We were asked this AM to start a peripheral IV on a patient with a Left CX PORT and Right AV Dialysis graft for a Stress Thalium in Nuclear Med--We asked why the PORT could not be used and was given a confusing set of answers--We attempted x3 to insert a PIV and finally was able to place a #20 in the Brachial vein above the Left AC using Ultrsound--Could someone in the know out there PLEASE clarify WHY the PORT was an unacceptable access for this test???????????--Thank you for your expertise  Â
I have never done one of these tests, but after reading about it, have a couple of questions:
1. Would the port access needle placement and dressing on the chest interfere with the EKG lead placement? It appears the IV is left in place during the procedure.
2. How small is the volume of the thallium isotope? I would suspect it might need to be followed by a good flush volume to get it out of the port/catheter.
I can't see that the port itself could not be used. You may be dealing with a knowledge gap in radiology about how to manage central lines. Believe me, better that they use a PIV if they don't know how to manage the port.
I am a Vascular Access Nurse who also performs Adenosine Stress Tests and the indication for use with Adenosine is that it can not be infused through a Central Access unless you modify the dose per the PI. Therefore we always use a peripheral line. If it is only a Nuc Med study it would be okay to use the patients CVAD.
Robbin George RN VA-BC
Robbin,
PI stands for "Product Information" which is the paper fold out included with all medications. This will give you information regarding the route for administration of Adenosine and states NOT through a central access.( Modifying the dose was something I read in a drug book, so I can't give you specifics.) I am not certain if there is any property that is incompatible with a CVAD versus the immediate infusion to the cardiac muscle. I will need to further read up on this. We are currently trialing Lexiscan which is a 10 second push through a peripheral access instead of the 4 minute infusion of Adenocard. Their PI states only through a peripheral access also. Hope this helps. I will post more after I get more info.
Bernadette
Robbin,
I did read the PI online and they state that they trialed Adenosine using peripheral access only and not through CVAD, therefore peripheral is there recommendation.