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valoriedunn
Accessed Ports Questions

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

 

Barbara Tinsley
Our policy is to change any

Our policy is to change any dressing with gauze at 48 hr.

Barbara Tinsley

Mark Osborne
Gauze may be placed under the

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.

MarkCVL
If the gauze is used as a

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!

lynncrni
The 2006 edition of the

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, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

valoriedunn
Lynn.  His port is accessed

Lynn.  His port is accessed all the time for TPN.  Thanks, Valorie

Valorie Dunn,BSN, RN, CRNI, PLNC

Gwen Irwin
Accessed ports questions

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 

lynncrni
I did not state that there

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, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

valoriedunn
Lynn. In a that precious

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

lynncrni
Sounds like an implanted port

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, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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