Should I have accessed her port?

[guest947568]

When I came on shift today in the ER I had a sickle cell patient. Patient had a PIV 20G in the right AC placed in triage (BEFORE my arrival/shift). The PIV in question flushed and drew back fine. She go her fluids and PCA pump through this line without issue. The patient had 2 nurses before me all of which refused to access her port because she had the PIV. the nurse I got report from stated she did not access the port because it was not clinically indicated because the patient had an IV.

The patient requested it be accessed because she can feel the PCA better in the port than the PIV. I asked THREE other nurses who agreed I shouldn't access it due to risk of infection and she already had an IV.

Patient went to floor and ask the nurses there to access it. All of which refused to do so and notified their manager. Management calls me upset saying I gave poor customer service by not accessing the port in the ED when she requested. They said the floor cannot do it as theyre not trained. Mind you this was AFTER she had the PIV placed in triage last night. The PIV that worked fine.

My last hospital I was told not to access ports unless clinically indicated as its an infection risk.

What would you have done?

[DextersDisciple, BSN, RN]

If she had really crappy vasculature (as many sickle cell pts do) and she would have asked if we could use her port instead then yes I would have went right for the port.

If she needed additional access I would also access the port.

BUT if she wanted it accessed bc she (for some strange reason) gets a better high then no, I would not access her port. That makes no sense.

ETA-my Dept places ports and A lot of nurses make it a point to say “do not let ANYONE access your port unless they are qualified to do so.” But when I see a port and someone is a really tough stick i would usually go for the port because I am skilled in port access.

[guest947568]

7 minutes ago, DextersDisciple said:

If she had really crappy vasculature (as many sickle cell pts do) and she would have asked if we could use her port instead then yes I would have went right for the port.

If she needed additional access I would also access the port.

BUT if she wanted it accessed bc she (for some strange reason) gets a better high then no, I would not access her port. That makes no sense.

ETA-my Dept places ports and A lot of nurses make it a point to say “do not let ANYONE access your port unless they are qualified to do so.” But when I see a port and someone is a really tough stick i would usually go for the port because I am skilled in port access.

That was my reasoning too! But she had a nice 20g that worked beautifully. I wouldn’t have had an issue accessing if she didn’t have a PIV but in my mind this is just extra risk for infection for a better high

[DextersDisciple, BSN, RN]

Yeah stand by your rationale because it’s the correct one.

[CalicoKitty, BSN, MSN, RN]

Some of the units in my hospital will deaccess a port and stick in a PIV if using the port isn't clinically indicated. "feeling" it better in the port is not a reason to access it. If the PIV is working, that's what should be used. "Customer service" is not giving them a CLABSI.

[brownbook]

1 hour ago, DextersDisciple said:

ETA-my Dept places ports and A lot of nurses make it a point to say “do not let ANYONE access your port unless they are qualified to do so.” But when I see a port and someone is a really tough stick i would usually go for the port because I am skilled in port access.

This is what we went by.....NO ONE SHOULD BE ACCESSING A PORT if they are not qualified....you do not want someone who saw it done once, or has done it "occasionally" in the past, messing up a port! End of subject!

[Daisy4RN]

Agree that nobody who is not properly trained should be accessing the port. That said, in this case if i were you i would not have accessed at the time you had the pt bc as you stated pt already had a patent IV. I would wait until that one went bad and then access it (according to P/P). Nurses on units should be able to access but if not the ED nurse, or whoever is trained, can go and access it. I think you did the right thing by waiting bc there is always an infection risk. But i dont know why it wasnt accessed from the beginning from the first encounter, nurse busy or inexperienced maybe?

[guest947568]

59 minutes ago, Daisy4RN said:

Agree that nobody who is not properly trained should be accessing the port. That said, in this case if i were you i would not have accessed at the time you had the pt bc as you stated pt already had a patent IV. I would wait until that one went bad and then access it (according to P/P). Nurses on units should be able to access but if not the ED nurse, or whoever is trained, can go and access it. I think you did the right thing by waiting bc there is always an infection risk. But i dont know why it wasnt accessed from the beginning from the first encounter, nurse busy or inexperienced maybe?

I don’t think our triage area has a place to do it! That or because it was a 6 hr wait last night so busy busy!

[JKL33]

I would be likely to access it - but the possibility/timing of that would depend on other priorities within the assignment due to the fact that the patient was already receiving medically-appropriate treatment through the existing PIV.

There is an infection risk with accessing a port and yet SCA patients have ports so that they can be utilized for these very types of treatment situations (even if not for the rationale that was given by the patient). SCA patients don't get ports so that every time they go to the hospital someone can tell them that using it is an increased risk of infection and then decline to use it after someone already thought it appropriate for them to have one in the first place.

[Kallie3006, ADN]

I understand the rationale on not accessing it while having a patent PIV in place while the patient was in the ER, however when it was known that the patient was going from OP to being admitted for IP or OBS status I would have accessed the port before sending to the floor. The patient is already on a PCA, assuming IVF, and will more than likely be getting labs and the port can be utilized for all those things. If your facility does not have everyone trained and checked off to access, it would make sense for the department that has staff trained to access to complete this task prior to the patient leaving for the unit, IMO.

[beekee]

A sickle cell patient that’s in and out of the hospital so much so as to get a port should be allowed to use it when they are in the hospital.

[JadedCPN, BSN, RN]

While I do understand the reasoning behind not accessing since the pt already had working access, as others have stated I still would have accessed it if the patient requested to do so (regardless of reasoning) because that is why the port was placed in the patient in the first place. Plus thinking ahead in regards to ease of use for the daily lab draws that will likely be ordered.