Should blood be obtained from dialysis ports?

ZASHAGALKA, RN · Feb 6, 2006

I have a question, should blood be obtaind from dialysis ports for lab testing?
Please forward your knowledge and thoughts.
thanks,
Lori

Not routinely, but I've done it a time or two, but only w/ an order. And that order must include exactly how to re-heparinize the port.

Dialysis ports are normally strongly heparinized. Routinely accessing them by non dialysis staff increases the risk of a. clotting them off, b. incidental heparinization of the pt.

I won't add c. infection, because I would assume that anybody accessing them knows and follows precautions against central line infections. That's not a precaution against using dialysis ports, per se, but central lines in general.

I would only advise it be done after multiple unsuccessful attempts to obtain a sample by stick.

There is a difference between these ports and central lines. They are much more difficult to put in, normally requiring some 'tunneling', and they are designed for the potential of much longer use. Using them for blood draws is risking a very valuable asset for a routine procedure. Not a good risk/benefit, if it can be avoided.

~faith,

Timothy.

loriannlpn · Feb 6, 2006

Thank you for the quick repsonse.

I am a LPN who is now in a RN program, I am educated on this issue because my grandmother is in ENRD. I have reqested that the doc change her coumadin therapy She is currently on 5 mg of Coumadin q day, Her Pt/INR are always high and then she requires several vit K injections.

Since she has a port in her Left arm, blood draws are obviously drawn from her right arm. The viens are getting weak. The last report that I got from her is she had to get PT/INR checks every day last week. Which required multi sticks, on Friday she had 7 sticks attempted to get a successful blood draw.

Today, she had to go again for another PT/INR draw, they attempted twice on a sore and bruised arm. I sent a message to doc's office, and also called to discuse with them 1.) a change in her coumadin dosages. To see if 2.5 mg everyother days and 5 mg on alternating days would be effective for her. 2.) To see if a Groshongs Cath would be beneficial for her. Rational: Multi blood stick per week, HGB low, requiring blood products.

Am I just crazy? Am I reading to much into this? Should I continue to be on it and demand the best for her?

Thanks,

Lori

ZASHAGALKA, RN · Feb 6, 2006

Thank you for the quick repsonse.
I am a LPN who is now in a RN program, I am educated on this issue because my grandmother is in ENRD. I have reqested that the doc change her coumadin therapy She is currently on 5 mg of Coumadin q day, Her Pt/INR are always high and then she requires several vit K injections.
Since she has a port in her Left arm, blood draws are obviously drawn from her right arm. The viens are getting weak. The last report that I got from her is she had to get PT/INR checks every day last week. Which required multi sticks, on Friday she had 7 sticks attempted to get a successful blood draw.
Today, she had to go again for another PT/INR draw, they attempted twice on a sore and bruised arm. I sent a message to doc's office, and also called to discuse with them 1.) a change in her coumadin dosages. To see if 2.5 mg everyother days and 5 mg on alternating days would be effective for her. 2.) To see if a Groshongs Cath would be beneficial for her. Rational: Multi blood stick per week, HGB low, requiring blood products.
Am I just crazy? Am I reading to much into this? Should I continue to be on it and demand the best for her?
Thanks,
Lori

Just to clarify, if by PORT you mean AV graft, then it would never be acceptable to access THAT for a blood draw. Too much potential for permanent damage to the graft, not to mention that, in that case, you'd be accessing ARTERIAL flow for a lab draw in a pt w/ a verified anti-coagulation issue - not very pt safety oriented.

If you need a line for draws/blood transfusion NOT related to dialysis (there is a working AV graft), then you don't need a 'dialysis' port. A simple central line would suffice.

~faith,

Timothy.

loriannlpn · Feb 6, 2006

I just called her to see if she could tell me the name of the Port inserted, she said all she knew is that they called it a "fistula". She said it was in her vein.

So, where should this go now?

Should I cntc her phycian? I just want to make sure that I have more knowledge on the matter.

Thanks for all of your help much appreciated.

loriannlpn · Feb 6, 2006

Major concern: She lives in a rural area, doc's are not up to speed as the metro areas. Also, she trust's what they say.

babyboomerRN, RN · Feb 6, 2006

hi! is your grandma receiving dialysis treatments via her fistula? if so they can certainly be drawing her labs pre-treatment. and if she does have a fistula or a graft in place no one should be using that arm for anything other than dialysis.