Second guessing a Port o Cath

[Cristol39]

Today I had a patient that needed to get blood drawn. So I accessed his port o cath but I did not get any blood return. About 5 -7 ml of the normal saline went in and I deaccessed the device and end up taking blood from the vein. Now that I am home I am concerned about not flushing with heparin (as per protocl when you draw blood or give medication) because I figured the heparin from the last time it was accessed was still in there. Again nothing was done with the port as far as blood being drawn or medication, but I am scared that it may clot becuase the patient it not due back to the office until Monday (it is wednesday now). What do you think???? Should I be concerned or not???

[FlyingScot, RN]

The saline you put in flushed the Heparin out of the catheter so yes you should have instilled more Heparin per your facility's policy. Whether the catheter will clot or not cannot be determined. Since his catheter is all ready showing signs of trouble it may clot off before Monday but there will be no way to tell if you had a hand in it. Can you have the patient come in tomorrow for a proper port flush? Our policy for routine flush is NS 10ml followed by Heparin (100u/ml) 5ml. We flush with NS 20ml after meds, blood draw or transfusion followed by the Heparin. You definitely need to notify the physician and might want to consider an incident report. Sorry I'm not offering you much in the way of comfort.

[iluvivt, BSN, RN]

Yes if you were able to instill the 5=7 ml of NS...you should have used a final flush of Heparin....we use the same flush as above...so I will not repeat that....It needs to be re-accessed as soon as possible...try to use at least a 20 gauge next time so you can assess the blood return issue....if you can not get a blood return after using the 20 gauge...making sure you are in the portal chamber..and pulling pts arm out to the side or other position changes....you need to instill 2-3 mg of Tpa (cath-flo) to see if you can re-establish a blood return.

[iluvivt, BSN, RN]

Yes if you were able to instill the 5-7 ml of NS...you should have used a final flush of Heparin....we use the same flush as above...so I will not repeat that....It needs to be re-accessed as soon as possible...try to use at least a 20 gauge next time so you can assess the blood return issue....if you can not get a blood return after using the 20 gauge...making sure you are in the portal chamber..and pulling pts arm out to the side or other position changes....you need to instill 2-3 mg of Tpa (cath-flo) to see if you can re-establish a blood return.