Recently as a cost saving initiative our health system has decided to only have Power Lock needles/sets available for accessing ports instead of having so many different Huber needles. My concern is that a non power port is now accessed with a Power Lock set making it "appear" to be power injectable, possible leading to port/catheter rupture or fragmentation if it is inadvertently power injected. I am aware that most Power Ports can withstand 300psi with a flow rate of 5ml/sec with a non power port on withstanding 40 psi. Does anyone have any knowledge of literature to support or statements from any organization? I am meeting next week and in order to bring back even a limited number of plain Huber needles, I must have "literature". I have manufacturer recommendations, but functionally the power lock needles will work in either type of port. To me it is a patient safety issue, not a functional issue. Help....
Our organization has adopted the same practice and I have the same fear as you. Not all ports are power injectable. The answer I got from senior management was "staff has to see 2 forms of identifiers of a power injectable port before power injection". I said I can just see a pt who has had their port for 10 years having a physican order a stat CT with contrast and those indentifiers being missed. We have also gone to one size, 1" needle for all ports which presents another terrible outcome in the making. I can see port needles becoming dislodged and extravisation occuring. Sad to say that I am the only CRNI in our organization (western region at least) and my knowledge and experience is not utilized at all. Let me know what the outcome is. Valorie
Valorie Dunn,BSN, RN, CRNI, PLNC
I am more concerned about only having one length than about only using power injectable needles. At least the staff is familiar with the process of 2 identifiers from patient identification so this could carry over. But the short needles can and will lead to extravasation injury and serious lawsuits. I have been the expert on several port extravasation injuries and I know of other oncology nurses that have done many more than me. So it will happen. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Yes Lynn, I can see some huge extravisation complications just waiting to happen and like you said, they WILL.
Valorie Dunn,BSN, RN, CRNI, PLNC
I have just revised our entire port policy. There were many issues uncovered during my research and investigation. I have the opposite problem as you. No power injectable needles are stocked. Luckily (well, only in this needle issue situation), they shy away from using the ports for power injection. In this circumstance, it ends up that is ok since we don't have the proper needles to use it. But, my fear is once in awhile they have or they will. So, our intervention is EDUCATION, POLICY changes, and correct SUPPLIES. This is going to improve the situation for the patient....
Could you provide literature (and there is plenty) that describes the circumstances that have to happen in order to enable the use of a port for power injection? Just see INS Standard 39, and the references to follow. So, if they have proper education and up to date policy, that is a good step.
Even still, I agree with you about the needles. It will be misleading. One of the biggest things I have learned is how important it is to have a variety of needles so that the appropriate one can be used, and documented for the patient. Your scenario reminds me of the horror stories about when a patient has a midline, and it is treated as a central line. Maybe you could talk about your concerns to your risk manager?
Is there any possibility that the cost information is incorrect? It seems odd that the power are cheaper, but I never pretend to understand different purchasing arrangements.
Let us know how you solve it!
Kathleen Wilson, CRNI
We have a nursing practice congress so any practice issues can be submitted thru that avenue. Today we had a PACT meeting regarding the Huber issue. Our system consists of several facilities so we are getting more people at the table to discuss how the ports will be positively identified as power and how to label the dressing. Apparently, even if the port is accessed with a power set, CT will not inject until confirmed. Unfortunately, people are people and I fear that someone will not do their due diligence. We shall see....we will be implementing system wide education to ensure that everyone is using the same process and that they know that just because they see the power needle doesn't mean it is power. Yikes!!
Kathy Langley, RN, BSN
Vascular Access Clinician
UAB/UAB Highlands Hospital
Birmingham, Alabama
Several years ago to avoid confusion we adopted the Power Hueber only policy as well [We stock both 3/4 and one inch needles]
All our patients receive a "scout scan" prior to contrast injection so Ports can be properly identified--If there is any question a peripheral IV is started
Robbin George RN VA-BC