I was recently involved in a discussion around the proper steps to take when there is no blood return from an indwelling chest port but the ability to flush. I am wondering how many people have changing the huber needle as the first step.
Thank you
I was recently involved in a discussion around the proper steps to take when there is no blood return from an indwelling chest port but the ability to flush. I am wondering how many people have changing the huber needle as the first step.
Thank you
It is important to have an idea about the cause of impossible blood aspiration with an easy injection ability. We always teach our nurses that they always have to replace the needle if ataccess you are not sure about the correct needle position, you have to place a new, mostly longer, needle. Second step is flushing and changing introthoracic pressure and the patient's position) and then check your tip position with an X-Ray. If the tip is located in the correct postion (VCS-RA), then a catheter tip thrombus migth be assumed and adminsitraion of thrombolytics is the next step, if the problem persists a big catheter tip thrombus or sleeve might be present and that you might visualise by a linogram.
We have published our olgartyhm a few years ago: Management of functional complications of totally implantable venous access devices by an advanced practice nursing team: 5 years of clinical experience. Goossens GA, Stas M, Moons P.Eur J Oncol Nurs. 2012 Dec;16(5):465-71. If you have problems in finding the publication please email me for a copy ([email protected]).
The only two case where we always replace the needle immediately is in cases of difficult or impossible injection abilities.
If I agree with ggoosends thought of using a longer needle when reaccessing, as I will switch to a larger non-coring needle, say a 20 vs a 22 g. Then without a brisk blood return despite nursing interventions, I will get an order for Cathflo, and let it work its magic. If that doesn't work, then we CXR.