Port-A-Cath

Published

Hello,

I was hoping someone had some advice on a port-a-cath issue. The patient has had her port for 2 years and is now complaining of burning when flushing and during infusions running at a high rate. A dye study was done and everything looks fine. Blood return is great and it isn’t hard to flush.

1
Up Vote Up Vote ×

Have they experienced it the whole time they have had the port or is this a new complaint? Sometimes if I flushed it too fast, pts would have this complaint. Can you slow down the infusion and see if that helps?

I would definitely still let the doctor know that the pt is still complaining though.

PS-thanks for helping make me feel like an oncology nurse again. I left it nearly 5 years ago for a different specialty that works better for my family and I miss it so much.

3
Up Vote Up Vote ×

This is a new complaint. The Dr is aware, but patient does not want to remove/replace port and is a really hard stick for a peripheral IV (3 sticks with no access last time).


Is it possible that the vein is just sore?

Would a larger gauge needle put less pressure on the inside of the port when infusing? I’m thinking the smaller gauge would cause the medication to put more pressure because the opening is smaller. That may be completely wrong. We use a 22 gauge now.

Up Vote Up Vote ×
Just now, Lucy2020 said:

This is a new complaint. The Dr is aware, but patient does not want to remove/replace port and is a really hard stick for a peripheral IV (3 sticks with no access last time).


Is it possible that the vein is just sore?

Would a larger gauge needle put less pressure on the inside of the port when infusing? I’m thinking the smaller gauge would cause the medication to put more pressure because the opening is smaller. That may be completely wrong. We use a 22 gauge now.

Yikes!

Yes, I would definitely try changing out the needle to a 20 gauge...I always used a 20.

I don't think it's because the vein is sore, I've never heard of that with a central line. The veins used are so large. Could it possibly be infected?

Up Vote Up Vote ×
Specializes in ER, ICU, Infusion, peds, informatics.

Where does it hurt? Near the port site itself or near the exit site (SVC), or somewhere along the path of the port tubing?

If anything around the port itself is painful, it indicates that the septum is leaking at least a little bit. Did the dye test confirm that there was zero extravisation, or did it just confirm that the tip is in the SVC (or IVC for a lower body port)?

Or is it possible that the needle you are using to access it isn't long enough and you are getting partial leakage into the subq tissues surrounding the port? Does the needle definitely hit the back plate of the port when you access it?

Infection is a possibility, but less likely since it only hurts when in use.

3
Up Vote Up Vote ×
17 minutes ago, CritterLover said:

Where does it hurt? Near the port site itself or near the exit site (SVC), or somewhere along the path of the port tubing?

If anything around the port itself is painful, it indicates that the septum is leaking at least a little bit. Did the dye test confirm that there was zero extravisation, or did it just confirm that the tip is in the SVC (or IVC for a lower body port)?

Or is it possible that the needle you are using to access it isn't long enough and you are getting partial leakage into the subq tissues surrounding the port? Does the needle definitely hit the back plate of the port when you access it?

Infection is a possibility, but less likely since it only hurts when in use.

The needle is definitely long enough. The pain seems to be near the body of the port, medially. There was some redness in the same area during the last infusion, but the patient was holding the painful area so I think it was from the pressure of her pushing.

The dye study found no evidence of leakage around the port and the catheter tip is in the correct location.

29 minutes ago, ihavealltheice said:

Yikes!

Yes, I would definitely try changing out the needle to a 20 gauge...I always used a 20.

I don't think it's because the vein is sore, I've never heard of that with a central line. The veins used are so large. Could it possibly be infected?

I don’t think it’s infected. No tenderness, redness, etc when not in use. Maybe we’ll try a larger gauge needle and see how that goes...

1
Up Vote Up Vote ×

Yeah this is odd. In IR we place, remove and check ports (when necessary). If the check under Flouro was unremarkable then I really don’t know what the issue could be. Plus you have +BR and no issue with flushing.

Definitely use a 20, I actually despise 22’s- they feel very flimsy when I Try to use them. How frequently is she getting infusions? Sounds like site irritation since everything else has been ruled out.

Maybe get the Dr to write an RX for Emla cream-It will at least make Huber insertion painless and the suqQ tissue pretty numb for a little while. Although this sounds like a rather ineffective solution I’m thinking it may have a placebo effect... Good luck. Let us know how it goes.

1
Up Vote Up Vote ×
4 hours ago, Lucy2020 said:

This is a new complaint. The Dr is aware, but patient does not want to remove/replace port and is a really hard stick for a peripheral IV (3 sticks with no access last time).


Is it possible that the vein is just sore?

Would a larger gauge needle put less pressure on the inside of the port when infusing? I’m thinking the smaller gauge would cause the medication to put more pressure because the opening is smaller. That may be completely wrong. We use a 22 gauge now.

And if she refuses to get it replaced/removed but still c/o site pain then it’s tough noogies for her ??‍♀️

2
Up Vote Up Vote ×
Specializes in Surgical, quality,management.

Get a set of cultures. This sounds inflammatory or infectious to me. The actual vein doesn't have pain receptors but the surrounding tissues and skin does.

If it is infected, out it comes and tough sticks for whatever time period is needed to clear the infection before a new device is inserted.

2
Up Vote Up Vote ×
18 hours ago, Lucy2020 said:

I don’t think it’s infected. No tenderness, redness, etc when not in use. Maybe we’ll try a larger gauge needle and see how that goes...

Twice I saw infections rear their ugly head ONLY when being flushed and infused. Now, that was an infected line, so the patient would spike a temp/get chills/complain of discomfort when flushed because flushing would push the bacteria into the blood stream which resulted in more of a systemic reaction.

I'm not 100% confident that it's an infection either (honestly, it was just a quick after thought), but just because you're not seeing anything physical on the outside doesn't mean there's not something necessarily going on in the inside.

1
Up Vote Up Vote ×

Sorry but If IR checked the port and noted any Possibility of infection they would have taken care of that right away. Rarely they’ll try PO abx first If they think it’s just a cutaneous reaction.

if the site isn’t swollen, extremely painful (constantly/not just during infusion), having any discharge and the pt is afebrile with no white count then it’s a fairly safe bet to rule infection out.

Up Vote Up Vote ×

What type of medication is involved here?

1
Up Vote Up Vote ×
+ Join the Discussion