[iluvivt, BSN, RN]

First can you find out if there was ever a blood return when it was accessed in the ED....also see if they used a 3/4th inch non-coring needle and you select a size up from that if they indeed did get a blood return that was good and not just pink tinged.....if they did not get a blood return at all. or you can not find out easily.. start from scratch....assess the port...feel for the septum...see if port is deep or shallow to determine needle length...if you select one that is too short and you never feel the back/click of the non-coring needle on the bottom of the port you may be barely in and with pt movement yes it can pop out. I have found this to be true of women with large breasts b/c as things shift with movement out it can come. So yes you need to try and access it b/c if it was accessed and got pulled out it could be clotted off by now. There is NO contraindication to re-accessing it again even if there was a slight infiltration at the site..it may be a bit challenging. but get someone who is comfortable doing it.

[HHRNurse]

I would not try to reaccess it without changing out the huber needle. It could have gotten moved/shifted since she was in the ER. You did good to start a peripheral line to give the patient their medication. I agree, let someone more experienced deal with it and let them teach you while they're doing it.

[iluvivt, BSN, RN]

Yes it is a sterile procedure and yes you need to use a new huber non-coring safety needle that is an appopriate gauge for the pts needs and appopriate length for the pts port. if is is a power picc you have to use a power injectable needle set IF you plan to power inject through it