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pbuhidar
MD orders for accessing mediports

have a question regarding the access of a mediport on inpatients

do you need a doctors order to access an existing mediport ? or can this be driven by policy, procedure or protocol ?

Have looked at standards (ONS, INS) and state board requirements and have found nothing in regards to this.

presently at our facility we access ports without physician orders ( unless the port is less than 7 to 14 days post insertion we will get an order )  but this has now been brought to light with an oncologist requesting a standardized order set with an order that specifically states may access port ?

We are wondering if this is institution based decision to place in policy or add to standard order sets?

 

thanks

 

lynncrni
A decision that must be made

A decision that must be made by your organization. I have never worked on an infusion team that required a specific LIP prescription for an implanted port to be used. I have never seen INS or ONS address this issue as this is based on personal preferences for your LIP. Frankly I think it is foolish to put in a port and then require such scripts for their use. Does not make any sense to me. 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

pbuhidar
thanks Lynn,

thanks Lynn,

we needed to put it out there since this has never been an issue for the years most of us have worked in infusion and vascular access.  However there is that one LIP that opens that box.

 

thanks for your input

 

Pamela Buhidar 

bartina
LIP order for accessing ports

My opinion.  If a LIP order is required to place a VAD, it seems logical that an order ineeded to access a port. 

Nancy Rose 

lynncrni
I have never worked where an

I have never worked where an order was required to insert a PIV. The order for any type of infusion therapy means a PIV is placed at least to get it started and then a more appropriate VAD is inserted if needed. When an implanted port is present, there was a reason for it and that was to infuse fluids and meds. So if it is present, I don't see the need for an LIP order. 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

Scottg
MD Orders

My opinion on needing medical orders is based on working today at a large medical center, serving on several nursing committees, working regularly on the Vascular Access Support Team (VAST) and interacting with the medical director of the vascular access team.   A LIP order at this institution (and is the community standard) is necessary to get out of bed, stay in bed, eat anything, go outside to smoke, get a venipuncture for labs, insert a PIV and remove a PIV, insert a PICC, insert a Midline, access, use, and deaccess the implanted port, provide NS flushing and lock with NS or Heparin.  Basically the best way to provide vascualar access services without ala carte orders for each item is to have a vascular access protocol written by the VAST and their Medical Dirctor/CNO, approved by the Nursing Practice Committee and the Medical Executive Committee.   In the climate of FOCL  (fear of central lines) in response to anti-CLABSI initiatives,  the use of PIVCs instead of central access (even when an implanted port is available) is becoming the new norm.   We have witnessed the deaccess of implanted ports or removal of PICCs when the chemo or TPN is no longer necessary and the placement of PIVs for fluids or antibiotics.   With a physician order.  If the patient arrives with an implanted port, it "may not be necessary" for the current treatment  ("the port is only used for chemo")  when a peripheral IV can be used.   This has increased the need for skill development for midline and USGPIV insertions to substitute for the PICC or other central access.  A well developed and approved protocol with carepath or algorythm for vascular access can allow the patient and nurse to arrive at the right decision for the right use of the right device at the right time.  An order set that states " Start Vascular Access Protocol: VAST may Assess and Insert" is ideal.   This is similar to the Respiratory Care Protocols that include "Assess and Treat" for airway preservation.  Our goal is  vascular preservation. 

Scott Gilbert, RN MPH  (Honolulu)

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