Question regarding heparinized ports

[KelliD]

Hello all!

I am a recent LPN grad and I just recently began working in an out patient oncology office. Today, I came across a patient who had just been discharged from the hospital and came over to out clinic to receive hydration. The patients wife was a nurse, and informed me the patients port had been heparinized at the hospital and that I must withdraw the heparin from the port before continuing with the flush, blood draw, and hydration. I was taught just briefly in school about ports and was under the impression that I only needed to flush the port with saline. I asked 2 of the RN's I work with and they gave conflicting answers;one became irritated that I asked, and ended up accessing the port herself. So now I am thoroughly confused as to the correct method of working with heparinized ports. Any clairification or tips would be greatly appreciated!

Thanks!

[Abbygirl09]

When de-accessing the port my hospital policy is to flush with 10ml of saline and 5ml of heparin. I have never "withdrawn" the heparin from the port before doing anything with it. As far as blood draws go, I would flush with 10ml saline, waste 10-20 ml of blood (10 if drawing something like a CBC or BMP and 20 if I'm drawing coags) and proceed with the blood draw. Even after wasting 20 I've seen coags come back funky from the heparin in the port so keep that in mind. I would check to see if there is a policy at your facility, or if there is an IV therapy team they might have advice for you. Don't let grumpy nurses stop you from asking questions when you're not sure and congrats on your recent graduation!

[farmerRN]

At the hospital based oncology clinic, our protocol is 10 ml of saline and 5 ml of Heparin for de-accessing. I never have pulled back when accessing. Heparin itself has a very short half (2-3 hours). So if you flushed it through, it really would not affect anything. It is interesting that the hospital de-accessed your patient when he was coming over for hydration...save the patient a poke!!

And that is cool as an LPN you can work with ports...in the clinic I work in, only RNs can work with them, which can be quite a pain!!

[iluvivt, BSN, RN]

No!!!! you do not need to withdraw the Heparin from the port.....you do need to flush it with NS (usually 10-20 ml)...I use 10 ml and after a blood draw I use 20 ml...then you instill Heparin.....INS recommends 100 units per ml (5 ml for port de-access and monthly flushes. If the port will be accessed and locked of and used intermittently you can use the lower dose of Heparin (10 units per ml-5 ml)...this is also from the INS recommendation (their catheter care flushing guideline cards. Also do a complete assessment for any port related complications and verify a blood return.

[tewdles, RN]

Your best bet is to review your P&P manual for this information. Although the practices are sort of standardized, there are minor discrepancies from place to place. In the end you will be held accountable to the company policy...not to the advice you received on AN.

[iluvivt, BSN, RN]

SURE CHECK YOUR POLICIES (IF YOU HAVE THEM AT AN MD OFFICE) BUT MAKE SURE THEY ARE WITHIN AN ACCEPTABLE standard and you can not do that unless you check around and find out what that is.

[XYcsccSN]

I think she may have been confusing standard CVL ports and lines for dialysis. There is no reason to pull back standard 100u/ml heparin from ports. You do need to pull back the high dose heparin used in dialysis catheters first.

[oncrnpa]

Curiosity question: Can LPN's in your state access a mediport?

[Hospice Nurse LPN, BSN, RN]

Curiosity question: Can LPN's in your state access a mediport?

We can in my state, as long as we have been trained.

[IVRUS, BSN, RN]

Curiosity question: Can LPN's in your state access a mediport?

In Missouri, an IV certified LPN can flush a port with saline and heparin flush solution, but the port has to be accessed and deaccessed by a RN. However, once a RN has accessed it, it can be maintained and medications approved by Missouri can be given into it. (No Chemotherapy, or Blood/Blood products can be given by the LPN)

[64rcs]

What brand of ports do your pt's have? Most of our ports are a Groshong tip caths so only saline is needed. Correct me if i'm wrong.

[ella1]

We insert 5000u/5ml heparin into our infusaports when deaccessing and as such always withdraw at least 5-7ml on accessing