We have a long standing issue with the appropriate indentification and access of power vads with power hubers for CT injection. The issue has generally been the identification of the port as "POWER" injectable prior to being accessed by the RN with the Power needle. It is generally not an issue to access all VADs with non-power needle sets. However, cases arise when a patient with a VAD accessed already or not gets an order for a CTA. Most of the time if the patient doesn't mention anything of a power VAD and a vien is found, we start a Peripheral IV. Even less frequently, is when the pt. has a VAD is ordered for a CTA and DOES mention that thier Port is "Power" or we are unable to place a PIV and investigate weather the Port is "Power".
It seems the identification is now the easy part. CXR or Scout scan the port for "CT" markings prior to access with the "power needle". As far as I can tell, all port designs for power injectability now include radiographic lettering of "CT"
Here is the hard part. I checked all of the IFU inserts for the Power VADs; BARD, Smiths Med, Med Comp, Angiodynmics, and navilyst. BARD of course states that you may "only" use the BARD Power Loc needle with the Power Port. (interesting though on the Power Loc needle IFU it states the Bard needle may be used with other power VADs ) Angiodynamics states that thier CT "Smart Port" MUST be access only with thier Lifegaurd infusion Power set. Navilyst, Smiths and MedComp only stated to use a power rated nedle set.
We carry the Bard Power Loc needle. the Bard ports have the palpable bumps so you know its Bard and you can safely use access these.
If it has no bumps, it could be any of the other brands including Angiodynamics. So we would need to use the Angiodynamics needle for any port verified as "CT" by CXR or scout without bumps.
So are we supposed to stock 2 brands of power needles for power port access? 2 different safety devices which does pose a risk for safety device failure and potential accidental needle sticks.
I have a feeling most are just identifying the port as "CT" capible and accessing with whichever power needle they carry.
I also have a strong suspicion that the wording is oly an attempt to keep people brand loyal with their purchasing.
Any thoughts would be greatly appreciated!
I think you have very nicely described why it is perfectly reasonable for clinicians to use products "off label". It is also perfectly reasonable for manufacturers to want us to use only their huber needles on their ports. They do not want to be responsible for another manufacturers product! Many company employees have warned about "off label" usage of their products on this forum. Piccs used in the jugular is just one example.
From a practice perspective it is ok to use products "off label" if you do so in a reasonable and prudent manner. Up to one fifth of all drugs are prescribed and given as off label use, I would hazard a guess that every nurse in every hospital in the United States has at one time or another used some product "off label".
At the same time it is definitely not OK for a company representative to promote off label usage, and in fact people have gone to jail for this. So in your situation I would say as a practicing clinician who is reasonable and prudent, I would not hesitate to use a AngioDynamics power port with a Bard Power Loc Huber and vice-versa. Part of being reasonable and prudent would be making sure your hospital has policies backing up that clinical decision!
Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness
At our facility our we require two identifiers befor power injectin a "power injectable port". One of them being the scout film, but I have seen many of these scout films done and the "CT" that is embedded on the backs of these ports are not always visable. We have to relay on the the shapes and other characteristics. You would think the FDA would have seen that manufacturers of these types of ports could have made them easliy and in the same manner identified.
Darla Tarvin RN VA-BC
Mercy Clermont Hospital
Update. I forgot to include Cook Medical which has the "Vital Port" power injectable. Guess what, as far as I can tell, this particular port has NO radiographic lettering "CT". Nice. Make this even more complicated. Any one aware of any other brands. With the addition of this one, it brings the total up to 6 brands(see above origional question). Thanks again
We have an internal database for which all port insertions are entered. We have an IR department that inserts only CT compatible ports and OR surgeons that may insert CT or non-CT compatible ports.
When we encounter a patient that has had a port inserted elsewhere we require identification of the device; manufacturer's card. We have even called the institution to identify the type of port that was inserted. If we do not have this we do not use it for power injection.
Initially we carried three different manufacturers huber needles. This was ridiculous trying to maintain different needle lengths and not have product expiring on the shelf. We decided to use one brand of non-powered needle and one brand of powered needle.