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?

[brownbook]

1 hour ago, turtlesRcool said:

No, but I don't think a nurse who has never done a skill should attempt to do it for the first time on his or her own. Accessing a port should be done by people who are trained to do so.

But, if you're not trained to do something, you get someone who is!

And this doesn't seem to be the case for OP. OP states that the ED nurses REFUSED to access the port because they decided it wasn't clinically indicated. No explanation as to what they thought would make a port "clinically indicated" in a SCD patient, if not hydration and pain meds, which is presumably what the patient was there for. The floor nurses refused to access a port because they don't have the training, which is a different issue.

I agree completely. It makes absolutely no sense. I can't imagine a situation where a nurse who is competent to access a port to not use it. My gut feeling is the ER nurses weren't comfortable with, or that they had never been in-serviced to, access a port. But you're right, the original post does not mention the ER nurses weren't qualified.

I'd love to hear back from the original poster.

[JBudd, MSN]

When I was admitted to a medical floor, not the oncology floor; my port was already accessed. However, the floor nurses didn't know how to pause the infusions to draw my daily labs. I taught my nurse how to do it (yes, I give those inservices, but not usually as a patient, lol); the next morning I had 6 people around my bed.

[Lunah, MSN, RN]

On 3/31/2019 at 8:05 AM, Jory said:

The purpose of the port is to access it and to keep the patient from being stuck...over and over again.

The PIV should never have been started.

Agree, Jory. But there is a trend to not initiate anything invasive beyond PIVs in the EDs. My last ED wasn't even supposed to place Foleys, they made it sound like the back hallway to the OR would be prefererable to ED Foley placement. Lol. This could fall into a similar scenario.

I have had a few patients on chemo who didn't want ports accessed, but other than that? I am am accessing the port as long as it is within policy and I have the right equipment and the doc is OK with it. A port is there for a purpose, and my purpose is not to judge.

[JKL33]

1 hour ago, brownbook said:

My gut feeling is the ER nurses weren't comfortable with, or that they had never been in-serviced to, access a port. But you're right, the original post does not mention the ER nurses weren't qualified.

More likely a time and space issue. People are trying to get stuff started for patients when they don't even have a room to put them in; some of these people are sitting in any spare chair to get things going.

My guess is whoever started this project was just trying to get things going in the quickest manner possible, and then later when the OP asked the advice of coworkers, they discouraged worrying about it through a rationale that was not legitimate.

[humerusRN]

I take care of a chronic population - and when they are admitted thru the ED, they always come to us with PIVs. We always discontinue them and access their ports on arrival to the floor. Why? Because they will be with us for 2-3 weeks. They require daily, sometimes more frequently, lab draws. They require some nasty antibiotics that I'm not about to infiltrate an IV with.

I think ED RNs should have this training....it's insane to cause unnecessary harm to a patient because an entire department doesn't have what I feel is a pretty basic skill for inpatient RNs. Why is this not required training? You can access a port just as quickly as starting an IV in most instances.

We do have some floors who don't get ports often, and when they do they call one of the floors that do get them often, and we go down and access for them. Team work makes the dream work.

Don't start unnecessary lines.

[JadedCPN, BSN, RN]

My frustration with this topic is that it shows the struggle that many sickle cell patients have to go through in order to get adequate pain control because providers often judge them as "drug-seeking".

For the people who were against accessing the port because it gave her a "better high," I wonder if you would be just as hesitant to access the port because she said "I know it is weird and might not make sense but for some reason it always seems like my zofran works better if it is through my port instead of an IV."

In regards to it not being accessed because the individual wasn't qualified to access it and maybe the emergency room was too busy...sure, I will take that excuse. But once that patient hit the floor and got settled, the port should have been accessed. Period. The excuse of being a risk infection is just that, an excuse...if she wouldn't have made the statement about feeling the PCA better in her port, there wouldn't have been the hesitation. Shame on the people who refused not to access the port.

[DextersDisciple, BSN, RN]

4 hours ago, JadedCPN said:

My frustration with this topic is that it shows the struggle that many sickle cell patients have to go through in order to get adequate pain control because providers often judge them as "drug-seeking".

For the people who were against accessing the port because it gave her a "better high," I wonder if you would be just as hesitant to access the port because she said "I know it is weird and might not make sense but for some reason it always seems like my zofran works better if it is through my port instead of an IV."

In regards to it not being accessed because the individual wasn't qualified to access it and maybe the emergency room was too busy...sure, I will take that excuse. But once that patient hit the floor and got settled, the port should have been accessed. Period. The excuse of being a risk infection is just that, an excuse...if she wouldn't have made the statement about feeling the PCA better in her port, there wouldn't have been the hesitation. Shame on the people who refused not to access the port.

I still don’t think ”zofran works better through my port” is a plausible indication to access it. There are many other good indications but this is not one of them.

[catsmeow1972, BSN, RN]

On 4/2/2019 at 7:24 PM, JBudd said:

I had an “entirely too long stint’ (also known as longer than 5 minutes) with an indwelling triple lumen and TPN some years ago. I would not recommend that as a weight loss regimen, by the way. Every. Dang. Morning. (Long after lipids were finished, mind you), while half asleep I had to refuse to let the lab tech stick me for blood. Even with a giant sign over my bed that said CENTRAL LINE!!

Even so, invariably a nurse from one of the units had to come draw my labs because the floor nurses did not know how. More than once, I was the inservice model on how to do that.

In regards to the person who brought up the Zofran....ODT works better than anything....IV included...just my opinion....?