port accessing tips.

[busybee04]

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.

[Quota, BSN, RN]

At my facility at least once you place the needle and confirm blood return you place a biopatch under the needle hub. Then cover with transparent CVC dressing (non CHG patch).

[Meger, ADN]

That’s exactly what I thought. But what holds the needle in place? The new transparent dressings don’t hold it in very well. I just worry that the needle will come out and stab the patient. ☹️ Thank you for your reply!

[Quota, BSN, RN]

So I’m guessing you haven’t placed or removed a needle from a port then. It’s not going to fall out, the septum the needle is inserted through under the skin is dense. It takes significant pressure to both place and remove the needle.

[sttpreston1]

I am a new nurse to home health. My specialty was drug and alcohol prior to this job. I was so frustrated today. It was my second attempt deaccessing a patient mediport and I was unsuccessfully once again. My preceptor took over and my confident just dwindled. I tried asking my preceptor for some tips but no suggestions were given. I feel so much better that I found this forum. I have hope once again ?

[IVRUS, BSN, RN]

15 hours ago, sttpreston1 said:

I am a new nurse to home health. My specialty was drug and alcohol prior to this job. I was so frustrated today. It was my second attempt deaccessing a patient mediport and I was unsuccessfully once again. My preceptor took over and my confident just dwindled. I tried asking my preceptor for some tips but no suggestions were given. I feel so much better that I found this forum. I have hope once again ?

Were you actually ACCESSING an implanted port, or truly de-ACCESSING?  Upon accessing, some ports are easier to access if the patient is sitting up; this is especially true if the pt is a large chested female.  

[sttpreston1]

I was Accessing the port :)

[pshiffman55]

I had issues for a while....then I found that if you stretch the skin over port with your non-dominant hand, find the middle circle that sticks up (squishy part) and then aim the wings of the needle just a bit more upward than might seem normal, and push the needle in. Until I learned to aim those wings up a bit more, I had trouble....and now I get it every time! 

[Judith RN patient]

As a nurse and CA patient I have an observation.

My regular CA treatment practice uses Huber needles which are longer than the distance from the skin to the back of the implanted port. These needles are more comfortable for me as a patient. When a nurse places the longer needle the “bumps” on the port, (where the skin is already stretched fairly taught)  are not impacted by the “plate” at the top of the needle. There is no painful “compression” of the tissue between the hub of the needle and the internal “bumps” on the actual port.  This distance also is a safeguard for the patient against the nurse who pushes against the needle when she’s not sure whether the needle is “all the way in” and compresses the tissue between hub and port several times when she initially does not get a return.  The dressing for this “free-standing” needle is a little more complicated, but there is no concern about erosion of the tissue sandwiched between two pieces of equipment.

Thank you for all you do!

[pshiffman55]

This is, without a doubt, the most valuable information I've read, despite all the "experts"!  

I can't thank you enough!  xoxo (Covid-free, LOL) 

[adventure780, BSN, MSN, RN, APN]

the infusion nurse I work with does not utilize heparin flush, how can I explain to her we need to use them?

[IVRUS, BSN, RN]

Heparin Flush will prevent fibrin build-up. Keeping a line open with Saline only is doable, but one should be flushing at greater intervals if that is what you are using.  In hospital settings, they usually use Saline only as they are manipulating and accessing their IV catheters frequently. This is NOT the case in home care, nor LTC.  AND, increasing the manipulation through flushing the line, in this case, introduces the potential for bacterial introduction. So, that is discouraged. 

[Wasnt, BSN]

I did a PICC care today and just remembered while on my bed that I didn’t flush with heparin. I flush with 10cc each lumen(3). The pt will be back next week for infusion. Any harm done? Thanks.