Port-A-Cath

[KaraB]

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.

[KaraB]

2 hours ago, JKL33 said:

What type of medication is involved here?

IVIG, Soliris, and fluids occasionally

[KaraB]

On 3/3/2020 at 8:51 PM, DextersDisciple said:

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.

Infusions are 3 days in a row, every 14 days. Days are long...8+ hours of constant use.

[ihavealltheice]

9 hours ago, Lucy2020 said:

Infusions are 3 days in a row, every 14 days. Days are long...8+ hours of constant use.

That's good info to know. Does she keep it accessed all 3 days? The area might be getting irritated if it is in 3 days in a row or conversely, maybe if she's poked 3 days in a row, that may be the source if irritation.

14 hours ago, DextersDisciple said:

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.

Very true.

[mermer_rn, BSN]

What type of port is it...a power port or other? Is it a subclavian or jugular? The reason I ask is that I have had experience with a non-tunneled cath that caused pain when flushing. There was some evidence of first rib pinch syndrome....so when a particular lumen was flushed, the cool temp of the fluid and the pressure of the expanding catheter against the bone caused a "burning" sensation. Also, even though fluoroscopy was done, I have seen one that was missed...a fracture to the body of the port itself that acted a bit like a flap...so when we would draw blood, the back would suck in and close the fracture and we would get great blood return, on slower rates it was fine but when flushed or higher rates were done the back of the port that had separated from the body of the port would flap open and a bit of leaking occurred. I also had a woman who experienced burning and we did we imaging and fluoroscopy and couldn't find anything...the she came back and no pain, only thing she could figure is she had spent the weekend with her 2 year old granddaughter who had bumped or rested her head right about where the catheter was. Either way...I would use your nursing gut feeling.

[KaraB]

8 hours ago, ihavealltheice said:

That's good info to know. Does she keep it accessed all 3 days? The area might be getting irritated if it is in 3 days in a row or conversely, maybe if she's poked 3 days in a row, that may be the source if irritation.

Very true.

It depends on the week. We usually access twice. She doesn’t like to leave it in for 3 days, but is willing to leave it in for one night. I don’t blame her..it can’t be super comfortable to sleep with a needle in your chest.

[KaraB]

5 hours ago, mermer_rn said:

What type of port is it...a power port or other? Is it a subclavian or jugular? The reason I ask is that I have had experience with a non-tunneled cath that caused pain when flushing. There was some evidence of first rib pinch syndrome....so when a particular lumen was flushed, the cool temp of the fluid and the pressure of the expanding catheter against the bone caused a "burning" sensation. Also, even though fluoroscopy was done, I have seen one that was missed...a fracture to the body of the port itself that acted a bit like a flap...so when we would draw blood, the back would suck in and close the fracture and we would get great blood return, on slower rates it was fine but when flushed or higher rates were done the back of the port that had separated from the body of the port would flap open and a bit of leaking occurred. I also had a woman who experienced burning and we did we imaging and fluoroscopy and couldn't find anything...the she came back and no pain, only thing she could figure is she had spent the weekend with her 2 year old granddaughter who had bumped or rested her head right about where the catheter was. Either way...I would use your nursing gut feeling.

It’s a power port! I feel like something is off. The patient doesn’t typically complain and the port has been fine for the 8+ months I’ve been working with her. The whole scenario is odd, but I guess we’ll see what happens.

[DowntheRiver]

Are you doing a hep lock? Some places do, some places don't which is why I ask.

I had a patient develop a sensitivity to heparin that turned into a full blown allergy and it started with irritation/itching in the septum of the port.

[KaraB]

31 minutes ago, DowntheRiver said:

Are you doing a hep lock? Some places do, some places don't which is why I ask.

I had a patient develop a sensitivity to heparin that turned into a full blown allergy and it started with irritation/itching in the septum of the port.

Yes, we do a saline flush and then a hep lock.

[DextersDisciple, BSN, RN]

3 hours ago, DowntheRiver said:

Are you doing a hep lock? Some places do, some places don't which is why I ask.

I had a patient develop a sensitivity to heparin that turned into a full blown allergy and it started with irritation/itching in the septum of the port.

Interesting point ??