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CVAD in Hemophilia patient

 I am looking for some information regarding the use of newly implanted ports in pediatric Hemophiliac patients. Is there a time from time port is placed til it can be used.  We are currently placing PICC lines until the port can be used which is usually 4 weeks. I have reached out to the Hemophiliac organization and they don't have any recommendations. The placement of picc and not using port comes from the recommendation of our hematology physician.  Any information would be greatly appreciated.  Thanks Cindy

 I have never seen any

 I have never seen any research on this issue and therefore are no standards or guidelines on it. So your only option is to go by the preferences of the physician. I do know that many oncology patients have their implanted ports placed and they are used immediately. The main issue is the healing of the incision from the surgically created pocket. Many patients come from the OR with the port accessed and use begins immediately. Lynn

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Thanks Lynn for your input.

Thanks Lynn for your input. Yes our Oncology patients come to the floor post op already accessed but not our Hemophiliac patients. c indy

 Cindy Brown RN BSN CPN

IV Nurse Educator/Clinician

I'm curious what the

I'm curious what the rationale is for not accessing ports for 4 weeks in hemophiliac patients.

Keith W. Gilchrist, MSN, RN, PHN, OCN, CRNI, VA-BC
Oncology Nurse Navigator, David Grant Medical Center
Travis AFB, CA

I am not aware of a reason to

I am not aware of a reason to hold of use of a port specific to Hemophiliac pt's.  sounds more like Physcian preference.  We have several different Physcian that place port & each one has a difference preference as to when the port can be accessed.


Timothy McCrory, RN, BSN, CCRN, VA-BC

Vascular Access

Columbus Regional Health

All of this "physician

All of this "physician preference" makes it very hard to have a institutional policy in place that allows a VA nurse to practice to the fullest extent of their scope of practice. If some physicians want to hold off on accessing ports until a specific amount of time has passed since insertion, could there be other conditions in which a physician would prefer to hold off on accessing a port? If the institutional policy is to verify that a port can be accessed, does this imply that there should be orders in place? I'd hate to be that VA nurse that accesses a port after a "reasonable clinician's" appropriate assessment when the particular physician wants to hold off for a week or four. I'm still curious why some physicians prefer to hold off on accessing ports for any reason. Not questioning, just want to learn if I'm missing something!

As an oncology nurse, this is a task, I must confess, that I take for granted. We certainly don't get orders to access ports for any reason. I've never heard of a waiting period prior to accessing ports. In fact, in my field there is the opposite problem. I can't tell you how often I hear, "If they have a port, use it," in the context of routine lab draws, power-injection, chemo, TPN, etc. I know there has been much discussion and even some practice guidelines that suggest this approach is not the best practice. I think this lax approach to implanted port use contributes to the surprising number of our patients who have their port 5, 10, 15 years after treatment concludes "just in case." Because of the perceived benign nature of ports, many oncologists are reluctant to compel their patients to have them removed if the patient wants to keep it. I've heard oncology nurses tell patients that ports are "God's mistake:" everybody should have been born with one because they make life so easy. Consequently we have a significant number of patients that we see every 4-6 weeks for port flushes, even though there has been no therapeutic indication for months-to-years. I am aware of the IHI (among other's) recommendation to remove a line when no longer clinically indicated, but for some reason, port removal is often not guided by this recommendation.

I'm rambling. Sorry. I find this topic very interesting. Port use and maintenance seems to follow a different standard than other central lines, often in direct contradiction to practice standards for "CVADs."

Keith W. Gilchrist, MSN, RN, PHN, OCN, CRNI, VA-BC
Oncology Nurse Navigator, David Grant Medical Center
Travis AFB, CA

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