schlemj

Thank you so much for the feedback. I do see what you mean about the thicker septum, I too have needed to use more force when accessing the power ports. We have several oncologists in our practice, so who puts them in depends on what doc's patient it is. One of the docs will only use the vascular surgeons one doc uses the radiologist, and another uses general surgeon. I do agree that certain surgeons that are used seem to be more difficult but again there are just so many that won't give blood, even early on. I think the power ports are more difficult toaccess if they are deep compared to the traditional counterparts. We are having much better success with the smart ports (angiodynamics) wich are CT comapatable as well.

Our oncology practice paticipates in study protocols. Since the nurses administer the treatments we have to review the nursing section in the protocol and it must be followed precisely, ie: the order of the meds, vital signs. In some cases the study provides the drug so we have a study drug log we sign it out in, sometimes we have to save the empty vial and it gets sent back tko the study. If something is not followed the way the study intructs it, it is a deviation. We have study monitors come to our offices to do audits, they check our refrigerator, our logs, things like that. We have a research dept that is dedicated to all our study patients, it's a big help because they are on top of what needs to be done and when, ( blood work and follow up appt.)

We have protocols that are followed consistantly, also before we use a specific product we have inservices as well as ongoing communication with the rep. Over the past 18 years of oncology nursing ( in wich ports are the main type of catheter we use) I have never experienced so many problems. The things wev'e seen are difficulty getting blood (even after pos change, flushing, etc) difficulty accessing. The issues are happening early on too. We have used more cathflo than I ever had to use in the past. This is what we have experienced with the bard power ports, not the traditional ports. We always flush with 20 cc after blood draws followed by 5cc hep/saline-nothing smaller than a 10cc syringe. We also have our patients come in every month for flushing if their ports aren't being used.

What types of mediports are being used out there? I work in oncology infusion and we started using power ports that are compatable with Ct machines that inject the dye. We had numerous problems with them. We now are requesting smart ports on our reqs. Would appriciate feedback.

Thank you so much for the imput. We are also requesting smart ports now as well, they are much easier to use, more reliable for blood draws, easier to acess.

Good news, from my experience as a med onc nurse, I transitioned to outpatient hem/onc in 1999 and that's when I learned about rituxan. It is NOT chemotherapy, you will not see the same side effects as chemo. Rituxan is a monoclonal antibody and when we give it as a single agent we don't even give an antiemetic. From my experience it is an easier drug to give than traditonal chemo. Even elderly or more compromised patients tolerate it easier than traditonal chemo. It is targeted therapy only goes after certain cells with certain receptoers were chemo is not as spcific, think of it more like a guided missel-very specific. No hair loss, doessn't effect blood counts like chemo, low emetogenic. If you have any side effects it's usually in the clinic and is during infusion. More common ones may be hives, or fever. I really have more allergic ractions with some of our chemo drugs tha rituxan. The majority of the patients that have a sensitivity rxn is on the first inffusionand we stop it, when the rxn resolves we re start the infusion at half the rate and patients usually do fine and tolerate the rest of their treatments. Overall it is an easier drug to give. You will be given tylenol and benadryl as premeds, some docs give decadron too but it is not mandatory. The first rituxan is given slower than the ones following. I think you will feel better after your treatment. My opinion, much much better tolerated that cisplatin!!!!!!!!!!!!

In the clinic i work at our policy is that for certain treatments (which are most of them) a doctor is required to be present. some treatments like bisphosphonates, gemzar, navelbine, 5FU don't require a doctor to be present. Every new treatment requires a doctor and most of the other meds require a doctor due to the potential for an allergic reaction. The treatments that don't require a doctor require a PA or nurse practioner. We have to have a provider we never do any treatments (even epos, port draws) with only nurses present, not only safety issues but I believe medicare guide lines or billing rules or something.

Once again this past week with a very busy clinic another patient with a bard power port that would not give blood after several flushes and positon changes cath flo (altaplase) had to be used. Another patient with her power port that was in clinic for treatment had to endure several position changes and finally after several flushes as well a good blood return. Please let me know do you out there have patients with bard power ports? Or are you still seeing the traditional ports ( not compatable with the contrast dye or machines that CT uses)????? Luckily a rep from another co inserviced us on the smart port, another ct comapatable port in which I have used and it was much more user friendly. Please send in any feed back.

I have been an oncology nurse for 18 years inpatient and now outpatient. I think it is one of the fields of nursing that we can't hlep but become emotionally involved as well as professionally. Our patients become part of our lives in sense as it is a specialty that we see them and their loved ones on a regular basis. We laugh with them, take care of them, treat them, and say good bye to them. I have so many patients that I remember and will never forget, some I still cry for. I take comfort in knowing that the ones we could not cure I have to believe we made a difference. In the care we provided as the bond that we made, the journey was going to happen but I hope that as a nurse I provided the care that was needed. It sounds to me that you are the kind of nurse that is an asset to the field, spending time with that family and feeling the way that you do, that is a true onc nurse. But don't get burnt out, it's ok to try other things, i did some school nursing for two years but I am bsck in hem/onc. Some how I believe we have the best patients on earth and you sound like a super nurse. I hope you know that support and care you give to your patients and their families is a huge comfort to them and it is something that they will never forget, it does help. :redbeathe:nuke:

I needed a change about 3 years ago, I worked in hem/onc/med surg for most of my career. School nursing was such a different world. It was more like community nursing. It was a change not having providers right there or a stocked med room. It was a great deal of working with the other proffessionals in the school. Educating teachers, parents. IMy school was in a high poverty , high crime area many of the children came from single parent homes with very young mothers. Many difficulties trying to coontact the parent and facilitate needed md f/u, medication refills for school-things like that. triage daily in the health office, during the year worked on the required mandates vision, hearing, scoliosis. The most sig change for me was getting used to being the only health care prof in the building, the other prof (teachers, administraters,etc) had their kown ideas about what should be done (re medical and health) and would want me to go and do what they suggested (sometimes unsafe). so i had to really set limits and explain safe practices. Also a lot of things get delegated to the school nurse that really aren't the nurses responsibility. It was a very good and rwarding experience for me. I absolutely loved the students and parents/families. Unfortunately my school was not well run by administration so I returned to hem/onc. Good luck.

This is unsafe, in the clinic I work in we have a policy that no nurse works alone, there is always another oncology nurse working. We cannot put one drop of chemo in a patien without another onc nurse checking the order, dose, calculation and then co signs (two initials required) in the med book. We do mix our own chemo under the hood with gloves and chemo gowns. Also if ther is an emergency/reaction you should have more than one nurse to help! Call the MD, get the oxygen, emergency meds/equipt and someone needs to be tending to the other patients!! what if there happens to be more than one reaction at a time? It's happened were I work. We use pumps for most everything but on a very busy day we may be short pumps, so things like 30 minute gemzar or carbo can be titrated and run according to the drip rate on the tubing-eye balling frequently of course. How the heck do you run rituxan w/o a pump??? Listen to your instincts as a nurse-you are right.

I am currently in outpatient but I worked on a unit for 7 years with that exact pt. population. 22 patient unit 4 RN's and one charge on days, 3 RN's on eves, 2 RN's on nights.

Hoping for some opinions regarding power mediports (I think bard makes them) as I am all for our patients to have a port that can be used for contrast dye for CT but my collegeus and I are finding they can be very tempermental with giving blood. The majority of our patients (with these power ports) don't give blood. We are having to try all the tricks of the trade, several position changes, having the pt. cough or deep breath, several flushes and eventually cathflo. The patients are frustrated b/c eventually they have to end up getting a peripheral stick for blood test and CT will not use them w/o a blood return anyways-so the whole purpose is defeted. These ports are also difficult to access in some pts. if they are deep. It is impossible at times to find or feel the 3 dots and the area to access is mush smaller, I never miss the port but I have hit the edge many times and I have to reaccess again. I never in all the years of onc nursing have experienced so many problems, I will take the traditional ports any day.