Portacaths

[LSRNgrad2008]

Hi All,

I am a new grad and recently finished orientation. I had a pt with a portacath that was already accessed with a huber needle, and had a pigtail extension with D5 1/2NS with 20 KCL running. I was given report that I needed to draw blood in the am, and I had never drawn from a portacath. One nurse told me that I needed to stop IVF, but not to disconnect and draw blood from the hub closest to the pt. Another nurse told me not to ever use that hub, another nurse said it didn't matter. I also ran IV AB's through the hub b/c the main line didn't have a port to piggyback and one nurse said not to do that, but another nurse said it was fine. I'm confused....I looked up hospital policy and it's very vague and doesn't mention anything about the proximal hub being used or not. Advice?

[joeyzstj, LPN]

Contact your hospitals education director. He or she will be the one who can tell you for sure based on what your hospital policy is. We very rarely see them, and the times that I have had them I have had many other lines to use for blood draws and procedures. It really depends on what your hospital policy is.

[neurorn6]

Absolutely find out what your hospital's policy is on port a cath's. That's your first step. It has been my experience (worked oncology) that you should stop any IVF's while doing a blood draw. You can draw from the proxiaml hub. The key is to pull at least 10cc off and waste it. (If you are doing a PT/PTT to be on the safe side pull over 12cc off). Once you have pulled your waste, you can then pull off the amt. necessary for your bloodwork. Make sure you flush your portacath as per your facility's protocal with NS and Heparin. Some hospitals are getting away from heparin flushes for portacath's and are flushing more frequently with NS.

Hope this helps. If you have an onocology they can be a great resource.

[LSRNgrad2008]

Thanks,

I will contact the educator, I did call the oncology floor I was on 3rd shift but no one there really new for sure.

[iluvivt, BSN, RN]

Non-coring needles or huber needles come in many sizes,lengths and configurations. The one you are describing has a non-coring needle with a small extension tubing with a Y-site coming off the extension tubing, It sometimes comes with a pre-attached cap or a small cap that can be tightened or removed and the cap of your choice can be attached. If your hospital policy allows you to draw from a CVC,then you can draw blood from it....we do it all the time and it is one advantage of this type of device. I usually draw from the main tubing b/c with this configuration is it easy to get some IV fluids in your specimen from this little Y-site. The Y-site should have a clamp....so shut off all IVF and IV medication for ONE FULL MINUTE. Clamp the Y-site and then draw your discard from the main non-coring needle tubing. I usually put a cap on this and attach the IV tubing so that if a blood draw is needed it is easier to get and also this reduces the risk of air embolus. Ports have a priming volume of about 2.5 ml so they will require more of a discard than your average CVC. Get a 6ml minimum waste. Get your sample and then flush with 10-20ml NS in a push-pause pulsatile fashion. Resume your IV fluids. Yes it is OK to use this little Y-site to administer medications...that is why it is there. By the way if any blood gets stuck in the y-site (it always does for me) flush that out as well to keep the infection risk low. These lines have a very low infection rate,but must be cared for in an aseptic fashion.

[LSRNgrad2008]

Thank you so much for the info. I'm glad that what I did was ok, even though the other nurse would have done it different, all the while still being fine protocol-wise. It's just tough b/c even though there is protocol that is sometimes vague, people have their little ways of doing things and sometimes it makes you feel like you've done it wrong when actually you haven't.