I told people at work that I would rather them support a Huber needle (that is ultimately, too long) with sterile 2x2s under the tegaderm drsg than risk dislodgement. Do you agree? Also, how often would the accessed port drsg need to be changed IF there were the sterile 2x2s underneath it?
Thanks in advance, Kathleen
This has been addressed in the INS Standards of Practice since 2006. See the 2011 document for the most recent information. If the wings do not lie flat against the skin, the standard of practice IS to place gauze under those wings to support it. Disldogement of implanted port needles is a significant risk associated with infusion through an implanted port. 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
Because the 2x2s are used as support rather than a dressing the drsg change interval is the same...that is, reaccessing and dressing change every 7 days unless otherwise indicated.
Some of the port needles now come with a closed cell foam pad for this purpose. 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
I find that if the needle is too long it seems to increase the chance of dislogement. If the needle fits well against the skin it will be bumped and wiggled less. Has anyone done any research on this? I haven't had one dislodge for several years.
Gail McCarter
Gail McCarter, BSN,CRNI
Franklin, NH
Thank you! Does anyone have any suggestions for helping staff assess which length of needle to use? For hospitals not doing peds, which size Huber needles do you stock?
Kathleen Wilson, CRNI
It helps to know what has worked in previous accesses. If you don't have that information, you will need to palpate to assess depth of the port body or how much SC tissue is on top of the port. It also helps to know the profile of the port being used - high, medium, or low. For adults, 20, 21, or 22 g is common and length is between 1 and 1.5 inches but you could sometimes need 3/4 inch length. 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
Most of my patients are taught what size needle to ask for if they are being accessed. We have 3/4, 1 and 1 1/2 inch needles for adults. Some of our surgeons put the ports very close to the surface, and we mostly use the 2 shorter ones. My rules are if you can see the bump from across the room the 3/4 will probably work. If you can see it up close and/or feel it very easily a 1 in will probably do.
Gail
Gail McCarter, BSN,CRNI
Franklin, NH
Thank you. Those are helpful replies. I am re-writing the port policy. The opportunity to bounce ideas and questions off others in the field is very appreciated.
Kathleen Wilson, CRNI
From what I read, any gauze used under a transparent semi-permeable should be changed ever 48 hours.
From INS 44
Patrick
Patrick Cassidy, RN
Infusion Therapy
IU Healthcare Paoli Hospital
Check out.....
#39 Implanted Vascular Access Ports; Practice Criteria G
"If gauze is used to support the wings of an access needle and it does not obscure the needle insertion site under a TSM dressing, it can be considered a TSM dressing and changed every 7 days"
Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.