Sudden issues accessing ports

[babyoncnurse]

Hi all. 

I have been an oncology nurse for 3 years now (it’s all I’ve ever known, I have not been in any other specialty). I worked in an inpatient setting and recently came to an outpatient infusion setting. Inpatient I dealt more with PICCs but did have to manage ports on occasion. Moving to infusion about 8 months ago, a large majority of patients have ports. In the beginning of my move, I may have had an issue with one or two ports, especially dealing with brand new equipment and setting (patient sitting up instead of laying in a hospital bed) but I quickly got what I felt like was pretty proficient with them, even deeper/troublesome ones. Now suddenly I find myself missing a port or two every other week or so. And by missing I mean catching the edge to the point where the port is unable to be flushed at all and they need to be re-accessed, causing unnecessary pain and distress for my poor patients who are already going through so much. The thing about it is that I get the needle right in the middle but I think it has to do with the angle (I am fairly tall and have to bend to my sitting patients in order to reach them in their chair). When this happens, I attempt to pull back on the needle slightly to see if I can “save” it but I typically get that dreaded terrible feeling as soon as I attempt to flush because I know they will probably need re-accessed. From my first couple misses, I have gotten into the habit of feeling, feeling, feeling to ensure that missing it completely is not the problem, so like I said I typically get it right in the middle but the angle is just off. I also always access quick with my darting motions, and do have them sit back and put their shoulders back so that I have the best view/feel/least obstruction. I also will add that I tend to be missing ports on patients that I have successfully accessed before without issues. Some coworkers say that they ebb and flow with their port accessing and that “everybody misses ports sometimes,” but it just doesn’t usually seem like that’s the case (but I guess most people don’t really tend to advertise their mistakes LOL) and I seem to be in quite the ebb these days. I just always feel incompetent and like I don’t have enough experience but I have gotten plenty of notoriously difficult ports with no issues. I know I’m still new compared to most of my coworkers but I tend to feel very confident accessing ports and do it so regularly, I just feel like my confidence slips more and more with each miss and the confidence is half the battle in my opinion (aim and commit!). I just feel like I do all the right things and it just sometimes still doesn’t work out, and I wouldn’t care as much about messing up if it didn’t inflict pain on my patients ?
 

So, do you guys ebb and flow with your port accessing (or were my coworkers just trying to make me feel better LOL)? Do you get into slumps? What tips do you have? I’ll take any and all advice. 

[DavidFR, BSN, MSN, RN]

On 7/15/2021 at 5:33 PM, babyoncnurse said:

 Some coworkers say that they ebb and flow with their port accessing and that “everybody misses ports sometimes,” 

So, do you guys ebb and flow with your port accessing (or were my coworkers just trying to make me feel better LOL)? Do you get into slumps? What tips do you have? I’ll take any and all advice. 

I agree with your co-workers. You genuinely do get slumps. The same as with posing a peripheral IV line. You miss once and it's too easy to panic and think "Oh my I'll never site an IV/access a port ever again!" but of course you will.

I had this a few years back where I missed a few ports in a row, and then bingo I got a good one and have never had a problem since touch wood. 

I doubt it's your technique if you've been successfully accessing ports before. If you really have a doubt ask an experienced colleague to watch you. The height issue I've never come across since I'm used to patients in beds where you can of course adjust the height. Is this a problem to take up with your manager as an ergonomics issue? Are your chairs adapted for patients needing to have ports accessed? I know that in our day hospital they have dentist style chairs which are adjustable height. This isn't good for your back long term to be bending like this every day as I'm sure you know. 

If you think it's the angle are you using needles that are too long? I don't know what needles you have. We use Quimoflow + and our standard size is 20mm which is OK for most ports. If a port is quite deep I'll go up to a 25mm. We go up to 30mm but I've only had to use this once on a very obese lady with a deeply sited port.

I would bet that this is most probably a case of you missed a couple and you lost a bit of confidence. You CAN access ports!!

Best of luck. let us know how it goes on.