Forum topic

5 posts / 0 new

Fri, 05/25/2007 - 05:34

sesymons

Pain and syncope following port flush

Looking forÂ comments regarding these symptoms:

Patient in hem-onc treatment room. Has port but due to situation did not have port flushed for 9 months (maybe 6?).Â Port was flushed with saline. Patient experienced metallic taste and then intense pain starting at the top of her head and then travelling down in sections. When pain moved down, the previous section stopped hurting. SaidÂ pain was worse than childbirth. When pain reached lower abd, i think, patient passed out. Code was called and she ended up in the ICU.Â Blood cultures were drawn and as of next day, so far negative.Â She's fine now, still in ICU, looks good. (Hx rare small intestine caÂ s/p distant chemo.Â In remission for about 7 years.) Yes, I believe the port will be coming out. No, I dont know if the nurse aspirated first, but I can find out. CT scan was negative for discernable clot.Â I think the prevailing opinion was that she showered some bacteria.

Fri, 05/25/2007 - 11:46

lynncrni

Metallic taste can be common

Metallic taste can be common with all brands of flushes especially in cancer patients and is probably related to other drugs they are taking. Bacterial shower is possible but this is usually not the signs and symptoms of that - usually you would see a fever spike and chills. Did she actually go into a cardiac arrest, respiratory arrest, both or neither during the code? Blood cultures are only going to be positive if there is planktonic or free-floating organisms at the time of taking the blood sample. Otherwise the organisms are imbedded in the biofilm and do not get pulled into the sample sent to the lab. But the biofilm is still present and could produce seeds or clumps or clusters of organisms breaking off from the flushing procedure, and thus the bacterial shower. Other possibilities could be vasovagal reaction or anxiety reaction, but these signs and symptoms do not fit either. Do you know where the catheter tip is located? Just curious if there is a connection. 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

Tue, 05/29/2007 - 13:30

(Reply to #2) #3

TNauman@peacehe...

The pain in the head would

The pain in the head would have made me think initially that the cath tip was in

the IJ.. I don't think port catheters (due to their size) migrate up the jugular

very often, but I guess anything is possible. I have seen a few patients get light headed when the flush is very rapid...and especially if the patient is very small...due to a "subclavian steal" effect.

Tanya

T. Nauman RN, CRNI

Fri, 05/25/2007 - 19:42

sesymons

Thanks so much for your

Thanks so much for your response

Code was called because she passed out. No actual arrest. Port is R subclavian with tip in proximal SVC. Patient is a fairly calm and very knowledgeable about her medical stats.

Can port tips flip about like PICC tips? Thinking flush was directed up IJ?

Blood culture grew staph coag neg

Tue, 05/29/2007 - 18:14

(Reply to #4) #5

lynncrni

Any catheter with the tip

Any catheter with the tip located in the upper or proximal section of the SVC has a greater risk of tip migration. Of course, you may be using the word "proximal" to indicate the end closest to the heart. This word is confusing. Tip migration is caused by changes in intrathoracic pressure from coughing, vomiting, sneezing, CHF or heavy lifting. Tips also migrate up and then can move down before an xray has even documented that it was in the IJ. so this is possible. Lynn