I am looking for supporting evidence related to not using ports with tip in Brachiocephalic vein. Left sided approach because lung tumor preventing right sided access. However, surgeon still unable to position tip any further. Patient receiving Carbo & Taxotere. Surgeon & Radiologist now say that the port is OK to use. Need evidence to make the case for not using Port.
Thanks
There is lots of evidence stating that the recommended tip location is cavo-atrial junction, however this patient is presenting with circumstances that would prohibit this tip location. Your only other option would be to come from hepatic, lumbar or femoral veins to have the tip in the IVC. I think you will have to use this catheter until it is no longer functional or the patient no longer needs it. If therapy will be anticipated for an extended period, I would begin talks and planning now with the physicains about the next site. I would use what you have as long as it met the criteria for a functioning catheter - flushes easily, no discomfort of any kind in the chest, and produces a blood return that flows easily and is the color of whole blood. This tip location is going to be at risk for more complications and this becomes a nursing resopnsiblity to do a thorough assessment with each use. Then plan for an IVC tip location if this one fails or therapy is needed in the future. This same thing was stated many years ago in an AVA paper on PICC tip location. 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
It seems to me there are three important considerations here.
1. The tip is not appropriately placed(but may be as good as it gets)
2. The patient needs therapy for treatment.
3. A surgeon and radiologist are saying it is OK to use, but they are not the ones using it!
I think it would be helpful if there was documentation in the op note stating they were unable to advance the port to proper location. Really helpful if imaging studies proved stenosis/blockage preventing placement. That would distinguish between a port really placed as well as it can be vs. a surgeon possibly rushing a job. This would make your decision to use the port stronger in case of an untoward event with litigation.
Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness
I am unclear from the original post as to why the surgeon could not place the tip any further . . . what brand of port was it? was the port catheter shortened too much? venous stenosis issue? tumor preventing catheter from getting into SVC? Does pt have SVC syndrome?