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.
Kathleen Crowe BSN RN CRNI VABC