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Pam Rogers
biopatch for port-a-cath
One of my co-workers was asked to de-access and re-access a port-a-cath for the sole purpose of placing a biopatch. We are uncomfortable with this. We have no experience placing biopatches with ports. We are concerned that with a close fit between the port and the needle,a biopatch could lead to infiltration or extravasation. Is this a valid consideration? What is the technique for placing a biopatch when accessing a port?
Angela Lee
We do use Biopatch with
We do use Biopatch with ports in patients that are at high risk for infection or have a history of line infections.  The technique is the same as for other lines-biopatch should be placed grid side (or blue side) up around the needle so that the sides touch and make a complete circle.  My population is peds so we seldom have a problem with needles sitting flush with the skin but frequent assessment is important anyway-I consider accessed ports to be much like PIVs in that the needle could dislodge at any time even though it's uncommon.  The biopatch is not so large that any edema or other S&S could not be detected.
lynncrni
I don't see the need to

I don't see the need to remove the existing port needle prematurely solely to apply a Biopatch with a new access. But Biopatch can easily be placed around the port access needle if patients where infection is a concern. In fact, there is a serious concern about infiltration and extravasation when the wings of a port needle do not lie flush against the skin and do not have any support under those wings. The INS standards addressed this with the last revision. Any type of gauze or support placed under the wings to add stability does not make the dressing a gauze dressing and therefore does not require a 48 hour dressing change. So can and should be placing some type of support (and Biopatch would work) under the wings when the length of the needle prohibits those wings from lying flat against the skin.  

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

Hortense Jones
Pam, Please contact Jane
dtarvin
biopatch a standard for ports?

Is bio patch a standard for ports. Our facility does not mention use of a bioPatch on porta caths. Anyone have comments on this?

 Darla Tarvin RN VA-BC

Mercy Clermont Hospital

Gwen Irwin
biopatch for port

Our oncology unit implemented changes in practice over 1 year ago that included using a biopatch.  Other changes were included as well.  With all of the changes, they have had a dramatic decrease in BSIs, even in the neutropenic patients.  We have not had incidence of infiltration or extravasation.

I do have to say that they chose to use the biopatch with the larger hole, for use with the biopatch.

One of the practice changes was to re-access ports that were accessed in the doctor's offices within 24 hours of admission.  The patients are comfortable with this, due to their understanding the desired goal of fewer CRBSIs.  We are aware of differences in practices from the doctors' offices and our practice that indicate a need to assure best practice with chlorhexidine, sterile access, use of masks, etc. are done for the port.  This was definitely one of the changes that led to the decrease in BSIs.

Gwen

Austin, Texas

ann zonderman
biopatch - hole size

I was under the impression that the size of  the hole for the biopatch had a significant meaning... small for iv use, large for things such as G- tubes.  I thought the small hole/ close contact to the infusion catheter/ insertion site location  was the desired placement to be most effective for bacterial invasion into the venous system.

 

 

Ann Zonderman, BSN, JD, CRNI

Gwen Irwin
biopatch for port

I totally agree with what you say about the size of the hole in a biopatch.  However, they (our oncology nurses) didn't use the smallest one and have had excellent results.  Is it the biopatch at all?  I don't know, but at this point, no one wants to change a thing.  Neutropenic patients without BSIs.......that is wonderful.

Gwen

Austin, Texas

LIP
Ports: Risk Extravasation with Biopatch or Protect

Ports have a VERY low rate of infection. Anyone who works in cancer knows this but apparently many IV people do not. In fact, the rate is so low, there are no standards.

In fact the risk of Extravastion is much higher than developing an infection with a port. The risk of a port infection is south of 0.02% while the risk of extravasation is north of 5%, a huge difference.

I see no reason to use a Biopatch with a port and risk activating the safety device as the Biopatch swells. Also unless the huber is right against the skin, the Biopatch will float and the patient will have no protection anyway because it is not against the skin.

I think it is much safer to Forgo using a biopatch with it's much higher risk of extravasation.

Marianne
Biopatch and Port

We are a home infusion company that works closely w/ our local health system and the outpatient oncology center.  The hospital changed their policy and now all central access lines require a biopatch including implanted ports.  I have used biopatches for years, but we do not use them for ports.  Since the hospital has started using them on the outpatient oncology patients we have had a significant increase in extravasations!  One was so bad the patient necrosed and became infected.  We have talked numerous times about the problem.  They use the Safety Gripper which already has a padding and adding the biopatch is what is causing the needle to pull out enough to extravasate.  We told them about this and they are now inserting longer grippers but these people are active at home and are at risk for pulling the needle out anyway...using the biopatch just increases the risk!  I agree with the previous post...extravasation is the greater risk here!!!!

Marianne Valentine, RN, BSN, CRNI

Nurse Manager

PharmaCare Infusion Services

Cumberland, MD

daylily
Since 2008

In 2008 we implemented Biopatch across the board for all types of central devices.  We utilize the small for ports, medium for PICCs & TLCs, and large for dialysis catheters.  Our infection rate dropped significantly.  We have never had an issue of extravasation due to Biopatch.  We have several different length of needles and choose the correct length to accommodate each patient individually.  The biopatch as someone mentioned will float out from underneath the needle, however, if it's placed with the slit "down" letting gravity work, it will not move.  If a patient is diaphoretic the patch will swell and the dressing comes loose.  Both of these will get changed, but the needle has not lifted because of it.  Like I said, we have been doing this for 3 years without adverse events.  I must note that we limit accessing ports and changing the dressings to oncology nurses and venous access nurses.  Our venous access nurses check every central line in the hospital everyday as well.

lynncrni
Daylily's response is a good

Daylily's response is a good example of what I would call best practice, especially to have the infusion/VA nurses check all central lines daily. Lynn

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

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