Port-a-cath issues!!!!

jamonit · Feb 19, 2010

Seriously? NO WAY. it's a really, really bad idea. At a hospital in my state a nurse accessed a patient's portacath without blood return and hung chemo (a vesicant, mind you) and the woman had the medication eat through her chest tissue. THe port was no longer positioned correctly and leaked throughout her chest. So, no, dont do it. It's also against any and every infusion nurse guidelines.

iluvivt, BSN, RN · Feb 19, 2010

Generally speaking NO.!!!!.. You need to see a blood return to verify that you are in the portal septum. All kinds of untoward complications can occur if not used and assessed properly such as creation of a drug leakage pathway,skin erosion, portal separation.catheter damage or fracture,extravastion or infiltration into chest wall or body cavity..plus more.. So make sure you are in the portal septum and can feel a click of the non-coring needle on the back wall of the portal chamber,flush,aspirate for a blood return. There are all kinds of things you can do to try and obtain a blood return. First find out if you can the port history..has the port always given a blood return?...Has it ever needed Tpa? Does the pt have to put their arm a certain way or lie down to get a blood return? If you have a 22 gauge in the septum..consider re-accessing with a larger gauge. I do this all the time and then I easily get a blood return. ............If I have done my tricks.the next thing I do is look at the most recent CXR and usually order another or get the order..once I can see it on the CXR in the correct location I instill the Tpa if I suspect a thrombotic problem or a fibrin sheath or sleave.....If all of that fails I may ask for a cathetergram....it really depends on the whole picture....There have been a few situations. over the last 27 yrs..after we tried lots of things and did our cathetergram and everthing was peachy..and with MD approval and really good documentation we have used it...and even then I was still able to get at least some pink tinged return

Tolos · Feb 20, 2010

Thank you so much!!!! I do IV infusions on rheumatology patients. 2 to 3 of them have port-a-cath. For 21/2yrs since I took up this job, one of these Patient's port brings back only pink tinged blood and I've been able to draw blood only 2 to 3 times. I sent her to the hematology/oncology nurses who use ports daily they have same experience. They alteplased X2, no result, sent her to the surgeon who inserted it. He did a cathergram, sent a record saying everything is fine with it, no fibrin sheath, it is well placed. Pt came back told me the surgeon did not get blood return and he said that the nurse should feel the click and use it as it is without blood return or blood drawing. I refused and sent her to the chemo nurses. They accepted and said they will do her infusions as it is. Scary!!! Thank you for the confirmation that I have made the right decision.

iluvivt, BSN, RN · Feb 20, 2010

You did everything right!!!!...odds are it was placed from the left side Was it? and may have been butted up against the wall of the SVC THE brachiocephalic vein on that side is longer and takes a really sharp turn into the SVC.Left side ports tend to be more temperamental b/c of this. You did Tpa at least twice and I hope you put in enough volume....The cathflo gets mixed with 2.2 mg sterile water and you can leave it in for 2 hrs and on ports I do. After all that was done...I would feel safe using it,and documenting those events as well as the current assessment and include there are no s/sx of any port related complications observed. Yes as said we have had to do this on a few occasions

MacNinni123 · Jul 30, 2016

My daughter had a port installed about 3 months ago, which has not been right since the beginning. Blood return happened easily only once...the first access. Since then, she has had to do the dance, or had tpa instilled. Fluoroscope revealed a tiny clot at the top back of the port. Her arm has been swelling terribly with each infusion (yes, port is on the left) and her left hand becomes almost unusable. Both lower extremities are edematous, also, with the right one being the worst. She must spend most of her time lying down, with L arm and bil legs ups on pillows to keep it under control. She has one more infusion, and then the port is coming out. Docs are not happy she is insisting on having it removed, because she still has more chemo -- a lot more --- to get. She's been having Taxol and Herceptin weekly for a total of 12 weeks. Next she will get Herceptin alone weekly, for six weeks, along with daily radiation txs. Then, she will receive Herceptin every 3 weeks, until next May, for a total of a year's tx. I am a retired oncology nurse; have not practiced for five or six years, and, in fact, Herceptin is new to me. But, with all the rounds if chemo I infused via ports, I never had a patient with the kind of swelling my daughter is enduring. Since, the second infusion, when a blood return was difficult - and, because the area was swollen and very sensitive to the touch -- I have felt the port was incorrectly placed. Docs rejected removing and replacing, however, and encouraged her to continue, claiming all is well. And, even now, after she has demanded the port come out after the next infusion, the docs want her to keep that port. I can't imagine her suffering through nine more months with it (she is miserable), yet I find myself walking a fine line here when she asks my advice. She needs to complete the tx. The docs tell her she may not be able to finish the tx without the port, because she has had so much edema in the L arm that a good vein may not be found to continue IVF. They cannot use her right arm as the lymph nodes were removed there. She is asking my advice. I am very concerned about the clot and the edema. Yet, I am also concerned about her having to stop treatment. I am also a breast ca survivor x2. I had chemo and radiation the first time around in 1985, but it was a totally different tx than she is receiving now. Nineteen years later I had a mastectomy, although it was a new and different ca of the same breast. The first time around, I was not an R.N. My survival encouraged me to become an oncology nurse. So, the second time around, I was one and knew a little more. But, now a few years out of practice, I am bewildered....and, it is my daughter.....somehow, this is harder to face than my own cancers. Any thoughts are appreciated.

IVRUS, BSN, RN · Aug 1, 2016

Well most research points to the fact that when any central line is involved with a thrombus, but NOT infected, it should have a 4-6 hour slow drip infused of a thrombolytic agent ( TPA ).

If it is seeded with a bacteria, it should be removed.

And, where does the CXR say the tip is? Is it suboptimal? Is it in the ideal location of CAJ?

That alone can contribute to the problem. I know that you said a fluoroscopy was performed.. and that they found a small clot. Was this then ignored? The oncology nurses MUST NOT use this, or any other central line that does not give a brisk, free-flowing blood return that is the color and consistency of WHOLE blood, a pink tinged return is NOT acceptable.