I am curious as to what evidence there is for the use of strict sterile technique in accessing a Port-a-cath in the out-patient setting? Currently, our process is the nurses don non-sterile gloves, clean port with chloraprep and access with our non-coring right angle needle. They do not wear a mask. After accessing the port, a piece of tape is put across the Huber needle to secure it. They do not apply an occlusive dressing. I would appreciate your thoughts.
Cindy Kahnk MS-APRN
My thought is that this is below the national standard of practice written by the Infusion Nurses society, page S45-46. This is a sterile procedure because you are accessing a central venous catheter intended for long term dwell and these patients are immunocompromised. A piece of tape is far below the standard for proper stabilization and an occlusive dressing must be applied. How long are these ports left in this substandard condition? Is this what is written in your policies and procedures? Extravasation injuries from implanted ports pose a great risk, so stabilization and dressing are required. You will also need to check the ONS guidelines.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
Hi Lynn--Thank you for your reply,
These ports, that are only secured with tape, are accessed in the out-patient infusion center for a blood draw. The patient may go up to their physician's office for a follow up visit. At their visit, the pt. may need blood products, chemo, or fluids, etc.. They may stay in the Infusion Center for blood, chemo, fluids etc.as well.
Sometimes these patients get admited to the acute hospital setting--the nurses on the inpt. units will redress the ports following our sterile technique policy. However, these ports, by that time, have been exposed (with only tape) for 12 to 24 hours.
I totally disagree with this established procedure and am in the process of changing this poor technique. Thank you for your expert advice and I will move forward in changing our out-patient process.
Respectfully,
Cindy Kahnk
In our AIC's and out patient chemo clinics we use masks and sterile technique when accessing ports according to the INS standards (I am assuming ONS has similar standards). Our kits come with a mask, sterile gloves, extension tubing and cap, transparent occlusive dressing as well as the alcohol and chlorprep. It does not take any more time to place an occulsive dressing then tape and guaze. I would not want to transport patients without proper securement. There is a great potential for dislodgement and infection compromising the patient and your license with your current practice.
Ann Marie
Ann Marie Parry RN CRNI
[email protected]
Ann Marie Parry, RN, CRNI, VA-BC
[email protected]