I would like to know if anyone or everyone is still using the infusaid needle for porta cath clearance. It's the huber needle that does not have an extension. I need to update our policy now that the floor nurses are having to do this themselves. They seem to have alot of difficulty with this. Is this method sort of Old School? It's the method  I was taught as an IV nurse, but I'm old, now.Â
INS standards does not mention having to use this type needle. I would like to remove it from the policy if possible or either just make it another option for us old school nurses that know how to do it properly.
Thank you.
JulieÂ
I think you are using a tradename and those are not listed in the INS standards. The INS standards do state that "Specially designed noncoring safety needles shall be used to access and implanted port or pump and shall be changed at established intervals"
You must use a needle with a deflected tip specifically designed for port access and you should choose one that has a safety mechanism. Rebound sticks are a definite problem when removing these needles. 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
That's not really what I'm asking about. I know we have to use a non-coring safety huber needle for cannulating, I'm asking about a non-coring huber needle that does not have an extension tube on it specificly for declotting with tpa.
I guess what I want to know does it make any difference when declotting to use a huber with or without an extension?
Julie-
I've neer used those needles,but have a few questions to satisfy my curiosity.
Aren't those needles intended just to be used for filling implanted pump reservoirs? If so,the IFU's ought direct their use.
Second,what are the steps you use to to TPA a port using these needles? Are you able to leave the needle in the port in between pateny checks or do you have to restick the site every time?
David
Hey David,
I don't know about the pump reservoir thing ,but this method was always very tricky. and yes we did leave it inplace for patency checks. We used a 3 way stop cock on the open end of the huber and 2 10cc syringes on the stop cock. I felt this was cumbersome and for non IV nurses it has been a night mare to teach this method. This is how I was taught at this institution when I was a new IV nurse many years ago. The days of an IV team here are gone, Now that the floor nurses are having to do this, I want to change the policy, to using a huber with extension, but wanted make sure this was within standard.
Thank you for your curiosity.
Julie
Ann Zonderman, BSN, JD, CRNI, LHRM
As an "older" IV nurse..... when I first learned to access ports there were Huber needles with NO extension.... we added then ourselves just prior to accessing.
if you access the port with the needle on a syringe filled with your declotting agent it may work but remember - you instill the agent, let it dwell, but would have to to switch syringes to flush with NS or Heparin. When you disconnect the syringe you would have an open line.... you would not have a clamp to close - or you would have to remove the Huber and reaccess to flush.
If you use a Huber with extension that has a y port built in you will be closer to the prot and be safer re potential for air emboli, bleeding.
Ann Zonderman, BSN, JD, CRNI
Thank you Ann.
I'm glad some else has seen this type huber, I didn't think I was that old school!
Ann I bet you used this huber when you worked here at St. V's?
Julie
Ann Zonderman, BSN, JD, CRNI, LHRM
St. V it was... Please send me an email address so I may contact you re a Florida Question .... Thanks
Ann
[email protected]
Ann Zonderman, BSN, JD, CRNI
Sure Ann.
[email protected]
To instill a declotting agent into a completely occluded implanted venous port, just use a regular safety non-coring needle which has a built-in extension tubing. The old straight Huber needles without an attached extension tubing are for those few procedures that require a non-restrictive tubing. For example, when returning whole blood in a patient receiving apheresis.
To declot using any type of safety Huber needle (non-coring), just attach the 10 or 12 ml luer lock syringe with declotting agent (Cathflo 2 mg in 2 mls) to the extension tubing. Pull back gently on the plunger 4-5 times very slowly. It will allow the Cathflo to mix with the saline in the reservoir and get the Cathflo to the clot which is either in the reservoir or in the port catheter tubing.
Periodically pull back on the plunger whenever you get a chance: every 15 to 30 minutes. As the fibrinolytic breaks down the fibrin in the clot, by pulling gently on the plunger it will move the thrombolytic closer up the clot. It may need to dwell for at least 2 hours. It is still active in the reservoir and/or catheter for up 1 a week (90% activity), and 50% active up to 2 weeks (in vitro work at Genentech).
It should open up the catheter in 2 hrs in most cases, unless the entire reservoir is filled with clotted blood. If the whole thing is clotted off, and the clot is well organized, then the port might have to be removed. Using a thrombolytic is always worth a try to try to salvage the catheter.
Nadine Nakazawa, RN, BS, VA-BC
Yes, I know the steps, just wanted to make sure it was ok to use a huber with extension. It will make things much easier.
Thank you.
Julie