Needs some help please. I can't find any standards related to deaccessing a huber needle from a portacath. How is everyone doing them and what reference do you refer to on your hospital policy and procedures? I found information on accessing a portacath but not for deaccessing portacaths. Thank you.
Have you read INS Standard #39 Inplanted Vascular Access Ports? What specific questions do you have about removal of the needle? 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
Thanks for comment Lynn.
I have read standard #39, Infusion Therapy book, Clinical Nursing Skills, by Smith,Duell and Martin, and Pulmer's Principles & Practice of Intravenous Therapy. I find all kinds of information on accessing portacath's but nothing on step by step procedure of how to deaccess one. What I need is a step by step procedure written on how to deaccess a huber needle from a portacath based on standards or evidence based practice. Our policy states remove dressing with regular gloves grasp device with non dominant hand and pull huber straight up then apply bandaid. I can't find anything to support this. I was taught to use a central line dressing kit, apply mask, remove dressing with regular gloves, apply sterile gloves, clean with chloraprep, allow to dry, remove needle and apply occlusive dressing. I appreciate the help. Thank you.
The way you were taught seems like overkill to me. We typically do not go to that extend to remove a percutanerous CVC. So why do it for removing an implanted port access needle? I have not seen any actual clinical studies on this procedure and I doubt we will ever see such a study. The rates of infection from implanted ports is the lowest of all CVADs. I think the procedure from the specific brand of needle in use should be where you would start. The safety mechanisms differ and they determines the technique for removal. You can use sterile technique if you want, but I have never seen any standards, guidelines, or recommendations that endorse this. An occlusive dressing is also not require because the septum in the port body should immediately close when the needle is removed. If it doesn't close due to coring issues, an occlusive dressing placed on the skin surface will not be helpful. I would definitely focus on the sterile technique for inserting the access needle but clean technique for removal. 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
Thanks Lynn. I will check with manufacturer to make sure I have covered all my bases. I appreciate the info!
I certainly wouldnt allow a nurse to use just clean gloves to deaccess me, I want my whole chest area to be free of any contamination.
So only personal reference as such, and 13yrs of no infection by sticking to my guns!! [not the bang stick ones]
Same as with a stethescope whether the port is accessed or not, it gets cleaned, or a cover put on. Its a very small area that gets stabbed daily/weekly/monthly so as far as I am concerned that tissue is compromised, esp with a foreign body of the port hub underneath it.
There are many articles how 'clean' gloves aint that clean
http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10894106
Yes you are correct about the "clean" glove issue. There is a risk of facilitating a port pocket infection and this will require port removal. I was not thinking of such a compromised patient. I am also wondering which patients would get an implanted port accessed on a daily basis. Please share that. I was only thinking about CRBSI/CLABSI. Research has not established what is required for this deaccessing procedure, but I do still think the full procedure as was first suggested is overkill. 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
I agree with you about the full monty procedure.
Home TPNers access as they feed, [ in a good percentage] there is after all a line attached to the huber needle, and lines get changed every 24hrs anyway. Also the HPNer is usually active so having a bling dangling from the chest, and trying to work, or drive a car [ depending on which country and which way the seat belt goes, and the side of the port but they always clash!] and as an example a fellow TPNer was involved in a car accident and her huber needle was very bent when she removed it, as she is made to use the safety ones with the big head/handle. It caught in her seat belt as she was flung forward, a good reason to use the butterfly head ones if self accessing, they are flat to the skin.
Also due to many years of using the port, allergies to the dressing emerge, so another reason for not having it in for any longer than treatment or 'meal'
For me personally, for de-accessing, the occlusive dressing is removed, then hands washed again, and alcohol gel used, and with a sterile pkt of 2 gauze swabs ready and open, the needle is removed with one hand and the other holds the port down. Gauze over as the site as it does leak,and pressure applied , moving the tissue over like doing a Z injection for about 30sec. [The septum is fine, there is a track for that mini-second, because the lock used stings greatly!
then the other sterile swab is folded so the surface going to the port site is not touched and sticky tape over, this is left on for 30min and removed.
I have used that method for the past 5 yrs with this port, with no infections either of the CVAD or site.
.