Port question

[TazziRN, RN]

We have a frequent flyer who has a port inserted in her chest, between her breasts (very obese pt, that's the best place for it). I accessed it and had a bag running via pump. She had to get up to the BR and my coworker pulled the tubing from the pump to let her walk to the BR. With our pumps, the slide clamp goes in the machine and when the tubing is removed the clamp slides closed. About half an hour later I went in to take her to her room on the floor and found the tubing still clamped off.......I didn't know she'd gotten up and my coworker got busy with another pt and didn't put the tubing back in the pump. Nothing had been running for at least half an hour. I opened the tubing up and the fluid wouldn't run. I tried to flush it, nothing. I spend about 5 minutes sweating bullets and manipulating it before I finally got the drip going again.

Later, when I talked to my coworker about it and my fears that we had almost lost the port because of clotting, she said that ports don't clot if they've had fluid running in it, even if the fluid isn't running for a while. She used to work onc and said that's one of the things she was taught about it. I'm having a hard time picturing that.......if there's nothing running in the port and there's no heparin because it's been flushed with the fluid, how does a clot not form?

Help?

[tgb3rn]

hmmmmmmm.... sounds fishy to me:trout: . Some people will say about anything to make themself not look foolish when confronted. NOT saying this is what she did, just saying..... I would think we Hep them for a reason, and you couldn't get it running right away for the same reason;) .

[RNsRWe, ASN, RN]

I realize I'm pretty new, but we were taught to always flush/hep flush a port that does not ACTIVELY have fluids running, and this is how it's handled where I work. Depending on what fluid is running (sticky?), there's every possibility it will clog up.

Sounds like your coworker was reaching to save herself.

And, frankly, if it "can't" clog up, what exactly were you doing for five minutes to get it going again? Perhaps she'd like to do it for you next time

[Marie_LPN, RN, LPN, RN]

Later, when I talked to my coworker about it and my fears that we had almost lost the port because of clotting, she said that ports don't clot if they've had fluid running in it, even if the fluid isn't running for a while. She used to work onc and said that's one of the things she was taught about it.

IF she was taught that, she was taught wrong.

Sounds like she was making an instant excuse for her mistake.

[meownsmile, BSN, RN]

You can have backflow into the tip of the catheter regardless of what type of line it is. All you have to do is have more pressure in the vein/artery than you do in the fluid line. The danger wasnt in the port it was in the tip of the catheter.

She was making excuses for herself, and wishing it so doesnt make it so.

[chenoaspirit, ASN, RN]

I agree with the others. Ive seen them clot before. Thats the purpose of packing them with hep when not in use. Maybe she really was taught that though, just trying to give them the benefit of the doubt. I was "taught" some strange things when I was new.

[gitterbug]

Your coworker was doing some CYA in this situation. I just do not understand why the patient could not go to the bathroom with the meds running via pump. Here, unless the patient is going to an area where the pump would pose a problem, the med is not stopped. That is why there are wheels on the IV pump pole. If the med is stopped for any reason, then the whole flushing process needs to be and must be done.

As nurses we need to remember our first rule is to do no harm. Next we need to place ourselves in the position of the patient, who needs another port inserted because a nurse was too busy to do a proper job flushing a perfectly good, patent port? Sounds like a refresher course is in order .

[TazziRN, RN]

Thanks, guys! It just wasn't making sense to me.

Gitter, the pt's size makes it difficult to take the pump in the BR with her. It was not a medicated line, just fluids, so when I had let her up earlier in the shift, I disconnected the tubing too, but I flushed it.

[Anagray, BSN]

The port can definitely clot without proper care. It happens to me all the time when a patient on a pump will go for US or CT or xray and comes back with a beeping pump stating " oh, it's been beeping for the last 2 hours"

Then we have to unclog it and hope it works. Not a good situation, but I never actually had to pull a port because of it.

[colleennurse, ASN, RN]

Just last night I had a pt with a triple lumen PICC. One of the ports I had an antibiotic going connected to a flush bag. When the med and flush were done running, I must have turned off the pump but forgot to disconnect the tubing (we do not use heparin with the caps we have at my facility), so later when I had to hang the antibiotic again, the pump kept beeping that it was occluded. I had a panic attack that I may have let the port get clogged, luckily it flushed when I disconnected it and it started working properly. But that just goes to show that it can get clogged with tubing connected that has fluid in it. Another lesson learned for me....I will not forget again to disconnect tubing and flush! I just got lucky this time :)

[NurseyBaby'05, BSN, RN]

The other thing that could have happened was that the needle became dislodged or bent. You can try to reaccess the port in that case. Sometimes that works when all else fails.

[TazziRN, RN]

The other thing that could have happened was that the needle became dislodged or bent. You can try to reaccess the port in that case. Sometimes that works when all else fails.

Nope, not the needle. That's the first thing I checked.