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Access of Intraperitoneal ports

Who accesses these in your hospitals?  IV nurses or oncology nurses or both, or ??  Our I.V. nurses have been the ones to access these ports(for intraperitoneal chemotherapy admin.).  Now, because we "don't get there soon enough", the oncology nurses want to be trained to do this procedure.  We're concerned because most of the IP ports we see are deep...they've slipped off the  lower rib into the abdomen and are difficult to stabilize and often require a 1.5 inch needle. 

 Any opinions?

Tanya Nauman RN, CRNI

LoisRajcan
Just recently I was asked to

Just recently I was asked to access a Bard 9.6 french vascular port that was surgically inserted as an intraperitoneal access for IP chemotherapy.

The surgeon specifically stated :  Do not aspirate and Do not use heparin.

How do you know you are confirmed placement in the port if you cannot aspirate?

Would thrombin build up around the catheter just like a vascular access?

Shouldn't the nurse aspirate some type of fluid?

Anyone with experience to share?  I am also in need of policy and procedures for accessing a port for IP chemo.

lynncrni
I just did a Google search

I just did a Google search using the phrase "intraperitoneal implanted port" and got lots of hits including several policies and procedures. I have never done this so I can not address the accuracy of these documents, but the first one I read quickly did have good references listed. Try the search and I am sure you will find what I found also. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Donna Fritz
The Oncology Nursing

The Oncology Nursing Society's Vascular Access Device Guidelines (2nd ed, 2004) states on pg 68:

"d) Nonfunctioning catheter:  Assess ability to flush or withdraw peritoneal fluid.  Reposition pt, and attempt to flush with sterile NS.  Administer heparin flush (10-100 u/ml).  Notify physician of problem.  Dye studies may be required to determine cause of problem."

In this section on IP devices, they discuss tunneleds and ports together, so this statement applies to both.

Robbin George
As far as I know the IP
As far as I know the IP Ports that are implanted SPECIFICALLY for tumor direct therapy are NOT vascular [The tip is directed into the offending growth] and so you will NOT need to check for nor will you get a Blood Return (Flushing protocols have been Patient/Physician directed)--However we have seen other vascular devices (specifically Groshong) implanted for IV use with the tip in the IVC

Robbin George RN VA-BC

Donna Fritz
The tip of the IP catheter
The tip of the IP catheter is generally directed to the peritoneal space and not specifically to the tumor.  This therapy is generally used for ovarian cancer and the natural course of the disease is to have peritoneal "studding"--multiple small tumors in alot of different places in the peritoneum.  So the IP chemo needs to "bathe" all of these tumors.  We check for peritoneal fluid return to make sure the cath is functioning properly.  Fibrin can also cause similar problems with IP catheters as they do with intravascular catheters.
LoisRajcan
I wanted to update this post

I wanted to update this post with good news. We have had good success with using Intraperitoneal Ports for Chemotherapy in the treatment of  ovarian cancer.

Intraperitoneal Ports are difficult to access, my experience so far shows the need for long huber needles (at times 2 inches in length).  I have aspirated a straw colored peritoneal fluid and sometimes no peritoneal fluid is aspirated. I also find that the placement of the IP port is in a sensitive area and I do recommend Emla cream for 60 minutes prior to access...

I have been training a few eager oncology nurses to access these ports which allows me time to perform my other vascular access duties.

Our hospital is doing more of the IP chemotherapy for ovarian cancer treatment.  I was wondering if any one else is experiencing an increase in IP chemotherapy and if there has been a need to use Interventional Radiology to access Intraperitoneal Ports?

I have heard that some IP ports are so deep that in order to access them Interventional Radiology has had to get involved...so far IV/PICC team and our Oncology nurses have been successful in accessing them.

I would appreciate any advice.

Lois Rajcan BSN, RN CRNI   -  The Chester County Hospital, West Chester , PA

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