We are seeing quite a few patients who are arriving for admission from an outpatient infusion center who have their portacath accessed and covered with a sterile guaze on arrival. I am wondering what other facilities processes are; if there is no reason to suspect any contamination is the area being cleaned and then a sterile transparent dressing appied or is the port being de-accessed and then re-accessed? I was not able to find any standards/guidelines that speak to this.
Thanks in avance for your advice
This is such a procedure-based issue, there may never be a standard or guideline about this issue. Do you know when the port was accessed? By whom? What size and length the access needle is? Do you get a blood return easily? Does it flush without resistance? How is the port needle secured? Any signs or symptoms of any complication? My point is infection is not the only thing to cause concern. Do you work in a hospital and these patients are being admitted? For how long will they need infusion therapy? 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
The patient population I am referring to arrives from the outpatient infusion clinic where the device was accessed earlier that day on to the medical oncology unit of our hospital. Patient has the correct needle gauge/length in place, good blood return, date and time the device was accessed is know, etcetera. This is an increasing population we are seeing, they arrive with the device accessed and covered with sterile gauze. I could not find anything that speaks to this so I was inquiring to see if maybe others had seen anything and to see what others are doing. We have been cleaning the site and applying a transparent dressing unless there was concern regarding the sterility of the access or other concern such as no blood return.
In our institution we apply a film to all accessed ports - regardless of length of therapy - I recieve incident reports of all IV access related devices across our hospital and a huber point needle "popping out" of place during infusion has been reported at times - especially with patient movement or transport across departments. Can you ask they secure the device on first insertion with the view to possible complications/transport?
I am wondering why they would be accessed in outpatient clinic before being admitted to hospital. Maybe these are accessed, blood drawn, results show a problem in need of admission, or something like that? Also, is this clinic owned by your hospital and therefore operating under the same policies and procedures?. If so, I would have a conversation to make sure they are actually following the same procedure as inpatient units, assess for patiency and rule out complications, then use it. If different, you could still discuss their practices - clean technique vs aseptic, etc - then decide whether to leave them accessed or start again. I would want as much information as I could get about outpatient practices before I made this decision. 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
Lynn,
Today is a good day to ask that question as we are waiting for a patient to arrive for inpt chemo admit. We decided to bring him to the Infusion Center (same building) FIRST, so Infusion RN could access his port and draw his blood which will expedite lab results reporting. If he is admitted directly to inpt, it may be 1-2 hours before he is actually accessed and his blood drawn (competing with residents, admitting assessments/e-paperwork, etc. for patient's time). Many times, we have their blood drawn before the decision is made to admit, just to make sure their counts are OK. HOWEVER, our infusion center RNs use the same access and dressing as the inpt nurses, so the situation I think she is describing (just a sterile gauze) is not an issue with us.