We have had an ongoing problem with infusaports at our Cancer Treatment Center. THere have been a number of times that the nurses have been unable to get blood return, particularly with the ones that we have put in here, which are the Bard titinuim XL with groshrong tip. We have been in contact with the clinical rep. at Bard. She suggested assessing our flushing technique, which we have, and our access caps ( B/Braun posiitive pressure). Our surgeons are placing them IJ, and most on the right side. One particular patient, whom I personally know, has had to have her infusaport replaced, and is one low dose coumadin, and STILL has yet another infusaport without blood return. Even with a dye study, the nurses are not comfortable infusing chemo, when there is no blood. Unfortunately we do not have an IV team that could look at this. Anyone else share the same issues with oncology patients? The patient has said she fears the issues with her port more than the cancer!! Maybe another kind of port is better for these kind of patients?? Thanks for your help
Cheryl O'Brien
The IJ site eliminates pinch-off syndrome. Where is the tip located? If in the cavo-atrial junction, this is the recommended site. Are you clamping these lines during your flushing procedure? If so, it must be AFTER disconnection of the syringe from the Ultrasite connector. What type of syringe are you using? A traditional syringe will promote blood reflux when there is not more pressure on the syringe plunger. Either leave 0.5 to 1 mL of fluid in the syringe to avoid compression of the gasket or switch to a prefilled syringe that is designed to prevent this. The only other factor is the Groshong valve lies in the bloodstream which can be the site of fibrin and thrombosis and this will prevent this valve from properly functioning. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
Hi, Cheryl:
Every once in a while we have difficulty with IVADs and no blood return. Our facility has primarily placed Groshong tipped IVADs for years, and usually have no trouble with them. There are a couple of patients who DO recurrently have issues, though. I spoke with our Oncology educator and one of the IR MDs to verify the above information, and they concurred. Oncology added that the two patients that consistently have difficulty are obese, but we don't know if that has anything to do with it.
If Cathflo clearance not effective and dye studies have helped all they can, we send the patient's to IR to assess tip position, catheter and system integrity etc., and the oncology nurses will then use the catheter to administer chemotherapy, and they have had no trouble with it.
I concur with Lynns statements. Check on tip location; left sided placements tend to be more problematic because of the degree of turn they must make. If the tip doesn't make it to the lower SVC, the tip of the catheter can be resting against the wall of the vein. Not only does it cause difficulty with blood return, the tip movement against the wall of the vein can cause vein damage, and possibly erosion of part of or the entire wall of the vessel.
If the person Valsalvas, the tip is more likely to malposition out of the SVC if it is not lower 1/3 SVC or caval-atrial junction.
Hope this helps - please post what you discover; I'd like to hear more about clinician experiences with non-valved IVADs as well.
Mari Cordes, BS RN
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center