Got called to double check a port. Patient had for a few months. Patient admitted from another facilty with port accessed. De-accessed and re-accessed in house by staff RN per policy at 7day mark. 2nd day after this, family reports leaking from site - TPN + lipids running. Flushed with dressing off - yup, leaking. De-accessed, muddy pinkish drainage (cultured, neg). Re accessed by me - at a different site, no button-hole. Aspirate brisk blood return, flushes easily BUT leakage is noted from previous skin opening - in direct proportion to turbulence of flush. IR Doc happens to walk in at that moment. IR doc calls admitting surgeon - rec'd a port study. [Port De-accessed and not used further]. Surgeon defers to oncologist, not with our system, so after discharge patient will return to oncologist's IR for study. SO...I really want to know what this was. Can I get some good guesses? Prior to re-accessing it, I was thinking needle dislodgement or fibrin sheath. But there was absolutely no resistance flushing, and I had great blood return. Picture about 1/2 the flush volume coming out the other skin opening (blood tinged) with the same rate as the flushing.
Patient's family reported that the nurse who de-accessed and re-accessed per policy "had some trouble" doing it. Potential TPN extravasation was treated with hyaluronidase without noticeable tissue damage for 7 days while in-house.
TYIA
Kathleen Crowe BSN RN CRNI VABC
Damage to silicone seal in port body leaving a hole in it. Sludge build up in port body being forced out that hole. Sludge may be blocking outflow track to catheter. With no septum hole you would probably NOTbe able to flush but would get blood return. 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
Was this port ever used for a CT power injection? You didn't mention what brand/model of port it was. I have seen a picture of a non-power-injectable port that had the backside damaged from a power injection. The catheter is still in the vein, so you will get blood back but since the back is damaged, any flushing will partially go into the port pocket.
Bard power port but no contrast studies during our admission