Port Access - Needle Securement

[Aurea, BSN, RN]

Hello,

The oncology nurses within my hospital system have been facing some challenges with securing port safety needles.  The safety aspect engages and begins to dislodge, putting patients at risk of infiltration. This problem is mostly seen in patients who are accessed for more than short term use and the pediatric population who tend to be more active during infusion. With the increased usage of implanted ports in the general patient population in the past few years, we are seeing more challenges.

They are securing using Steri-Strips, however, this blocks visibility of the insertion site. Is anyone else experiencing these issues?

What are your solutions?

Challenges?

[DavidFR, BSN, MSN, RN]

We have a foam block which goes underneath the arm of the needle to support it, which is then fixed in place by 3 steri-strips which are placed over the arm of the needle but not over the insertion site itself. We then cover with a transparent dressing: Tegaderm IV advanced is the current favourite.

We have full view of the insertion site and the needle stays in place. I'm in inpatients so the needles are often not for short term use. We don't have the problems you describe.

Is the problem with needle size or a cheap brand of needle? We use Qimoflow+ manufactured by Vygon here in France. 20mm is our standard length, sometimes using 25mm. For a very deep set port or a very obese patient we may go up to 30 or even 35mm but that's very rare. Sometimes people are tempted to go too big which leaves a less secure needle with too much exteriorisation. Provided you get a good reflux 20mm is usually fine for most patients.

[londonflo]

Aurea said:

The oncology nurses within my hospital system have been facing some challenges with securing port safety needles.  

Hello Aurea,

I am wondering if you are a salesperson since your profile says "design and innovation"?  If so, I would talk to a nursing clinical specialist (MSN) to develop a procedure for securing the needle and dressing changes. Best Wishes on your endeavors. I remember a world without infusaports and gosh, they are fabulous! 

[londonflo]

Aurea said:

They are securing using Steri-Strips, however, this blocks visibility of the insertion site. Is anyone else experiencing these issues?

, Steri Strips were never made to secure anything except at a superficial level. Taking out staples/sutures, yes we put some on but they are not going to keep dehiscence from happening. Sweat and any moisture will eliminate any adhesion provided by them. They are engineered to fall off, never meant to keep something like a port in place. 

[Aurea, BSN, RN]

londonflo said:

Hello Aurea,

I am wondering if you are a salesperson since your profile says "design and innovation"?  If so, I would talk to a nursing clinical specialist (MSN) to develop a procedure for securing the needle and dressing changes. Best Wishes on your endeavors. I remember a world without infusaports and gosh, they are fabulous! 

Londonflo, 
Thank you for reaching out and asking questions. I am not in sales. Our hospital system has a department that specializes in realizing the ideas and solving the problems our team members face and I am a part of that team. We do everything from create devices, to institutional use only solutions, workflow, culture, and IT. If we cannot find a solution or make a solution, we connect them to those who can. In this instance, a nurse from one of our vascular access teams came to me wanting to address the securement issues she is seeing in our inpatient population.  While some are careful to not block the insertion site, others are struggling to keep it in place without doing so. I am reaching out to see if this is a problem with our health system, a problem regionally, or one that encompasses a more wide spread area, what are their solutions, and where are their challenges. In addition to posting on nursing forums, I have also reached out to organizations like ONS, Moffitt, etc.

[Aurea, BSN, RN]

DavidFR said:

We have a foam block which goes underneath the arm of the needle to support it, which is then fixed in place by 3 steri-strips which are placed over the arm of the needle but not over the insertion site itself. We then cover with a transparent dressing: Tegaderm IV advanced is the current favourite.

We have full view of the insertion site and the needle stays in place. I'm in inpatients so the needles are often not for short term use. We don't have the problems you describe.

Is the problem with needle size or a cheap brand of needle? We use Qimoflow+ manufactured by Vygon here in France. 20mm is our standard length, sometimes using 25mm. For a very deep set port or a very obese patient we may go up to 30 or even 35mm but that's very rare. Sometimes people are tempted to go too big which leaves a less secure needle with too much exteriorisation. Provided you get a good reflux 20mm is usually fine for most patients.

David,

Thank you for sharing your experience. Our nurses are using a variety of needles depending on patient size and port placement.  I am sure some are choosing to go too large, however, on the whole I would say that is not a widespread problem as the most common used is 19mm (20G) in the adult population. I have seen that most do not support the wings and have been exploring why that is. As far as needle brand, they have just finished trialing several brands, choosing the one that was the most comfortable for the patients and users found easy to use. They landed on Bard PowerLoc. 

[DavidFR, BSN, MSN, RN]

 

I remember needles with wings but haven't seen one for about 10 years. When we switched to Qimoflow+ we thought it strange that there were no wings, but like most changes, once we got used to them we now think they're much better.

That said, I still don't remember the problems you mention with winged needles.