I am working on everyone in our facility being on the same page when it comes to proper care and maintenance of any type of central line at our hospital.
I am running into some issues in the Emergency Room department with not accessing infusaports and wondering if anyone else is experiencing this or has any feedback.
First off it is the patients who are complaining and dissatisfied that they have a port and are being stuck multiple times to get a peripheral IV , and even sometimes getting an EJ to gain access when they have a port. Or the pt says that the ER nurse says " We will not access that because it could get infected" or....if the pt is getting intermittent chemotherapy some nurses will not access it. This is all in the Emergency room, on the "floor" the nurses will obtain an order from the MD for " line access" and utlize the line.
I understand if the pt is going to be a quick in and out visit in the ER and has good veins to do a peripheral but....if poor veins and has a port why not utilize it????
On a different situation, some patients oncology doctors tell them "never use the port for anything but chemo" then the pt has terrible veins and says the doctor says no to using the port. Meanwhile they are experiencing more harm than benefit from not using the port. What is the general consensus on this? I typically practice, if we use proper process to maintain sterility while accessing the port and proper care and maintenance technique it should be ok to utilize the line.
thanks in advance for your response,
Gina Ward, RN, VA-BC
Lots of discussion about this issue on other forums! At this very moment I have a lawsuit involving serious peripheral extravasation when the patient has a port and no one knew how to access it. The primary measurement I use is what would I require for me or my family. That would be providing a skilled clinician to access and use the implanted port, regardless of what the other infusion therapy was or what the doctor said. Some doctors act like that port belongs to them. That is so very wrong! Any VAD belongs to the patient and they must be part of the decision-making team to determine how and when that port is used. Each facility must provide a clinician with the skill to assess, access, and infusion through an implanted port. Difficult venous access is one reason or their insertion and I would never allow even a single peripheral venipuncture if I had a port in place.
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
Thank you so much for your response. I agree 100%
Gina Ward R.N., VA-BC
Hi Gina,
We have this very problem at my hospital as well. It happens on the floors as well as in the ER. We have some patients reporting that someone from the Cancer Centre told them it was only for chemo. I am glad to know we aren't the only ones, but it also means we have our work cut out for us. Some patients have had 9 attempts to get peripheral access, (another issue) when they had a port. I also question the legality of it when the patient has requested their port be accessed, not to have a PIV and that request being refused, and attempts at peripheral access are attempted. I have been concentrating education related to ports in hopes to change this. Is it right to address the consent issue as well?
Kerry
K. McDonald RN, CVAA(c)
Yes Kevin it appears a common issue, and I too am working on educating staff to be more knowledgable in decision making and whats best for the patient.
I am not sure what you are referring to with regards to consent.
thanks for your response, Gina
Gina Ward R.N., VA-BC
The legal issues would apply if there is an implanted port in place yet PIVC was inserted, regardless of the number of attempts, and there is a complication that leaves the patient with a long term or permanent injury. This could include infiltration/extravasation or nerve injury. The long term outcomes include surgical scarring, tissue necrosis, loss of arm function. The patient could argue that these would not have happened if the port had been accessed and used. It would probably become a battle of experts as tissue necrosis, etc can occur with implanted ports, so it would come down to which expert is the most believable by the jury if it goes to trial.
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