Xylocaine for Port Access

[Sailingshoes]

We have a running debate at my facility regarding port access for our chemo pts. Some nurses prefer numbing with a xylocaine injection, some spray. The injection may increase the risk of infection due to an additional stick? Is the spray actually sterile? I know some places (especially hospitals) use nothing. I am interested in hearing what other Outpatient Cancer Centers do and based on what information.

[Kim O'Therapy, BSN, RN]

The facility my husband goes to for treatment prescribed Lidocaine/Prilocain Cream 2.5%. He massages into the skin covering his port 30 to 40 minutes before access and he has wonderful results.

Good luck.

[DLS_PMHNP, MSN, RN, NP]

We use EMLA cream at our facility. We instruct the pt to put in on 60 min. prior to their port being accessed.

[ORSmurf]

We offer our patients a xylociane injection. I'd say it's half and half as far as how many prefer it. We don't have the spray or emla cream options.

[lbwrn]

We use the spray at our facility. Less than half of our patients use the spray.

[Sailingshoes]

Thanks for the replies! I forgot to mention we do prescribe Emla Cream as well but for some pts it's too much too remember therefore the question of spray vs. stick.

[prowlingMA]

The Center I work at will perscribe cream only if pt has a lot of pain with access. And only uses the spray if the patient requests. Lidocaine rarely used, some times if it is the first time being accesses after placement. Probably 75% of the time they don't use anything.

[scma]

Our practice will give a Rx for Emla for the patient to apply at home. 95% of our patients use nothing at all. We use 22G hubers only. When I access patients they all say it is not as bad as they brace themselves for.

[iluvivt, BSN, RN]

The spray you are talking about is Ethyl Chloride and can be used to freeze the skin prior to port access. It is an accepted practice. I would apply the spray and allow it to dry,then cleanse the skin,(preferably with Chlorhexadine) for 30seconds and allow that to air dry (air drying is mandatory in order for it to work properly) and then proceed in sterile fashion. As far as the injection,I assume you are using a 1% Lidocaine and this is also acceptable practice as well. Be aware that over time with repeated access the skin over the port becomes desensitized. We rarely use anything,unless patient is difficult to access or if they are very frightened about the stick and can not calm down.

[Beaches10]

We gave our patients the choice of xylocaine vs nothing, both peripheral and via port. About 4% chose not to use Xylocaine while 96% state it makes the experience better. Only 2% felt the topical was worth the trouble of remembering to apply. I'm torn - topical would be worth it with a port if it were me, unpredicatable as far as a peripheral site access. Infection at the port site is rare, so can't say the extra stick with Xylocaine use would be a true factor.

[estralita]

Will there be a chance of damaging to the silcone surface of the port if u use inj xylocaine?

[MissRNC]

We use 0.5% lidocaine intradermally prior to port access. Most of our pt's request it with the exception of our sickle cell pt's that have had their ports for years.