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port accessing tips.

Oncology   (32,301 Views | 38 Replies)
by busybee04 busybee04 (New) New

1,488 Profile Views; 7 Posts

Hi,

I am fairly new to the oncology field, and have minimal experience accessing ports. I have successfully accessed ports in the past, however, I did miss the last two ports I attempted to access (not sure if I hit the edge). I do take my time feeling for the port. Maybe my more experienced nurses have some tips they would like to share so I more efficient in accessing ports.

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melizerd is a ASN, RN and specializes in Med/surg, Onc.

461 Posts; 8,639 Profile Views

I can usually feel the center of the port, it's slightly squishy. I can't say I've missed one ever though either. So maybe just bad luck?

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FlyingScot has 28 years experience as a RN and specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.

2,016 Posts; 21,718 Profile Views

The two biggest mistakes I see when I'm training people on ports is that they either fail to adequately stabilize it or they "hook" the needle. Both of these actions can cause you to miss the center of the port. When I access I stabilize it on all 4 sides with three fingers on my non-dominant hand and the pinky finger of the hand I'm holding the needle. This does not allow it to move in any direction. Some ports are really mobile! As far as "hooking" the needle. When you look at a Huber needle there is a bit of a bend near the end that causes an optical illusion making you think the needle isn't straight up in down. In reality the tip of the needle is in direct line with the shaft. Because of this illusion people tend to insert it in a curved fashion positioning it so that little bend is straight up in down. This acutally places the needle in at an angle. The better way is to make sure the flange or wings of the needle are parallel with the chest wall (if the port isn't tipped) which results in the needle going straight in and centered where it needs to be.

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decembergrad2011 has 12 years experience as a BSN, RN and specializes in Oncology.

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SafeStepImage.jpg

This is what our port needles look like. I tell people that the port is like a juicebox and the needle is the straw. The inner section between the bumps will feel slightly squishy compared to the rest. You should find two squishy sections surrounded by separate sets of bumps if it's a double lumen port. I will position the needle directly over my site with my dominant hand while holding the port in place with my non-dominant. To access, I push down straight and quick like pushing down a push pin as I ask the patient to take a deep breath and exhale. It will feel as if you are sticking a very tiny straw into a opening and sometimes you'll feel a pop similar to what you can get on a vein on a phlebo stick. Then I usually will flush 1ml and attempt blood return, if no blood return but good easy flush will do another 2-3 ml and attempt again. 90% of the time that works. If not...

I usually will get a 1 inch needle if it's a well-endowed female or otherwise a person with a lot of tissue in the area that may keep the needle from fully reaching the port cavity for a good blood draw. Otherwise a 3/4 inch works for most people. I have accessed someone with a 1.25 inch needle once because their port was super deep. Normally if we get good flush but no blood return, and we are sure we're in the right place, we'll do a small dose of TPA infused and then pulled back out of the line. If no luck twice, our protocol is calling interventional radiology to check the port's functionality. This is especially important for our chemotherapy.

Ports are always flushed with saline and heparin prior to deaccess for our patients too. It keeps the line patent.

Anyway, that's random but I love ports and those are some random thoughts on them.

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weirdscience has 4 years experience and specializes in Critical Care.

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Pushing hard like pushing in a thumbtack is a great analogy. I missed a lot 'til I figured out you need to push reasonably hard and not be timid.

Stabilizing with the other hand really helps, too.

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Littleguccipiggy has 2 years experience and specializes in Oncology.

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I usually ask my patients if they've ever had problems with their ports in the past. I've had one patient who's port historically did not draw blood. I was only able to determine patency by if she could taste the saline, per the patient that's how they determined patency in the past. Ever now and then I'll get a port with those annoying fibrin tags that won't let you get blood return even though you know you're in the @#%$ middle of the port and there's no way the needle can't be in the right spot. Then it needs to have tpa to get it reworking.

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FlyingScot has 28 years experience as a RN and specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.

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SafeStepImage.jpg.

This is a perfect example of what I meant when I spoke of the bend in the needle being an optical illusion that sometimes causes people to go in at an angle. Look at the tip. You'll see what I mean.

Also, I never have the patient take a big breath. Two reasons, it doesn't really do anything and when the chest wall moves so does the port. It's not wrong to do it. It just hasn't proven beneficial to me.

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168 Posts; 4,207 Profile Views

I feel accessing ports is a lot like IVs. The more you do, the more confident you become. I just try to stabilize it with my mom dominant hand, and go in with conviction. The times I miss are because I hesitated, and the needle slipped/I didn't hold it down firmly enough.

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FlyingScot has 28 years experience as a RN and specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.

2,016 Posts; 21,718 Profile Views

I feel accessing ports is a lot like IVs. The more you do, the more confident you become. I just try to stabilize it with my mom dominant hand, and go in with conviction. The times I miss are because I hesitated, and the needle slipped/I didn't hold it down firmly enough.

I agree I teach "commit to the stick". Going slow and hesitating increases your chance of missing and greatly increases the patient's discomfort.

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13 Posts; 548 Profile Views

As mentioned in previous replies, positioning your fingers around the port is the best way to ensure you won't miss. Don't be afraid to take your time in that part of accessing. Where you don't want to "take your time" is puncturing the skin...think about a needle puncturing your own skin, a slow insertion will prolong the pain. Once you've secured where you will puncture, be swift. Your patients will be very appreciative. As for no blood return, there are a few tips to try before tPA...if it is a woman, ask them to unclasp their bra...no scientific explanation, but it works. Also you can try and lay the patient flat and then attempt to pull back for a blood return. Depending on your facility's policy, you can also do a heparin push (just as you would prior to de-accessing) and allow the heparin to "sit" in the line for a few minutes and then attempt to withdraw again. Turning their head to right or left or leaning to right/left, deep breathing followed by a cough has also been found to be effective. Hope that helps :)

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IVRUS has 32 years experience as a BSN, RN and specializes in Vascular Access.

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Depending on your facility's policy, you can also do a heparin push (just as you would prior to de-accessing) and allow the heparin to "sit" in the line for a few minutes and then attempt to withdraw again. Turning their head to right or left or leaning to right/left, deep breathing followed by a cough has also been found to be effective. Hope that helps :)

Heparin flush solution, of any concentration will NOT help in this endeavor. Heparin flush just prevents fibrin buildup, it does absolutely nothing to lyse the fibrin, once it has accumulated.

Now, turning the patients head to the opposite side and giving a good cough, that works well, as does the repositioning of the pt.

Also remember that when you feel that the noncoring needle has hit the bottom of the ports body/well, do NOT continue to push as one could barb the needle and damage the port.

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FlyingScot has 28 years experience as a RN and specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.

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Heparin flush solution, of any concentration will NOT help in this endeavor. Heparin flush just prevents fibrin buildup, it does absolutely nothing to lyse the fibrin, once it has accumulated.

Thank you! Thank you! Thank you! For saying this. Why oh why do people forget how Heparin works? I can't tell you how many times I've heard this and it makes me want to flick the person in the head.:bag:

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