Many patients are treated in our oncology department with implanted ports that don't allow nurses to get a blood return when accessed. Some were treated successfully with Cathflo or had placement verified by port-a-gram (dye test) but the next time they came for treatment there was no blood return. The nurses want to know if it is ok to use the port for subsequent treatments without another port-a-gram or Cathflo treatment. The port is deaccessed after each treatment and it may be a week or longer before the next treatment. The oncologist is frustrated that some of the nurses are wanting verification before each use. Is there anything anywhere that supports using implanted ports without blood return or dye test? Should you always verify with blood return or dye test prior to each use with new needle insertion?
Blood return is imperative from all VADs before each use. Implanted ports present the highest risk IMHO because you cannot see any component of the port or catheter. Successful access in the right place is critical. This is more than likely caused by regrowing fibrin sheath at the tip but there is no possible way for you to know that at the bedside. Using an implanted port without a blood return creates a significant risk for your patient, you and your facility.This practice is below the standard of practice and the standard of care. See INS Standards on Flushing and Locking, Parenteral Fluids and Medication, Antineoplastics, and CVAD Malposition. Please look at these references on need for blood return comes from medical, not nursing, literature.
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