Port Access Question

IVRUS, BSN, RN · Oct 25, 2007

Any help is greatly appreciated.
I'm a hospice nurse with a patient with stage III-IV lung cancer.
She has an implanted port to her right chest wall, it is quite visible and easily located.
In the critical care hospital setting, we had always used 20guage, 3/4" huber needles, and since december 2006 this patient has insisted on this port being accessed every 8 weeks (as she had been having chemo and it was accessed with that frequency before choosing to stop treatment). Her doc was more than happy, (after patient fussed at him a good 15 minutes), to write an order for hospice to maintain her port (every 8 weeks as she was adamant about---as she told her oncologist that the surgeon told her she would "get an infection" if it wasn't accessed and flushed with that frequency).
The last time I accessed and flushed it, following sterile procedure; she stated that "it hurt for a week" (granted, she said nothing that day and was in a hurry to meet a friend for a lunch date). Well, my last visit, she says "it hurt the last 3 times...the last time it hurt for a week, you need to use a smaller needle. She stated "it NEVER hurt when nurse so and so did it at Dr. K's office...etc. Frankly if she prefers to have it done there, it needs to be done there. She doesn't want to go there because the doc said that he would have to charge her separately (as now she is under hospice and we do have a policy and procedure for port access).
In the hospital setting, I recall patients that had their ports for several years and had not been accessed until they had eventually had another illness.
Her hubby now has a port and she had the wrapper from his last access (it was a 20gauge that is 3/4" which is what I had always used for her).
((I was reading an article about distraction in children, and I have noticed that when her port is accessed, she attempts to look down and is highly anxious (this has been with each access in the last 11 months))
Is it NORMAL for a patient to have their port accessed every 8 weeks even if they aren't getting ANY bloodwork or medications through said port. I am concerned as she isn't having any fevers or for that matter, actually declining since we started services 11 months ago.
I always get blood return and there is no redness or swelling and I follow procedure. If she says it hurts her then it hurts her...pain is pain.
Any information is greatly appreciated.
Thank you.

Well,

There is some things that I would do differently... Number one being I would use a 22g 3/4 " huber to access the port. You will save on the life of the port by using a smaller needle, plus it will hurt less. In addition, when you access the port make sure you are holding the skin taunt with your non-dominant hand. This also decreases the pain sensations. INS (the national organization who sets standards for IV therapy) states that an implanted port should be flushed monthly. Can a port be flushed q 8weeks instead? Yes, but it isn't the standard.

I usually get a brisk blood return using 22gauge huber and if I don't, I will reaccess with a 20g, but usually this won't yield either and it's Cathflo time.

If a port hasn't been flushed in "years" I wouldn't access it. I'd worry about the fibrin sheath that is on its distal end and throwing clots &/or throwing a storm of bacteria into the vascular system.

Hope this helps.

AtlantaRN, RN · Oct 25, 2007

THank you sooo much!

I looked online and ordered a #22 gauge 3/4" from sterling medical. It should be in by the time it's port access time.

thanks again

PICC ACE · Oct 26, 2007

If the patient's only pain associated with the procedure is from the stick itself,you could have her ice the area for 30" before you are scheduled to arrive. You could also look into getting her a tube of EMLA cream that she could apply and dress herself prior to your arrival. Either way should numb the area enough to make for a pain-free stick. It will also allow her to participate in her care in a way that she has some control or responsibility in the matter.

Good luck.

WyoRN3 · Oct 29, 2007

I work in an ambulatory care setting to which we frequently flush ports. Our policy is to flush every four weeks to maintain the line. We also use use lidocaine before port access, although we do have one lady who said her former doctor used a numbing spray, so of coorifice she is not to pleased with the lidocaine injection.

iluvivt, BSN, RN · Oct 31, 2007

sounds like you got your answer use the 22 gauge by the way for future reference ports not being used should be flushed at least once monthly----- his is an INS recommendation as well ) this keeps fibrin and clotting problems to a minimum---also be adviced that non-coring needles come in many configurations ranging from 24g to 18g and from 1/2 inch all the way to 2inch you should only use the 1/2 inch on pas ports---- never on chest port because it will barely make it past the septum ---the longer one I had to special order for a peritonal port and had to go down to radiology to assist with access generally you will see the 3/4inch and the 1inch. this may not help your pt but over time the skin over VAP's does become desensitized also get some Emla cream for the pt here you are trying to help and you have to hear that someone else did not hurt them also keep the skin tight while acessing and make a very controlled precise speedy jab---is that asking too much

PILOT3 · Aug 7, 2008

I need help! I have accessed many mediports without any problems until now. (Wouldn't you know its a friend of mine). The port is about three years old. I have had trouble accessing it the last three months. Today I tried twice. First time the needle needed way to much pressure so I stopped and started over. The second attempt felt like I was pushing the needle through styrofoam. She was lying at a 45 degree angle. It was a one inch huber. (i have found one inch is better and she is overweight). Port is just above right breast. I was holding the edges with my nondominant hand. This has happened sitting up but I usually get it lying down. I am just stumped. Any ideas? I HATE MISSING! :no:

accessqueen · Aug 7, 2008

Ports are sutured in place, usu one suture on either side, (underneath the skin). Sometimes these sutures become loose making the port very difficult to stabilize when accessing. Some docs only suture one side cause they're in a hurry. These ports too can be hard to access due to instability. You might want to have the doc order a flow study to check position.

also when women are large breasted, or the port is just buried in breast tissue, the higher they sit up the better, because the breast tissue then is below the port.

infusionRN · Aug 8, 2008

I have seen the port actually turn upside down. I would get a chest x-ray or even better dye study ordered to check for port problems. I would call the MD that implanted port or current MD and ask for this to be done.