port accessing tips.

allnurses Guide · Jul 17, 2015

Thanks for this thread. I work hospice and we have patients with ports at times but not enough to feel comfortable when you do get one. I always think that I need to re-educate myself before trying.

nicolemy0215 · Jul 17, 2015

To avoid being flicked in the head let me clarify, I did not state that heparin's function/use is to clear a port, I simply passed along a tip that does, in fact, work, despite that not being its intended use or capability. Much like many other things in nursing, sometimes the unexplained simply work. I work in an area where >75% of patients have ports and myself, along with every other Onc nurse in our facility use this "tip" daily with success. But thank you for reminding the forum of the function/use of heparin.

FlyingScot, RN · Jul 17, 2015

nicolemy0215 said:
To avoid being flicked in the head let me clarify, I did not state that heparin's function/use is to clear a port, I simply passed along a tip that does, in fact, work, despite that not being its intended use or capability. Much like many other things in nursing, sometimes the unexplained simply work. I work in an area where >75% of patients have ports and myself, along with every other Onc nurse in our facility use this "tip" daily with success. But thank you for reminding the forum of the function/use of heparin.

I really, really don't want to get in a p----ng match with you but there is a big problem with advocating this pratice. First, Heparin does not lyse fibrin so it is absolutely not doing anything with any occlusion related to clotting. Second, there is no way that you have proof, other than anecdotal, that it is the Heparin that is making the difference any more than the flushing that occured prior to. Finally, by doing this you are going way outside of your scope of practice and using a medication in a way it was not intended. If Heparin worked this way then why is it not the first line choice for catheter occlusions? It's a heck of a lot less expensive than Cath-Flo. I'm not trying to be disrespectful I even searched some reputable sites to prove that I am wrong but the evidence backs my position. I'm not telling you what to do I just don't think it's a good idea to advocate this on a public forum with thousands of nurses who may not know better. :shy:

nicolemy0215 · Jul 17, 2015

Thank you for being so passionate about it. We do have orders authorizing us to do this. And no need for a "pi##ing" match. I'm simply giving a tip that I use and that works. My mistake was not including the pharmacology/intended use of heparin or the warning to have a physician order....which I thought was an obvious understanding. Thanks again!

OCNRN63, RN · Jul 18, 2015

FlyingScot said:
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.

I did it because while the pt. was focusing on taking the breath, I could do the stick. I saw it more as a distraction technique. Much the same as jiggling the pt.'s arm when giving an injection of Neulasta/Neupogen. The brain is focused on the sensation of the arm being jiggled v just the injection.

OCNRN63, RN · Jul 18, 2015

Quote
Thanks for this thread. I work hospice and we have patients with ports at times but not enough to feel comfortable when you do get one. I always think that I need to re-educate myself before trying.

ONS has a virtual course regarding accessing CVADs. You might find it useful, plus you'll get CEUs. ?

NurseKate16 · Jul 18, 2015

Agreed, stabilization is key and it's better to be firm with the stick like it's a thumb tack. It goes in smoother and is less painful than a slow break of the skin. I have only been doing this about a year but am very comfortable with ports. We have one surgeon who puts them very deep in the patients breast and we use 1.5 inch hubers... they are super deep. I never hesitate to take my time feeling for the port and getting a good hold of it before even picking up the needle with my other hand. Especially with the deeper ports it's important to feel and know you've got a good grasp on it.

busybee04 · Jul 22, 2015

Thank you all for taking the time to post. I will def. keep all this in mind upon my next port access.

iluvivt, BSN, RN · Jul 31, 2015

Flying Scott and IVRUS you are 100 percent correct in your posts about the Heparin.What is most likely happening is that the patient has changed their position and it was not a true persistent withdrawal occlusion to begin with. Not all ports have palpation bumps. I have only seen BARD power ports have these and for the others you just must feel for the softer center of the port and the self sealing septum. Stabilization is the key and if you need to get another healthcare worker to pull the patient's skin in one direction or the other do so. it also helps me if I have the patient lie down or lie back and and then I check in what position I can stabilize and then access the port . Do not hesitate to get the patient in a position that allows you to easily access the port

Asystole RN · Aug 2, 2015

The main thing I teach nurses is not to be afraid to grab and hold onto the port. Many nurses will put tension on the skin but few will actually grab that port. Grab the port while applying tension to skin and then stick, makes it about 100 times easier, especially if the port is at an odd angle.

Fun fact: Heparin and saline flushes are regulated as medical devices, not medications as many nurses think. The primary mechanism of action for both flushes is mechanical in nature, the chemical action is strictly a secondary function.

decembergrad2011, BSN, RN · Aug 11, 2015

I have used the heparin flush "dwell" trick also with success. I have also tried it with no success. It is definitely something I try before going to TPA, even if it simply gives me the time I need for the patient to move around and get it working again without thinking I'm just delaying care So it works for whatever purpose I need it. Heparin flushes are supposed to be given up to twice a day in non-infusing lumens of central lines as standard anyway on our unit so it's not a doctor's order as much as a nursing intervention from our POV.

I agree that a deep breath will change the position slightly but if they are focused on that instead they are so much less likely to flinch. Our seasoned pros don't need anything but a reminder that you're going to poke, while your newbies really need an entire conversation that keeps them calm before a successful access. That deep breath can really help you to access a brand new, sore and swollen port.

I also agree with committing to your stick! Every time I have missed it has been because I was still slightly unsure of where I was going to stick. This has also happened to me with IV access and butterfly lab draws, so I try to take my time with these skills because I personally need the extra time as a perfectionist to figure out the best positioning and commit. I may try to "grab" the port as suggested above! I always try to use the least amount of skin touching, especially on females because of the proximity to the breast, but I can see it being especially helpful for some ports and double lumen placement.

knoxnurse236 · Aug 11, 2015

When you get the skill down its so much easier to access and change port needles then placing an iv. I work on an inpatient chemo floor so the majority my patients have ports. I worry more about sterile technique, sticking is easy. Feel for the bumps, have your patient lay flat and really hold the port in place. When changing the needle look for the old stick marks for guidance. Also know the difference between a power and regular port. The right size needle is key. 3/4 inch for most patients and 1 inch for patients who are larger. Although sometimes that rule doesn't always apply, always look in the chart to see what was used previously.