Bluanthrogrrl

Thanks for the tip! When I instilled the Cathflo the first time and waited the appropriate amount of time, blood return was still absent. When I went to instill it the second time per the protocol, the pt became very nervous and refused. We have been through this so many times, I'm afraid that without heparin or infusions of some sort, it has perhaps clotted or has a sheath formation (which is what the flow study showed previously but the radiologist was able to get blood return at the time).

Hi IVRUS, that's what I've always said and what I've always followed but the physician/surgeon completely disagrees and says it's useable. Since there are no other nurses, I alone must advocate for me and the pt. I just wanted to make sure I'm justified in "digging in my heels" with this issue or if there was some other protocols if flow studies have shown correct placement (and how long those flow studies are good for). Thanks for the input!

I'm currently giving Remicade infusions in a clinic setting and work alone (no other nurses). I have experience working with ports but my current patients usually have relatively good veins and get peripheral IV's. I have a new pt who had to get a port d/t inability to consistently have venous access. Her first port did not have blood return so another port was placed. The second port again had no blood return even after TPA instillation so a flow study was completed over 3 months ago. After the study, the port had blood return but the following infusion there was none. The patient refused the infusion without having blood return despite the study showing correct location, etc. The physician has spoken to the pt and the pt is now up for having the infusion but my question is how often should the flow studies be completed to show that no negative changes have occurred with the port? The one completed was way over 3 months ago (by this time) and since I can not get blood return, how will I even know if it is in the correct location? I understand that Remicade is not a vesicant but I'm not sure how comfortable I am with giving the infusion if I don't have recent information. Am I being overly cautious with this? Any and all information would be greatly appreciated. thanks

Thanks caroladybelle for the response. Being new to this field and previously from the anthropological arena, I tend to analyze people's responses, reactions, etc. More of an observation than a concern. I just find it extremely interesting since I feel that all of nursing has it's difficulties and challenges but I have heard/seen distinct preferences, dislikes, assumptions of difficulty or plain grunt work for various areas of nursing that appear to be similar throughout different hospitals, etc.

I work on a unit that is a certified stroke facility with lots of back surgeries. I suppose it is a basic neuro-medical unit. We do see progressive diseases but more often than not it is strokes and surgeries. As you said, many of the patients are total care (or close to total care) and therefore very hard work but I've been surprised by the very visceral reactions I've received from people of their disdain for this area of nursing.

I'm a new grad who will begin working on neurology. I love the nurses and management and couldn't ask for a better group of people to work with. What I'm confused about is the reaction I get when I tell people that I will work on neurology. I have gotten faces, smirks and just recently had a past instructor tell me 'there is no way' she could/would do it. I really don't understand these reactions and was wondering if others have had these types of remarks.