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Discussion

Portacaths access

I was an the ED department the other day. A patient came in with significant blood loss, septic, hypotensive, and had just had a porta cath placed less than 24 hrs, I wanted to access the port for Levophed but my charge stated that it hasn't "matured" yet and we shouldn't use it. My question is do portacaths need time to "mature" and if so how long?

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    • Featured Replies

    Ours are used as soon as they're placed. We have kids who have them placed in the OR, have them accessed when they're placed and then get admitted to the oncology floor to start chemotherapy.

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    Yup- they are used immediately.

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    Yes can be access immediate after placement, As it is in a pocket under the skin, and incision suture site. Is above it...

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    It is amazing how confident people are in their beliefs. While I personally don't know anything about brand new ports, it just sounds wrong. I would guess if you asked where that information comes from, the answer would be "Well, I was taught in nursing school...", or, "We always...."

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    • Experts
    It is amazing how confident people are in their beliefs. While I personally don't know anything about brand new ports, it just sounds wrong. I would guess if you asked where that information comes from, the answer would be "Well, I was taught in nursing school...", or, "We always...."

    Sounding wrong and being wrong are two entirely different things. I am the port/picc/cvc resource person for the entire ambulatory department of a huge university medical system. I teach, write policy and troubleshoot all sorts of lines. I am also the Bard liaison and am on the committee that evaluates new products. I can tell you unequivocally that, unlike a dialysis fistula, there is no such thing as "maturing" of a port. It can be used immediately but should be accessed by an expert clinician because sometimes there is swelling that can make it a little difficult. The only thing that must be done with a new port is if the incision is glued, not stitched, betadine is the antiseptic of choice in the first week because the alcohol in the CHG duo swabs will dissolve the glue. Now, that being said there may be some vascular surgeons/interventional radiologists who don't like them being accessed immediately but that is physician/facility dependent.

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    Hi,

    As the others have stated you can use portacaths right away. I think that other nurse maybe was confusing a portacath with a dialysis shunt or fistula, which cannot be used right away, and does have to "mature".

    Annie

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    Our patients sometimes get them placed the morning they start chemo

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    • Experts

    I reread the OP and I do want to clarify something. My previous post was directed at the question regarding "maturing" a port. I failed to mention something that I think is important. In the scenario given I might have thought twice about using the port given the sepsis picture less than 24 hours after it was placed. I would be somewhat suspicious that the port itself was the culprit and that would give me pause. However, if a patient is desperately ill as this patient was and needed a line ASAP I might mentally wince a little but go ahead and use it (with an order of course) with the hope that the antibiotics start doing their job. It's certainly one of those uncomfortable gray areas.

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    I was just thinking the same thing Wuzzie.How do we know the problems are not caused by the port placement.I probably would access it but may consider verifying tip placement and assess carefully.There is no need to let a port mature although newly placed ports may be a tad difficult to access due to swelling as well as s bit sensitive.Years and years ago we used to wait 3 days before we used new ports as this allowed the swelling to subside but this is no longer the case.I bet the nurse has not kept up with newer IV therapy standards.

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    Completely agree. You've got a central line, use it. Get your labs, start your levo/blood/fluids etc. The discomfort of accessing a brand new slightly swollen/ouchy port is so much better than dying of shock.

    Had a rapid response yesterday that bounced back to my unit - floor and Rapid nurse wheels him in saying she hadn't been able to get any labs or start any fluids/blood/pressors because had "no IV access." BP 60/30 and crashing. I took one look at the shiny brand new beautiful tunneled permacath in his chest and was like "Ahha! Well here's a pipeline!"

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