Pt. with new port. Had chest ecchymosis initially after insertion.
Port not needed for access until 3-4 weeks after insertion.
Port able to draw back SLIGHT amount of blood in tubing of huber needle. Nurse can flush but not easily (not forceful, but just doesn't feel right).
Dr. orders xray, to be followed by cathflo pending xray (this is tomorrow).
Unless the xray shows pinch-off, don't we really want a dye study--
Also, does old heparin from a port always have that brown color ? The little bit of blood they got out did not.
Thanks.
I would see what the xray shows and then it there was any question I would also want a dye study. I would ***not*** use this catheter for infusion until it functioned properly. I can ever remember see a brown color upon aspiration of any port, so I am not sure what you are seeing there. Since the nurse can not see any portion of the implanted port, we must rely totally on how it functions to determine if it is safe to use. I would refuse to use it if I had any question. 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
I have seen that brown color and I believe it is related to old blood that is sitting in the catheter and port body. If a good venous return is present you can see the transition to bright red blood. I make every effort to aspirate as much of the brown fluid as possible...I definitely don't want to flush it into the patient. We see this most often with a port that has not been flushed at standard intervals or perhaps not cleared out well with the last flush. If there is not a brisk blood return and there is a resistant flush then a dye study is in order.
It does seem reasonable that this brown fluid would be old blood but it should be aspirated easily and turn to true color of a sufficient blood return as you described. Depending on the age of the port, it might also contain some of the planktonic biofilm. 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
Thanks all. The reason I asked about the brown tinge fluid is I have seen it before (not on this pt!!). It made me wonder, is that the degradation of heparin. And, if so, is the absence of it in this particular case meaningful to the fact the port is not functioning. (and I agree, I always disgard that stuff).
Update. Xray shows that the port is not twisted, pinched off, etc. Xray shows 4 to 5 cm difference in tip position. It was originally about 3 cm below the corina, how it is about 1 cm above it. Keep in mind! This port had not yet been used, was placed about a month ago.
Spoke with Dr. Ordered a dye study, has to be Monday.
If they can't use the port, could someone please explain if there is another way to do the dye study to examine the vessel at least for thrombosis?
Thanks, Kathleen
Kathleen Wilson, CRNI
In comparing the CXR done at placement with the CXR you just took, is the port body position different also, or just the tip? Was the patient in the same position for both CXRs? Does the pt have a large BMI?
Usually, pt's have these placed while lying flat (either in OR or IR). I suspect the post-placement CXR may also be taken while flat. THEN the patient sits up. If they are a large pt, the tissue in which the port body is implanted succumbs to gravity, pulling the catheter out from its original position. Just wondering . . . .