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Gail-Anne
PORTS

Just had a conversation with the surgeon who inserts most Port-o-caths for the local Ca Clinic. He was stating that the chemo nurses shouldn't have to withdraw blood prior to inserting chemo. When I said they are following the accepted protocol, he (of course) stated that it's faulty, that Ports where never originally designed for withdrawing blood, that he "defies anyone to show any literature" that seeing blood makes infusing chemo any safer.

So, any suggestions for articles??!!?

He was quick to say that he only means Ports, not PICCs or PIVs. I assume thats because I insert the PICCs for the Ca Clinic!

Thanks,  Gail

lynncrni
Ports carry a greater risk
Ports carry a greater risk for infiltration and extravasation because the entire system is implanted. Blood return depends upon the skill of the physician who inserted it - jugular and not subclavian sites that could cause pinch-off syndrome and depends upon the skill of the nurse to correctly access it. Add to those factors, the position of the catheter tip, the development of fibrin/thrombosis around the catheter tip, etc. This physician is wrong about blood withdrawal from a port - you can prove this by obtaining an instructions for use booklet from the product he is inserting. Blood sampling is listed and therefore, a port that will not produce a brisk blood return is not functioning the way it was intended to. Also, the chemo guidelines from the ONS goes into great detail about what to do, what to tell the patient, etc when a blood return can not be obtained. Stand your ground and do not allow this physician to put you in the position of finding the literature to prove him correct. Put that responsiblity on him! Lynn

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Gail-Anne
Thanks Lynn, we all know

Thanks Lynn, we all know he's wrong! I don't work for the Ca Clinic, but would like to provide them with the "Written Word" as I know the issue will come up with more frequency (as I know that he's trying to setup a system where he does even more Ports for them). That's why I put out the query re: articles in journals etc.

I'd planned to nab the company rep for a copy of directions.

Thanks again, Gail

Stana
When infusing chemo

When infusing chemo vsicant administration you must establish bood return to document CVC patency. Port extravasations are just as high as PIV with chemo vesicants becouse they are totally implanted and the needle can disloge at any time.

 

Nadine Nakazawa
Gail:   Where are you
Gail:   Where are you located?   Email me privately.  I'm doing a lot of lecturing in a number of cities on Catheter Obstruction Management.   I have a number of examples of what happens in WORSE CASE SCENARIOS when there is a lack of blood return and vesicant drugs are infused through central venous access devices.   [email protected]

Nadine Nakazawa, RN, BS, OCN, CRNI, VA-BC

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