Port Access Question

[bshaw96]

Hi there. I have a question about port access. I am a home health nurse and this has been a week for things I've never seen before. First a male foley problem, and now a port problem. 12 years of nursing, you think you've seen it all, guess not. Anyway, I went to do an admit yesterday for IV ABT thru the patient's port. The woman was not a heavy lady, but her port was not easily palpated and was in no way visible. And when I tried to palpate it, it almost felt "turned on it's side". And it seemed to be moving around. But I was eventually able to palpate the septum and access the device, but no blood return. I have had patient's that don't always get blood return, but she says she always does. Attempted to flush, and she complained of pain. So I deaccessed and repositioned the needle. Same scenario. I called her doc and he said to send her to hospital to have it checked out. The patient states it took them all of 5 minutes to access the port! Now I'm not new to ports, and have accessed plenty. She says the IV team nurse "told her to tell me" the port was tilted and there was a certain way to access it. It actually appears she accessed it upside down, as if she came from over the patient's shoulder if that makes sense. My poor patient couldn't remember the instructions nor the nurse's name for me to call, but I'll see what I can find out next week before the needle is to be changed. But I thought I'd see if anyone here had worked with a port like this, and suggestions. I'm actually just plain nervous about the whole thing now. And I've never had a problem with pacs.

[NurseyBaby'05, BSN, RN]

I wouldn't sweat it. This pt's port sounds like it's particularly ornery. We have a few of those. I would try to find out what the hosp's IV nurse did, but if you can't, you can't. We have one woman's whose PAC migrates too. We have found over the past few months that it's just easier to have her accessed in IR. Also, if this "migration" of this lady's PAC is new, it probably should be checked in IR to be sure it is still functioning properly.

[IVRUS, BSN, RN]

Hi there. I have a question about port access. I am a home health nurse and this has been a week for things I've never seen before. First a male foley problem, and now a port problem. 12 years of nursing, you think you've seen it all, guess not. Anyway, I went to do an admit yesterday for IV ABT thru the patient's port. The woman was not a heavy lady, but her port was not easily palpated and was in no way visible. And when I tried to palpate it, it almost felt "turned on it's side". And it seemed to be moving around. But I was eventually able to palpate the septum and access the device, but no blood return. I have had patient's that don't always get blood return, but she says she always does. Attempted to flush, and she complained of pain. So I deaccessed and repositioned the needle. Same scenario. I called her doc and he said to send her to hospital to have it checked out. The patient states it took them all of 5 minutes to access the port! Now I'm not new to ports, and have accessed plenty. She says the IV team nurse "told her to tell me" the port was tilted and there was a certain way to access it. It actually appears she accessed it upside down, as if she came from over the patient's shoulder if that makes sense. My poor patient couldn't remember the instructions nor the nurse's name for me to call, but I'll see what I can find out next week before the needle is to be changed. But I thought I'd see if anyone here had worked with a port like this, and suggestions. I'm actually just plain nervous about the whole thing now. And I've never had a problem with pacs.

It sounds like you have an implanted port which the MD erroneously placed too deep in the pt's chest wall given the breast tissue present. I hate it when MD's do that! However, a couple of suggestions...

1. Be sure to access the port while that pt is lying flat in bed. By doing this, you'll be able to get a better feel for the margins of the port which will enable you to steady it when you need to access it.

2. Use at least a 1" huber if not 1.5". If you are having alot of tissue to go thru, your needle has to be the appropriate length. Remember that the port body is sutured into a subcutaneous pocket and if there is alot of SQ tissue....

3. Keep your non-dominant hand on the margins of the port body whle accessing.

4. Accessing from the shoulder, or next to the pt's head is do-able, but may not provide any real benefit in reality. Your goal is to get a good grip on it so it will not be mobile during the accessing procedure. This should be accomplished no matter where you stand.

Hope this helps. DD:nurse: