Good afternoon,
IWe are currently weighing the pros and cons of Broviac vs port for one of our little patient. She is 3.5 yo and weighs approx 18 kg. She's been on home TPN since birth. She is progressively needing less parenteral nutrition, enough to give her 2 breaks from iv lines during night time!!! Parents are really interested in the PORT since their child can go swimming and have real baths. Mom is a nurse and we know that the family is reliable... but we are really concern about the risk of needle dislodging and extravasation happening.
What have your experiences been on similar situations? Which brand are your ports? Do you use the mini-loc from Bard? Is your dressing different?
Thanks for sharing!!!
Lorette You
Vascular access coordinator
Montreal Children Hospital
It is unclear from your message as to how long the port would be accessed. Will the PN be infusing only at night or during the day as well? What activities will the child be doing while the PN is infusing? What is the reaction of this child to being stuck? If the PN will be infusing while the child is awake and active, doing what all 3 year olds do, I would focus extreme attention on securement of the port access needle with a stabilization device and not just rely upon tape and the dressing. There is a Statlock designed for this purpose, although I am not sure of their available sizes. If cyclic PN at night, I would make a careful assessment of the port needle and require a good blood return before starting the PN infusion. If cyclic PN at night only while the child is sleeping, there would seem to be less risk of needle dislodgment and extravasation. 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
Hehe, yes you are right Lynn, my message was not as clear as I thought!
The child is currently needing 9hours of TPN per day. Her PN is only running during night time.
Loretta,
The majority of our young long-term infusion patients have tunneled CVCs. We do place ports in toddlers but they typically have intermittent periods of time unaccessed (e.g. hem/onc pts, cystic fibrosis).
While there are many advantages for a port, TPN extravasation would be a concern. Since the pt requires daily TPN, she would never have a break from having her port deaccessed for long.
Prior to a pt swimming with a port, we like to have the site scabbed over (may take a day or two). With our tunneled CVCs, we have a plastic shield that we put over the dressing that protects it from water.
Darcy Doellman RN, BSN, CRNI, VA-BC
Vascular Access Nurse
Cincinnati Children's Hospital
Hello
I am a grandmother RN currently care giving for my 5 and half year old short gut grandson. He has recently had to go back on TPN due to malnutrition. A central line was placed appox 6 weeks ago we did ok with drgs able to go up to a week between changing dressing. Than he decided to handle the situation himself and began taking off the dressing at night until he pulled out the central line. The doctors decided to place a port since Ryan is running out of sites. He has 3 left. The first week when his energy was still low due to malnutrition we could get a week. Now due to heavy sweating durning sleep I am changing the dressing daily. I have consulted with VAT RN at Children's in Chicago they have suggested mastidol to increase adhesive. If any of you have any further recommendations it would be so appreciated. This beautiful child is TPN dependent Due to a set of circumstances such as divorce poor medical management and mental illness of mother this child's gut in my opinion was not giving a chance to detrimined potential. I disparatly want to avoid transplant. This issues with the dressing adhesive is now becoming a detrimined factor. Any suggestions?
Grandma Laura RN MCM