Port in the arm instead of the chest

KelRN215, BSN, RN · Jan 4, 2012

Is the port infiltrated? I have known patients that have ports in their arms and it shouldn't be any more painful than a port in the chest if it is accessed correctly. I also don't see how EMLA would help with pain that comes from flushing a port. We use EMLA when accessing ports but if the pain is from flushing, there's probably something wrong with the port itself or with the access needle.

blondy2061h, MSN, RN · Jan 4, 2012

One of our nurses tried unsuccessfully to flush a port in a patient's arm. Is there a secret? We ordered EMLA cream to numb the area as it is very painful for this patient when it is flushed.So do they move a lot or get flipped over? If I flush the thing what are the tricks?? She was in a great amount of pain, so that makes it even harder.

I've only seen it once, in a patient who had too high of a tumor burden in his chest to get it to work there. His port didn't work either.

Vtachy1 · Jan 4, 2012

She couldn't access the port at all. Its the accessing that we had trouble with and that was so painful. So what technique do you use? Hold the port real steady and tight with your fingers? What is the trick to it?

Toquay · Jan 4, 2012

Sounds like a passport was implanted which looks like a mediport only much smaller. The passport can indeed migrate or flip over so its very important to feel and determine that the port/septum side is up. You must still use a huber or noncoreing needle to access the silicone septum which is only about as big as your smallest fingers nail bed. The size of the patient or the amount of tissue one has to feel through can make this port a little more tricky to access. You should still feel the back of the port through the septum when accessing before trying to use it. Once accessed follow your hospital port policy for maintaining it. Hope this helps.

Toq

caroladybelle, BSN, RN · Jan 4, 2012

One of our nurses tried unsuccessfully to flush a port in a patient's arm. Is there a secret? We ordered EMLA cream to numb the area as it is very painful for this patient when it is flushed.
So do they move a lot or get flipped over? If I flush the thing what are the tricks?? She was in a great amount of pain, so that makes it even harder.

I have not seen ports in the arm in a very long time. The common ones in the arm were called passports.

From what I understand, they fell out of favor for many reasons, some of which, you are describing. The position was not as stable with the port occasionally shifting under loose tissue, repositioning on it's side or flipping over, and occasionally getting the catheter portion positioned in a place, where it gets stuck instead of the port access.

While this can happen also to those in the chest, I have seen occur much less often, there. Think about it, you use your arms to carry items, swing them around, and when you gain/or loose weight or edema, the tissue is more often affected in arms. The changes tend to affect position more in the arms than most flat areas of the upper chest. Pts with ports generally have them for illness where steriod use, lasix, weight gain or loss is an issue.

My question is who placed it/when was it placed? Has radiology confirmed that it is in the correct position. It may need to be replaced or revised if not positioned well.

There are community hospitals/MDs that will disagree with my opinion that follows. The purpose of these accesses is to provide an easy, safe, comfortable IV access to draw labs and give drugs, often highly irritating meds. If the port is not easily accessible, is shifting to much which presents risks of infiltration/extravesation, and very painful to boot, it is failing in its primary task. The port needs to be assessed and possibly replaced/revised. Having nurses have to continually fight to access the port repeatedly (while often may be encouraged by MDs and facilities) - is not a good idea.

raged by MDs/facilities

Vtachy1 · Jan 5, 2012

A radiologist inserted this "passport" patient told me that a doctor didn't have to place this kind of port in the arm it could be a radiologist, under guided radiology. I'm thinking it was placed 5-10 years ago.

This is the first time it was unable to be accessed, although the nurse that did it got fired so therefore, no one else has had to flush it.

So what am I feeling for exactly to know if its been flipped over? THanks much for your help!

caroladybelle, BSN, RN · Jan 5, 2012

Well, first, a Radiologist is an MD.Second, it is very rare that a port (especially in the arm) is in for 5-10 yrs. They are generally removed within a few years, and/or after they are not needed. That reduces risk of blood clots and infection (if you ever see one after they have been removed, even after a year's time, they have a lot of residue in them). It is rare to have one stay for 5-10 years.As far access, when you feel the port, you should be able to feel the flat side of the port, and the small palpable rubber bubble in the center of the port that the needle goes in. If you cannot feel those, then it is not safe to access the port. And if you feel the Catheter itself on top of the port, then there is a problem. The port should have been flushed and heparinized at minimum, once per month. I find it difficult to resolve that only one person has done that job in there last 5-10 years.If all else fails, it could be accessed by radiology under fluoroscopy, where they can see below skin and tissue, perhaps.Also, be aware that the ports' rubber access, can "wear out". Despite using noncoring needles, after so many sticks, the access site gets damaged. This is another reason to check length and extent of use.

2shihtzus · Jan 6, 2012

I have only seen 2-3 ports in an arm.....and they should not hurt when being flushed. When accessing them, it is not much different than accessing a chest port. Hold it securly and use the right guage and length of needle. The only pain the patient should feel is the initial stick. Pain whilst flushing is a sign of a problem.

Vtachy1 · Jan 6, 2012

Well, first, a Radiologist is an MD.Second, it is very rare that a port (especially in the arm) is in for 5-10 yrs. They are generally removenkd within a few years, and/or after they are not needed. That reduces risk of blood clots and infection (if you ever see one after they have been removed, even after a year's time, they have a lot of residue in them). It is rare to have one stay for 5-10 years.As far access, when you feel the port, you should be able to feel the flat side of the port, and the small palpable rubber bubble in the center of the port that the needle goes in. If you cannot feel those, then it is not safe to access the port. And if you feel the Catheter itself on top of the port, then there is a problem. The port should have been flushed and heparinized at minimum, once per month. I find it difficult to resolve that only one person has done that job in there last 5-10 years.If all else fails, it could be accessed by radiology under fluoroscopy, where they can see below skin and tissue, perhaps.Also, be aware that the ports' rubber access, can "wear out". Despite using noncoring needles, after so many sticks, the access site gets damaged. This is another reason to check length and extent of use.

I think when she said doctor, I took it to mean a surgeon instead of a radiologist.

And gosh no, I'm saying that there has only been one nurse accessing it for the last 6 months since she has been on hospice care. Yikes! I feel like I was just called a liar LOL.

So when you a "few years" they are generally removed, how many is typical? I am going to see her today so I will look at the things you are describing. Thanks for the great tips!! Its been very helpful for me. I don't know if she will want to fuss with getting it removed.

caroladybelle, BSN, RN · Jan 7, 2012

No, not calling a liar. But if it has been there 5-10 yrs, it would have had to be accessed at least 60 to 120 times just for flushing it. And many more times, when it was being placed for whatever purpose it was intended ( blood draws, chemo, tpn, etc). It would be surprising to have one single to have cared for it all of those times in every instance. Not to mention shortsighted. To have only one person on staff that can access ports is not good.I have rarely seen ports in longer than 2-4 years. And never one in the arm that long. For that matter, I have not seen a new passport placed in over 10 years, because of the problems with them.Also had number of issues with phlebotomy in the ER sticking them in the port, or worse, the cath itself with a regular (coring) needle. Big mess.

Isabelle49 · Jan 7, 2012

Where in the arm is the port? I cared for a patient with a port to left upper arm, mid way between the shoulder and elbow and along the inner surface of the arm (could draw a line from arm pit to port). For quick, easy access and better stabilization of the port, I would stand behind her to access her port. This allowed my body to prevent her arm or body from being pushed away when I applied pressure with my fingers and the needle. Was very successful and the patient was happy that the port could be accessed so easily. P.S. the first time I cared for her and had to access her port, I thought OMG when I saw the location and knew that I would probably not be able to access it by being in front of her.