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Ann Williams RN CRNI
Weird port issue

I would like to hear if anyone has ANY idea what was happening in the 2 cases I am going to share.  This occurrence involved Patient A and Patient B.  It involved 2 different nurses, so we ruled out nurse error/technique.  Both patients are Hospice patients.  Both had Power ports that were accessed for maintenance flushing and both had an excellent free flowing blood return.  Both RNs felt like the access went without a problem.  However, in both cases, when the needle was withdrawn, the site bled and wouldn't stop.  She said it wasn't a drop like you sometimes get, but just wouldn't quit, and required a dressing.  Later, both patients developed pain at the site, in one case the patient hurt so bad he resorted to taking his Oxycodone, 10mg, every 1-2 hours.  The pain in both lasted about 24hrs.  They both also developed some extensive bruising, with it still being present a week later, but was receeding in color.  One was described as purple and black initially, and at least 3" in diameter.  We have checked lot numbers on the heparin (100U) as the nurse was sure it was something to do with the heparin.  The lot numbers are different and both lot numbers have been used on other patients without any effects.  My pharmacist and I are at a loss for what this could be.  We think of an infiltration, but both had a free flowing blood return.  Needles used were 22g, 3/4".

lynncrni
 I think this could be

 I think this could be related to damage to the silicone septum in the port body that has created a hole in that septum. The bleeding is coming from blood reflux from the vein into the catheter, port body and into the port pocket. There have been reports of some brands of port access needles causing this septum damage.

Go to Safety Alerts for Human Medical Products > Huber Needles: Recall - Risk of Coring

This is a website from the FDA with much more information about this problem. Do a search of www.fda.gov/MedicalDevices using "implanted port" for much more information on this issues. 

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

Ann Williams RN CRNI
Thanks Lynn!  I should have

Thanks Lynn!  I should have thought of that.  We use the Deltec Gripper Plus.  I will be reviewing the links you sent.  Thanks again!!

Ann

Donna Fritz
small vessel?

Could a small vein in the tissue have been punctures with the non-coring needle as it was inserted into the port?  I find that in/out procedure for flushing or even same day in/out bleed more than needles that stay in for several days.  How much tissue do these patients have between skin surface and port septum?

 

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