I recently did a home visit on a pt. who has the oncology nurses change his Huber needle on the weeks he gets chemo and our nurses change it on the weeks he does not get chemo. Any way my question is the oncology nurses place gauze under the bend of the Huber needle so this should have been changed every 48 hours correct? Or am I thinking too much "inside the box". I am currently looking at our P&P regarding this so any feed back is appreciated. Valorie
Valorie Dunn, RN, BSN, CRNI® Infusion Therapy Coordinator Home Health Pharmacy 1416 Salem Street Lafayette, IN 47904 765-423-6359
Our policy is to change any dressing with gauze at 48 hr.
Barbara Tinsley
Gauze may be placed under the wings for support to prevent "rocking", which can damage the septum. As long as the gauze does not obscure or cover the catheter-skin insertion site, it is not considered a gauze dressing and the TSM dressing can be changed at least every 7 days.
If the gauze is used as a "Bridging" device for the huber needle....
First question...Was the needle too long? Would a shorter needle remove the need for gauze and provide a better fit?
We allow "Bridging" gauze to remain for 7 day...AS LONG AS...it doesn't obstruct from the visualizing of the site. There is a big difference between a "Bridging" gauze and a bulky dressing!
My 2 cents!
The 2006 edition of the Infusion Nursing Standards of Practice addressed this issue. It stated that gauze or other foam pads could be used to support the wings of a port access needle without making this a 48 hour dressing. Our rationale on this was that wings extending off of the patient's chest required adequate support to prevent needle dislodgement and subsequent infiltration/extravasation injury. This type of injury is very common in the oncology literature. There is a greater risk of this injury that infection associated with the use of the gauze. So you can pad and support these wings, use a transparent dressing and change at least every 7 days.
I do have one question about your original message though. Why is this port accessed when there is no chemotherapy being given? Is there some other type of infusion therapy prescribed? If not, it should not be accessed again on the off-week when nothing is being infused. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Lynn. His port is accessed all the time for TPN. Thanks, Valorie
Valorie Dunn,BSN, RN, CRNI, PLNC
Lynn,
What are the references that indicate the risk of too long needle that needs support with gauze vs. the risk of gauze longer than 48 hours for CVC dressing? I am not aware of any, but would like to know.
Gwen Irwin
Austin, Texas
I did not state that there was a direct study addressing this issue. I said that the expert consensus of the 2006 INS standards committee was that the risk of extravasation injury due to inadequately supported port access needles or needles being too long for the patient was greater than the low risk of infection due to the gauze under the TSM. The problem with port access needles is well documented in the oncology literature. Lisa Schulmeiester has published quite a lot on this problem. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Lynn.
In a that precious reply you had asked why it was accessed when he wasn't getting chemo. I was only ansewing that pice of the question. I understand the rest of your reply.. Thanks, Valorie
Valorie Dunn,BSN, RN, CRNI, PLNC
Sounds like an implanted port was not the ideal type of device for this patient since he has to be continuously accessed. Thanks, Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861