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dockhill
Ports

We have recently had several patients who received dye studies due to no blood return from their port IR has determined the integrity of port and deemed the port functional. Should we use the port once IR confirmed iokay to use? I'm uncomfortable based on INS standards using a port with no blood return.

lynncrni
It sounds to me like your

It sounds to me like your radiology dept is not looking for and providing complete information to you. A dye study is where dye is injected under fluoroscopy. Are you certain that is what is being done or are they just doing a simple xray? Tip location alone is not sufficient. Integrity of the port alone is not sufficient. You are looking also for retrograde fluid flow between the wall of the catheter and the fibrin sheath. If they see the dye flowing downstream from the catheter tip and is unimpeded, they should be telling you this. If they see retrograde flow for any distance, this should also be told to you. The distance of the retrograde flow is also very important. If it extends back to the puncture site, this is the greatest danger because the fluid can leak into the SC tissue. This along with tip location in the CAJ, and a completely intact catheter and port body is what you need to know. There could also be a fibrin tail or flap at this tip and this will not impede the infusion, just aspiration of blood. The dye study should also show if there is a thrombus at or near the catheter tip. So armed with all this information, you should be able to move forward with each patient.

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

Donna Fritz
possible issues

I have seen several ports in my day that did not give blood, but could flush and a dye study was negative.  When looking at the ports on CXR, some of them have a kink that is apparent (albeit very slight).  I would wonder if when flushed, the catheter straightens a bit with the pressure, but when you exert negative pressure, the kink collapses and you get no blood return.  This is a difficult area to navigate:  Surgeons don't want to replace them; it's expensive to do a dye study each time the patient is admitted; clinical guidelines say to get a blood return; since the kink is a point of stress, it could possibly develop a leak.

bsherman
How often to do Dye Studies

If a patient is seen once every few weeks for infusions does the dye study need to be done each time if there is still no blood return at each visit?

G. Irwin
Ports

I have to ask this:  Where is the tiip location of the catheter?

This is our problem.  We see that the left sided port has a catheter that is not in the distal SVC.  They have lifetime issues with blood return, because it abuts the wall of the SVC.  Hmmmmmm, different issue, isn't it?

Gwen Irwin 

bsherman
These are Ports that have tip

These are Ports that have tip confirmed in SVC and Dye study indicates no problems.

MarkCVL
Left subclavian/axiallary

Left subclavian/axiallary approach tip will sometime be in the SVC....but against the right wall of the SVC!  I have patients lay (if able) and turn on left side (side of port down).  This will sometime allow the catheter tip to drop away from the right wall of SVC....  Just a trick to try

lynncrni
As other have mentioned, it

As other have mentioned, it is well documented that any CVC inserted from the left can abut the right side of the vein wall, especially if the tip location is not at the CAJ. The nurse must have a blood return each and every time all CVCs are used for any infusion. Please check the ONS Chemo Guidelines document. They go into great detail on how important it is to get a blood return, how to manage the situation including what to tell the patient. A chest xray alone will not provide the needed information about fluid flow through the catheter but it will tell you tip location. If this is a recurring problem for a specific patient, you need to dig deeper into why. Tip location too high in the SVC, a fibrin sheath that is re-growing over the catheter tip between infusions, or a hypercoagulable patient. Then create your plan of care around the specific problem, but a blood return is so very, very important. 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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