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rnjenny
Using ports for outpatient CT scans without an order to access it

Often times, the VAT is asked to access ports in the outpatient CT department.  Usually there is no order to access these ports.  It makes sense to use an existing vascular access device for the injected contrast to avoid a peripheral stick.  Sometimes, patients will verbalize that their ports have been used for scans in the past and their doctor has no issue with using it.  However, there may be a situation where an ocologist may not want a port accessed for anything other than to infuse chemotherapy.  I am concerned that I will someday access a port that an oncologist is reserving only for chemo, and without an order, I would be held accountable.  Also, a patient may not know if their port can be used for anything other than chemo.  What is your institutions policy/practice in this type of situation?  Many times, our radiologist will give VAT permission to use the port, even though the radiologist has no knowledge of what the port is to be used for (especially for oncology patients).  What is best practice for our VAT to abide by to avoid potential legal ramifications?

 

 

lynncrni
 Create a protocol that has

 Create a protocol that has gone through all of the appropriate committees. Practice according to this protocol. Once accessed, ensure that the port can be used for power injection before proceeding. 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

kejeemdnd
Just as an aside...I have

Just as an aside...I have only ever worked in oncology and I can honestly think of no reason why an oncologist would limit a power-injectable implanted port to chemotherapy use only. Unless  a hospital's policy explicitly prohibits the use of implanted ports for routine blood sampling (which I think is done in some facilities for reasons other than infection control), this function is well within the device's indications. This is like limiting a PICC line to vesicant antibiotic infusion only. Patients for whom a port would have exceptional risk will not get ports. For instance we don't place ports in bone marrow transplant patients (usually Hickmans) because the profound cytopenias caused by the therapy create risk for infection with skin punctures, hematomas from accessing the ports, and they don't have the flow rate needed for the apheresis, among other reasons, I'm sure.

I agree, however, that performing an invasive procedure such as puncturing the skin to access a venous port should require some sort of physician order. Without an order it seems like there is no accountability if something goes wrong. There really ought to be a policy and SOP created an vetted to standardize this issue hospital-wide.

Keith W. Gilchrist, MSN, RN, PHN, OCN, CRNI, VA-BC
Oncology Nurse Navigator, David Grant Medical Center
Travis AFB, CA

lynncrni
 Keith, accountability for

 Keith, accountability for any procedure or intervention performed by an RN rests with that RN with or without a physician or other LIP order. I have seen many lawsuits where physicians were never named in the case or were dismissed from the case leaving only the nurses to be held accountable for what they did or did not do. So that order offers no legal protection or alteration in accountability. In my opinion, this is an example of a situation where an RN should be allowed to practice to the full extend of our license. I think we should be able to assess the patient and access an implanted port without a specific LIP order to do so by following established protocols. Of course, others see it differently. 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

kejeemdnd
Thanks, Lynn. I agree. Not

Thanks, Lynn. I agree. Not really sure why I suggested an LIP order was necessary to access a port. We certainly don't have that practice in my facility! Thanks for clarifying. Keith

Keith W. Gilchrist, MSN, RN, PHN, OCN, CRNI, VA-BC
Oncology Nurse Navigator, David Grant Medical Center
Travis AFB, CA

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