Situation: chemo patient with an implanted port. Port is now dormant as he no longer requires chemo at this time. The port is being flushed and locked every 30 days. The situation now is that it flushes easily but they are no longer able to obtain blood returns. Cathflo was instilled by protocol (2 mg left to dwell for 2 hours. This was done twice.) Then an overnight dwell of Cathflo was done, followed by an infusion (2 mg in 50 ml saline over 3 hours). Still no blood return. Chest x-ray shows good postioniog of the port. Line-o-gram is inconclusive.
We are thinking the next step is to remove the port. Does anyone have any ideas for us?
Thank you very much
Andie
Any vascular access device that is no longer essential for medical management should be removed, acording to CDC. Since this patient is no longer receiving chemo and it is not functioning correctly, I would say to get it removed. If this were me or one of my family, that would be my choice. The risk of BSI increases with each day of dwell. There is a great possibility that the occlusion is due to vein thrombosis and your instillation procedure is not allowing the thrombolytic agent to reach the thrombus. All the increased manipulation to achieve proper functioning is only increasing the risk of BSI. Treatment of BSI will be much more costly than insertion of another port at a later date if he should need more chemo. 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 very much for your reply. That makes complete sense.
I would like to ask this: if the port was still required for use now, would the right thing still be to remove the port due to unresolved persistant withdrawal occlusion and insert a new one? Would you ever continue to use this port, based on x-ray confirmation of correct placement?
Thank you
Any CVAD, including implanted ports, that will not yield a blood return that is the color and consistency of whole blood requires further diagnostic assessment. Because implanted ports are totally internal and nothing is seen externally, there are more problems that can happen such as incorrect access, catheters breaking off of the metal stem on the port body, etc. I would require a blood return before using an implanted port. Repeating the access procedure is the first step. Declotting procedure if your assessment leads you to believe that that problem is thrombotic occlusion. Other agents for catheter clearance if you believe this is a drug precipitate. Moving the arm changes the ability to inject and aspirate is indicative of pinch-off syndrome. On this one, I would be concerned that the contrast study was inconclusive. What did they actually see? I am assuming this was contrast injection under fluroroscopy. If not, that needs to be done to determine exactly where the fluid is flowing. Xray confirmation alone is not sufficient to rule out the risk of retrograde flow which can produce a dangerous extravasation. Both INS and ONS call for a blood return before using CVADs. 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