I am looking for helpful information about locking implanted ports. I have always followed the practice of instilling Heparin solution after using the port when there is not a continuous infusion running. We have patients in our facility that require frequent pain medication via a portacath. What is happening is the port is only being flushed with normal saline before and after pain meds are given. The only time heparin is instilled is when port is deaccessed prior to discharge. As an IV nurse, we are frequently being called to troubleshoot the port due to no blood return. I feel strongly that the current practice of only using normal saline is creating this issue. Cathflo will usually clear the line but what is the long term effect of not using heparin flush between uses? Are we ruining the patients port?
You need a written, approved policy and procedure to standardize practice. In my opinion heparin should be used to lock all CVADs according to INS SOP.
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 discourage intermittent use of ports especially in the hospital setting because of problems with clotting off. In fact, we have it in
in our policy. We have also discourage drawing lab work from ports because they are more likely to clot off if the nurse does not
flush with enough saline afterwards. Some patients of course insist. Nothing worse a poor functioning port. We don't have a lot op;
in the chemo clinic. So, it must be the hospital nurses. Apparently, the port had ruptured at some point. His new port
worked fine. I was glad the surgeon listened to me.
Sherry Cline Martin RN, CRNI
I would agree with discouraging lab work drawn from any CVAD due to the increased manipulation and possible increased contamination. However, I would not agree that an implanted port should be avoided for intermittent infusions. The fact that the therapy is intermittent does not produce a greater risk of clotting, but there are numerous device-related and nursing-related causes. For instance, what type of needleless connector was being used? Were the nurses taught the correct flush and clamping sequence? Was a traditional syringe design being used for flushing and locking? If so, there is also syringe induced reflux. Were you locking with heparin or saline only? Then there are numerous issues with inserting the port access needle. For the implanted port that "ruptured" where did this occur along the catheter? If it was a few inches away from the port body, and the insertion site was subclavian, I would strongly suspect pinch-off syndrome rather than any issues associated with flushing ahd locking the port used intermittently. 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
Hello,
I discouraged our staff to use the ports intermittent therapy in the hospital setting because the patients are usually
receiving a lot of different IV medications such as antibiotics and pain meds throughout the day. A lot of connecting
and disconnecting. We do use the Postive Displacment Site injection caps at the end of the t-tube extension.
As far as the ruptured port, the top of the actual port where you insert the needle popped off The surgeon showed me.
It looked like someone used excessive force to flush it possibly. I remember telling the oncologist that the port lacked
blood return the last time the patient was admitted. The nurses had it saline locked after a blood transfusion in this case
and IV fluids running peripherally. I was called because they couldn't flush it. The oncologist said he would take care of it in the
office. Our hospital staff is just not used to dealing with ports frequently and problems tend to occur.
Sherry Cline Martin RN, CRNI