Tag Archives: Portacath

Leaving Your Portacath Accessed

26 Jun

Going through the sterile procedures to access your portacath can be expensive and a hassle, but if you infuse Cinryze often, you want your port to be quickly and easily accessible.

So, how long can you leave your port accessed; i.e., how long can you leave the Huber needle in the portacath covered by a clear dressing, such as an OpSite?

Well, here are the results of an interesting study that says more than a week is completely safe!

Huber needle in situ inpatients under continuous infusion chemotherapy: results of a study, Phase II

Prof Inferm. 2000 Apr-Jun;53(2):71-4.

[Article in Italian]

Milani A, Vernizzi S, Passoni C, Sociale O, Macciola F, Grimaldi C, Comensoli M, Peruzzotti G, Lunghi L, Colleoni M.

Divisione di Oncologia Medica, Instituto Europeo di Oncologia, Milano, Italia.

Abstract

PURPOSE: Chemotherapy administered as a continuous infusion is a widely used treatment in oncology. Huber needle deserves close attention during chemotherapy, but no data are reported on how long it can be left in situ without change. We therefore evaluated the feasibility of leaving in situ the needle for a prolonged time. METHODS: Patients candidated to continuous infusion chemotherapy were considered eligible for the study. The needle was changed at the end of the 21-day period when the patient started a new cycle of chemotherapy. On that occasion the site of injection was evaluated while replacing the needle. RESULTS: On 129 evaluable patients submitted to continuous infusion chemotherapy, 124 patients did not demonstrate any adverse cutaneous reaction. Five patients (3.8%) presented sores but we were able to continue the treatment leaving in situ the needle. CONCLUSION: Our results demonstrated that the needle can be left in situ for the entire time the patient is at home between cycles of chemotherapy. This procedure avoids patient stress and anxiety due to unjustified substitutions of the needle.

So, the above study supports leaving the ports accessed for as long as 3 weeks.  This following study supports an even longer timeframe, a whole month:

Port needles: do they need to be removed as frequently in infusional chemotherapy?

J Infus Nurs. 2003 Jul-Aug;26(4):239-42.

Karamanoglu A, Yumuk PF, Gumus M, Ekenel M, Aliustaoglu M, Selimen D, Sengoz M, Turhal NS.

Outpatient Chemotherapy Unit, Marmara University Hospital, Tophanelioglu C, 13/15 Altunizade, Uskudar, 81190 Istanbul, Turkey.

Abstract

Protracted chemotherapy regimens are new treatment modalities used to treat patients with cancer. These treatments are preferred because of the ease of administration and limited side effects in the outpatient setting. Sixty patients were treated with continuous infusion chemotherapy via implanted infusion ports at Marmara University Hospital Outpatient Chemotherapy Unit in Istanbul, Turkey, from January 2000 to December 2001. Although usage of Huber needles for central venous catheters was limited to between 48 and 72 hours, needles were not removed unless there were signs of inflammatory reaction. The needles remained in place for 28 days (1-49 days) on average. No catheter infections, signs of local irritation, or thrombus formation were observed despite prolonged stay of the Huber needles. Huber needles can be left in place up to several weeks without any untoward effects as long as proper aseptic technique is used.

For the past month, I have been leaving my port accessed for two weeks and everything is going well.  If all continues to be well, I may extend another week with a final goal of changing my Huber out monthly.  This will decrease expense (i.e., supplies) and wear on the port.

The Sticky World of the Huber Needle and Accessing Your Port

11 Jan

When accessing a portacath/med port, sterile procedures must be followed. The following steps reflect my personal training and the Phoenix Children’s Hospital Procedure Brochure #810 for steps I do not use. How you were or will be trained may differ.

1. If desired, 30 to 60 minutes prior to the procedures, put EMLA or L-M-X 4 cream on the skin over the port.

1.a. Some people use a numbing cream before inserting their Huber needle; I have never used a numbing cream. I normally use a 22 gauge needle, which I find to be practically painless. However, I have been needled and pricked so often, my tolerance could be higher than average.

1.b. A common cream used to numb the portacath area is AstraZeneca’s EMLA (Eutectic Mixture of Local Anesthetic) cream (non-brand generics are available). This cream contains 2.5% each of lidocaine and prilocaine. MLA is a local anaesthetic for topical application, developed to anaesthetise intact skin and often used to prevent pain associated with needle insertion. Local dermal anaesthesia is achieved after approximately 60 minutes and the duration of anaesthesia is approximately two hours. Source: Wikipedia

2. If the heparin is refrigerated, take it out of the refrigerator about ten (10) minutes before you use it. Let it warm to room temperature. Cold heparin will not harm you, but you may feel the heparin’s coldness when injected. (I do not refrigerate my heparin; pre-filled heparin syringes do not require refrigeration.)

3. If the Cinryze is refrigerated, take it out of the refrigerator about ten (10) minutes before you use it. Let it warm to room temperature. Cold Cinryze will not harm you, but you may feel the coldness when injected. Prescription literature states Cinryze should be stored at 36F-77F. (I do not refrigerate my Cinryze; my prescription label reads, “Store at room temperature.”)

4. Clean the work area with soap and water, and let it dry.

5. Wash your hands with antimicrobial scrub for 30 to 45 seconds. Wash the entire surface of your hands. Wash under your fingernails, the backs of your hands, your wrists and between your fingers. Rinse completely and dry your hands with a clean towel or paper towel.

6. Remember, as you open the supplies, touch only the outside packaging until your hands are gloved. Keep everything sterile. Sterile means there are no germs at all. Once you open a package, it is not sterile. Even though you washed your hands, they are not sterile until they are in sterile gloves.

7. Prepare your Cinryze. Make sure you have the right amount of the right medicine, and it is the right time to give it.

7.a. Wipe the top of each Cinryze bottle with an alcohol pad.

7.b. Wipe the top of each sterile water bottle with an alcohol pad.

7.c. If Using Transfer Needles:

7.c.(1) Uncap the shorter needle of the double-ended transfer needle (included with Cinryze prescription) and insert into a sterile water bottle (included with Cinryze prescription). Up-end the sterile water bottle, uncap the other end, and insert the longer needle into a Cinryze bottle. Vacuum pressure will draw the sterile water into the Cinryze bottle. Carefully withdraw the longer needle from the Cinryze bottle and recap it. Carefully withdraw the shorter needle from the sterile water bottle and recap it. Gently roll (DO NOT shake–you’ll create bubbles and foam) reconstituted Cinryze bottle between your palms to mix and set aside.

7.c.(2) Repeat with second set of sterile water and Cinryze.

7.c.(3) Wipe the top of the Cinryze bottle again with an alcohol pad. Put a clean unused needle on a clean unused 10cc syringe. Uncap the needle. Pull back on the plunger to fill the syringe with 2cc of air. Put the needle into the Cinryze bottle top, and push all the air into the bottle. Pull back on the plunger to fill the syringe with 5cc of Cinryze. To remove air bubbles from the syringe, (a) point the syringe up, (b) gently tap the side of the syringe with your finger, (c) large air bubbles will rise toward the needle, and (d) press the plunger until a tiny amount of Cinryze squirts out with the air bubbles. Any small air bubbles that stay attached to the inside of the syringe after you tap are safe.

7.c.(4) Repeat with second bottle of reconstituted Cinryze until you have 10cc of solution in the syringe. Recap the needle and set aside.

7.d. If Using Mix2Vials:

7.d.(1) Remove the cover from a Mix2Vial (included with Cinryze prescription) and place the unit over the top of one of the sterile water bottles, pressing down firmly. Holding the sterile water bottle, lift the Mix2Vial plastic packaging up and off of the bottle. Turn the unit over and fit the other end of the Mix2Vial over the top of one of the bottles of Cinryze, pressing firmly straight down. Vacuum pressure will draw the sterile water into the Cinryze bottle. The contents should be thoroughly mixed with little foaming; if not, gently roll (DO NOT shake–you’ll create bubbles and foam) the conjoined bottles between your palms to mix; set aside. Do not remove Mix2Vial apparatus.

7.d.(2) Repeat with second set of sterile water and Cinryze.

7.d.(3) Open a 10cc syringe. Pull back on the plunger to fill the syringe with 2cc of air. Using a twisting motion, separate the reconstituted bottle Cinryze and its half of the Mix2Vial from the empty sterile water bottle and its half of the Mix2Vial. Set the sterile water half aside for later disposal. Screw the syringe onto the nipple on the Mix2Vial apparatus attached to the bottle containing the reconstituted Cinryze. Push all the air into the bottle. Pull back on the plunger to fill the syringe with 5cc of Cinryze. Unscrew the Mix2Vial apparatus and set aside for later disposal. To remove air bubbles from the syringe, (1) point the syringe up, (2) gently tap the side of the syringe with your finger, (3) large air bubbles will rise toward the needle, and (4) press the plunger until a tiny amount of Cinryze squirts out with the air bubbles. Any small air bubbles that stay attached to the inside of the syringe after you tap are safe.

7.d.(4) Repeat with second bottle of reconstituted Cinryze until you have 10cc of solution in the syringe. Leave the empty bottle and Mix2Vial in place and set aside.

8. If you use pre-filled saline and heparin, remove them from their plastic wrapping and set aside with the filled Cinryze syringe. (I use pre-fills.)

9. If you do not use pre-filled saline and heparin:

9.a. Wipe the top of the saline bottle with an alcohol pad. Put a clean unused needle on a clean unused 10cc syringe. Uncap the needle. Pull back on the plunger to fill the syringe with 2cc of air. Put the needle into the bottle top, and push all the air into the bottle. Pull back on the plunger to fill the syringe with 10cc of saline. To remove air bubbles from the syringe, (1) point the syringe up, (2) gently tap the side of the syringe with your finger, (3) large air bubbles will rise toward the needle, and (4) press the plunger until a small amount of saline squirts out with the air bubbles. Any small air bubbles that stay attached to the inside of the syringe after you tap are safe. Recap the needle and set aside.

9.b. Repeat.

9.c. Wipe the top of the heparin bottle with an alcohol pad. Put a clean unused needle on a clean unused 10cc syringe. Uncap the needle. Pull back on the plunger to fill the syringe with 2cc of air. Put the needle into the bottle top, and push all the air into the bottle. Pull back on the plunger to fill the syringe with 5cc of heparin. To remove air bubbles from the syringe, (1) point the syringe up, (2) gently tap the side of the syringe with your finger, (3) large air bubbles will rise toward the needle, and (4) press the plunger until a small amount of heparin squirts out with the air bubbles. Any small air bubbles that stay attached to the inside of the syringe after you tap are safe. Recap the needle and set aside.

10. Open the package of the non-coring Huber needle, but do not take the Huber needle out of the package. (I use LifeGuard.)

11. Take the clave or micro-clave cap out of the package and remove the cover from the connector end. (I’ve used both; the micro-clave was developed for pediatrics.)

12. Without putting the micro-clave down, pick up the capped end of the Huber needle’s IV tubing, uncap it, and twist the micro-clave onto the IV tubing end. The micro-clave/IV tubing end is no longer sterile and CANNOT be placed back into the Huber needle package. Let the micro-clave/IV tubing end rest on or just over the edge of the packaging and be sure that it does not touch any of the other sterile needle components.

13. Wipe the tip of the micro-clave with an alcohol pad.

14. Uncap/remove the needle from one of the saline syringes and connect it to the micro-clave.

15. Push the plunger of the saline into the IV tubing until drops of saline come out of the end of the needle that is still INSIDE the Huber needle package. Leave the syringe connected to the micro-clave OUTSIDE the Huber needle package.

16. Open the Central Line Dressing Change Kit. DO NOT touch anything inside yet.

17. Open any remaining supplies and let the contents drop into the kit WITHOUT TOUCHING the contents. Examples include, but are not limited to: Biopatch, Chloraprep Sepp Applicators.

18. Use a gauze square to wipe the EMLA or L-M-X 4 cream off the port site.

19. Usually, the mask is on top in your dressing change kit; put it on if you are working on someone else or if you have a cold, cough, or snotty nose (I hardly ever use mine when working on myself).

20. Remove the waterproof drape next and, using your fingertips and touching the drape as little as possible, position it over your workspace, plastic/waterproof side up.

21. You are now ready to ENTER THE STERILE ZONE. If you accidentally touch any non-sterile surface, you must START OVER from this point forward. This includes touching yourself (don’t touch your face or absent-mindedly scratch that itch!), don’t touch the unprotected work surface or the arm of a chair to help yourself up, don’t touch the outside of any packaging, just DON’T TOUCH ANYTHING THAT ISN’T STERILE.

22. Take out the packet of sterile gloves and place them on the drape. They should be marked right side up, or left and right. Unfold the outer packaging in the proper orientation.

22.a. Starting with your preferred hand and touching ONLY the INSIDE of the folded cuff with your other hand, slide your first hand with your thumb in the indicated direction (usually means palm up and thumb facing outward) into the first glove. DO NOT TOUCH the OUTSIDE of the glove with your UNGLOVED hand. Your UNGLOVED hand is NOT STERILE. Touching only the INSIDE of the cuff, pull the glove on and up over your hand and pluck the cuff into an unfolded position. Your first hand is now STERILE.

22.b. Using your gloved and sterile hand, you are now ready to glove your other hand. Since you are going to place your non-sterile hand into the inside of the second glove, you DO NOT want your STERILE hand touching the INSIDE of the second glove. The trick is to slide your gloved hand UNDER the cuff of the second glove while your second hand is holding down the inside of the cuff to open up the second glove enough for your second hand to begin the slip inside (palm up, thumb out). Sometimes it helps to grab the sterile paper wrapper with your GLOVED hand and fold it over the second glove to give you some extra maneuverability with your GLOVED hand if you are having trouble getting the cuff to pull apart. Pull the glove on and up over your hand and pluck the cuff into an unfolded position. Both of your hands are now STERILE. Applaud yourself, but DON’T give yourself a clap on the back! (This was the second hardest part for me to get a grip on (yeah, I love bad puns and didn’t even TRY to resist).)

22.c. Place the paper wrapping to one side to keep your work area uncluttered.

23. Sterilize the port area using the method that you and your doctor determines is best for you (for instance, I am allergic to Betadine and that’s what comes in my kit). Here are some possible techniques:

23.a. Take three Chloraprep Sepp (2 percent chlorhexidine gluconate and 70 percent isopropyl alcohol) applicators out of their package. Hold each applicator upside-down and squeeze the applicator until the plastic cracks. This releases the contents into the pad. Scrub back and forth over the port site with the pad on the applicator for 30 seconds. Repeat twice. Place used applicators on the drape. Let the port site dry for 30 seconds.

23.b. Open the Chloraprep (2 percent chlorhexidine gluconate and 70 percent isopropyl alcohol) or PVP (10% PVP povidone iodine solution equivalent to 1% available iodine; i.e., brand name Betadine) swabstick packet using the tear-notch. Gently squeeze the some of the excess liquid from the cotton heads of the three swabsticks to prevent excessive dripping. Remove the first swabstick and, using a circular motion and starting at the center of the port, swab outward about 3 inches on either side while rotating the swab such that all sides of the swab are used ONCE. You DO NOT want to transfer any germs or skin cells from one area of the port to another area. Repeat twice. If excessive dripping occurs, use the gauze pad supplied in the kit to light pat away the “juiciness.” Placed used swabsticks and gauze on the drape. Let the port site dry for 30 seconds.

24. Pick up the Huber needle using only the wings. Remove the needle cover.

25. With your other hand, find the edges of the port. Use two fingers to frame the port and hold the port in place.

26. Push the needle into the center of the port. Press it through the skin until the needle touches the bottom of the port. Tip: If you are doing this yourself, it really helps to stand in front of a full-length mirror (no kidding! this was nearly my undoing and the tip came from, of all people, my psychiatrist–you just never know who is going to save your lily white butt or how).

27. If you are using a Biopatch, slide it over the needle between your skin and the needle housing, bluish side out.

28. The attached saline syringe (even when it was in its plastic packaging) is NOT STERILE and this next step will take you OUT OF THE STERILE ZONE.

29. Pull back on the plunger of the saline syringe until blood flashes into the IV tubing attached. This lets you know the needle is in the right place.

29.a. If you do not get a flashback, check to see if the IV line clamp is OPEN. Without touching your skin because you are no longer sterile, carefully check the needle placement. Is the needle in far enough? Is the needle in the center (sometimes the needle slips between the port’s portal and septum–I bent many Hubers this way when I was learning). Try carefully wiggling the needle back and forth, forward and back.

29.b. If you still cannot get a backflash, remove the needle using the procedures for your needle type (see here) and start over from Step 10 with a new needle and dressing change kit.

29.c. If you still cannot get a backflash after Step 29.b., call your Home Health Care Nurse or physician’s office. Your port may be clogged, broken or infected.

30. Push the full contents of the saline flush into the port and unscrew the syringe. Set it aside.

31. Unscrew the needle or Mix2Vial from the Cinryze syringe, set it aside the needle for disposal in a sharps box later, and screw the syringe onto the micro-clave. Using a timer, gently depress the plunger so the 10cc of Cinryze is administered over ten minutes.

32. Uncap/remove the needle from the second saline, screw it onto the micro-clave, push the full contents of the saline flush into the port, and unscrew the syringe. Set it aside.

33. Uncap/remove the needle from the heparin, screw it onto the micro-clave, push the full contents of the heparin flush into the port, keep pressure on the syringe, and CLOSE the CLAMP on the IV tubing.

34. IF LEAVING THE NEEDLE IN THE PORT: If using a product line Skin Prep, apply the pad around the outside perimeter of the dressing site.

35. IF LEAVING THE NEEDLE IN THE PORT: Put a transparent dressing on the port (usually included in the change kit). Tip: If not already folded, fold the dressing in half. Then peel the backing off one-half of the dressing to the fold. Place the fold line in the dressing over the centerline of the port and needle, and press the dressing in place. Peel the remaining backing from the other half and press that half into place. This method keeps the dressing from curling and sticking to itself.

36. Put all the needles, including the double-ended transfer needle, in the sharps box.

37. Other materials can be placed in the trash.

I can do Steps 1 through 30 in about 5 minutes, and if I can do it, you can, too. I’d say it took me about 2 months to become really comfortable and get up to that speed, and I’m a freakin’ big chicken, so I expect you all to surpass me!

Want A Portacath? Here’s Some Stuff You’ll Need

10 Jan

I remember what it was like when I was first trying to figure out just what a port was, let alone what a Huber needle was, what it looked like or even how to spell it.  The people I was talking to or corresponding with were so familiar with the terms and ideas that they either were in too much hurry or just couldn’t break down things to my layman’s level.  So here’s a peek at what some of the stuff you’ll be getting/needing looks like.

Portal, Septum and Catheter

Typical Portacath: Portal, Septum and Catheter; whole unit is inserted under the skin; septum is the yellowish space in the middle and is where the Huber needle is inserted

Saline Usually Have White Caps, Heparin Have Yellow

Pre-Filled Flushes: Saline Usually Have White Caps, Heparin Have Yellow

Shows Threads So Syringe Screws onto Clave

Shows Threads So Syringe Screws onto Clave

Example of a MicroClave

Example of a MicroClave: Remove blue cap from left side and attach to end of IV tubing; right side screws into syringe

MicroClave Attached to IV Tubing

MicroClave Attached to IV Tubing

Biopatch -- A Little Bigger Than a Quarter

Biopatch -- A Little Bigger Than a Quarter

These are the types of Huber needles that I know about:

Huber Plus from Now Medical

Huber Plus from Now Medical

The Huber Plus Safety Huber Needle was the first self-contained, passive, safety non-coring huber needle to receive FDA pre-market notification as a safety device. It requires minimal change in user technique and can be activated using a one-handed operation.  The safety feature does not interfere with the normal use of the product. The HUBER PLUS safety wings are color-coded to identify needle gauge size and is offered in several needle lengths ranging from ½” to 1 ½”.  Straight sets are available as well as sets containing a needle free y-site featuring a positive pressure valve.

The Huber Plus is activated by simply grasping the wings with thumb and forefinger and squeezing.  The needle is encapsulated within the locked wings as the needle is removed from the port.  The safety mechanism provides both visual and audible (the safety “snap”) confirmation that the exposed needle is now covered and the clinician is protected from accidental needlestick injuries.  Additional information can be obtained from Now Medical by clicking here or call 610-455-0258.

Gripper Plus from Deltec

Gripper Plus from Deltec

The design of the GRIPPER PLUS® Safety Needle allows the user to de-access the needle in one safe, easy, natural motion. Its unique feature is a safety arm that is lifted to lock the needle into a protected position when removing it from an implanted port.  The fingers are placed on each side of the needle base. With the other hand, place a finger on the tip of the safety arm. The safety arm is lifted straight back until it CLICKS into its locked position.  The product can then be dropped into a sharps container.

The Gripper Plus has a cushioned needle platform for greater patient comfort, needle stabilization and protection of the access site.  It has a removable contoured grip for controlled needle placement. The clamps are color-coded for needle gauge size identification. For more information on the Gripper Plus click here or call 800 426 2448.

LifeGuard™ Safety Huber needle from Horizon Medical Products (HMP)

Lifeguard Safety Huber Needle from HMPLifeGuard Safety Huber Needle from Horizon Medical Products

This is what I used at one point.

LifeGuard’s needle trap fully encapsulates the needle upon removal.  Compared to traditional Huber needles, Lifeguard is designed for maximum control and safety with minor changes to technique. It provides both visual and audible confirmation of safety.  It has colored safety handle for needle gauge confirmation.  To remove the needle from the port septum simply raise the needle trap upward to 90°.

Using non-dominant hand, grasp the safety hinge with thumb and middle finger. Gently push the safety hinge down against the patient’s skin and port.

Flip the safety needle towards the needle trap into the safe position. For more information contact Horizon Medical Products at 800-472-5221 or visit their website here.

Surecan® Safety Huber Needle by B. Braun

Surecan Safety Huber by B. Braun

Whether you’re delivering chemotherapy, antibiotic therapy, or parenteral nutrition, the Surecan® Safety Huber Needle’s patented safety clip will automatically engage as you withdraw the needle from the base plate.

It is color–coded by size with 19, 20, and 22 gauge needles available. The Surecan® is latex-free to avoid the risk of allergic reaction and DEHP-free for compatibility with chemo drugs and lipids. Enables you to inject medication or withdraw blood from the Y–site with a simple luer connection. The base of the port is stabilized by firmly holding down with the non-dominate hand. The needle is withdrawn by pulling straight out by the hub grip. The safety clip automatically activates covering the needle.  For more information click here or call 800-523-9676.

LiftLoc™ Safety Infusion Set manufactured by Specialized Health Products(R) International, Inc. and marketed by Bard Access Systems

LiftLoc marketed by Bard Access Systems

LiftLoc Safety Infusion Set features a robust shield that is deployed as the needle is withdrawn from the port, effectively reducing the risk of accidental needlesticks, including rebound injuries. A Patient Comfort Pad™ is included with each LiftLoc set, and is designed for patient comfort. The use of the Patient Comfort Pad is optional.  LiftLoc’s safety mechanism is easy-to-use and conforms to common user technique. To access simply grasp the wings and lift them.  As the wings are lifted up, the clinician pulls the LiftLoc from the port while covering the needle.

The LiftLoc Safety Infusion Set is distributed under the SHPI label by Cardinal Health, Medline Industries, Inc., and Physician Sales and Service, Inc. (“PSS”), leading distributors with a strong presence in the oncology, chronic hematology and long-term intravenous nutritional markets.  The product line is distributed in the hospital market on a private label basis by Bard Access Systems, Inc., a subsidiary of C.R. Bard, Inc.  For more information about the product contact Bard Access Systems, Inc. at 800/545-0890 or go to their website.

Luther Safety Huber Needle Protector by Luther Research Partners

Luther Safety Huber Needle by Luther Research PartnersLuther Safety Huber Needle by Luther Research Partners

The Luther Safety Huber Needle Set is a device intended to administer medications to a patient through a subcutaneously implanted port.  This safety device is for use on all Huber needles manufactured from ½ to 1 ½ inch.

The Huber Safety Needle cover is manually activated.  It uses a permanent locking tip that renders the sharp portion of the needle inaccessible upon removal of the needle from the implanted port.   It has a foam pad for patient comfort. The sure-grip handle is available for easy insertion and removal from even the most difficult ports. Simply grab the sure-grip handle and lift the needle from the implanted port septum.

The safety system cannot be defeated or reset.   For more information call (714) 434-1564 ext 4 or visit their website here.

Kawasumi Laboratories America, Inc. – K-Shield

K-shield by Kawasumi America

Kawasumi America is marketing a new needle safety device designed to protect oncology clinicians from Huber needle stick injuries incurred while removing needles from subcutaneous ports. The device also provides a convenient means for disposing the Huber needle after removal from patients, but does not discomfort the patient at any time, nor does it present any needle movement during the time of infusion. The K-shield ensures safety for the clinician while maintaining maximum patient comfort. When deaccessing the Kawasumi Huber needle from the implanted port, simply lift up and fold the wings down on top of the needle. [kshield.jpg]   For more information on this product call 800-KAWASUMI (529-2786) or visit their website here.

TriState – Centurion® HuberGuard™ Safety Device ( Manufactured by Harmac and distributed by TriState Hospital Supply Corporation)

Centurion® HuberGuard(tm) Safety Device provides needlestick prevention when used in conjunction with the Centurion® huber infusion sets for removal and disposal. The low-profile needle is comfortable for the patient and reduces bumping and dislodgement from the port.  To deaccess from the port septum the HuberGuard is aligned over top of the Centurion huber needle.  The needle is pulled up by the right wing so that the needle is held within the HuberGuard. The needle clicks securely into place providing both tactile and audible safety lock position indicators. The needle is then disposed of in a sharps container. The Centurion HuberGuard is available in sterile or non-sterile configurations.  For more information contact Tri-State Hospital Supply Corporation at 517.546.5400 or visit their website here.

Huberloc (Manufactured by MedCare Medical Group, Inc. and Distributed and Marketed through Baxter Healthcare)

Huberloc marketed by Baxter

The Huberloc is a safety product that removes the needle from the port and contains it thus eliminating rebound needlestick.  It allows the clinician to use the huber needle of their choice.  The Huberloc Device also offers a positive pressure flush and lock technique.  Because the Huberloc Device enables you to remove a huber needle with one hand, you can perform a positive pressure flush during decannulation with the other hand.

This simultaneous flush and lock technique helps maintain catheter patency. The Huberloc is designed for compatibility with 19 GA x 1 ½” long and smaller 90° winged huber needles.  Simply align the HuberLoc with the needle hub that is opposite of the tubing.  The forks of the HuberLoc are slid forward until the needle shaft is all the way to the back of the forks.  While pressing down on the top of the HuberLoc with your thumb, pull up on the finger grips with your first two fingers (like syringe motion). This extracts the Huber needle. Continue this motion until the slide “snaps” into its locked position. For more information please phone 888-229-0001 or visit their website here.

Is the light getting better in here, just a wee bit?  I hope so.  There are more posts on my website that deal with the sterile procedures on how all this stuff comes together.  Either use the “Search” feature or the drop down menu under “Check Out What Faerie♥Kat’s Been Writing About” and scroll down to “HAE”.

Be well and don’t swell!

HAE and Caring for Your Port

10 Jan

What follows is an email I composed for the Hereditary Angio Edema (HAE) Digest in response to requests for information, posted here for those who may not be on the Digest’s mailing list (to join the mailing list, which is open to HAE patients and their families, click here).

CARING FOR YOUR PORT

On the premise that no information shared is ever wasted and no one can ever have too much knowledge, here’s some great info on how to take care of your port.

First, let’s define “port:”

In medicine, a port (or portacath) is a small medical appliance that is installed beneath the skin. A catheter connects the port to a vein. Under the skin, the port has a septum through which drugs can be injected and blood samples can be drawn many times, usually with less discomfort for the patient than a more typical “needle stick.” The term portacath is a portmanteau of “portal” and “catheter”. Port-a-Cath is a brand name; others include Microport, Bardport, PowerPort (power injectable), Passport, Infuse-a-Port, Medi-Port, and Lifesite (for hemodialysis patients). The term Totally Implantable Venous Access System (TIVAS) is also used. Additionally, portacaths are a form of a “central venous access device” and are frequently referred to as such in the medical field.

It’s easier to take care of something if you know how it works:

A port consists of a reservoir compartment (the portal) that has a silicone bubble for needle insertion (the septum), with an attached plastic tube (the catheter). The device is surgically inserted under the skin in the upper chest or in the arm and appears as a bump under the skin. It requires no special maintenance and is completely internal, so swimming and bathing are not a problem. The catheter runs from the portal and is surgically inserted into a vein (usually the jugular vein, subclavian vein, or superior vena cava). Ideally, the other end of the catheter terminates just upstream of the right atrium. This position allows infused agents to be spread throughout the body quickly and efficiently .

The septum is made of a special self-sealing silicone rubber; it can be punctured hundreds of times before it weakens significantly. To administer treatment or to withdraw blood, a health professional will first locate the port and disinfect the area. Then he or she will access the port by puncturing the overlying skin with a 90° Huber point needle. Due to its design, there is a very low infection risk, as the breach of skin integrity is never larger than the caliber of the needle. This gives it an advantage over indwelling lines such as the Hickman line. Negative pressure is created to withdraw blood into the vacuumized needle, to check for blood return and see if the port is functioning normally. Next, the port will be flushed with a saline solution. Then, treatment will begin. Also, after each use, a heparin lock is made by injecting a small amount of heparin (an anticoagulant) into the catheter. This prevents development of clots in the system. The port can be left accessed for as long as required. The port is covered in a dressing to protect the site from infection and to secure the needle in position.

Check out this site to see what a port looks like before implantation and to see a quick video of a needle insertion: http://www.gynoncology.com/Movies/Portacath_Insertion.htm

This link is to a photo-essay by a gentleman using a port to get chemotherapy: http://diehlmartin.com/infusion/

Source: Wikipedia

Care Tips:

  • After the port is put implanted and the skin over the port is healed, you may return to normal activities.
  • Live as normally as possible. The port is just a part of your life.
  • The port needs to be kept safe. Ask your doctor before you play a contact sport.
  • After the skin over the port is healed, you can get the skin wet.
  • When there is no needle in the port, can take a bath, shower, or swim. You may wash the skin as usual. A dressing is only put over the port when a needle is in it.
  • You should not swim or take a shower when the needle is in. You can take a tub bath while the needle is in only if you keep the dressing dry.
  • You must change the needle at least once a week if the dressing is transparent (OpSite, Tegaderm, and Sorbaderm are some examples of transparent dressings).
  • If using a gauze dressing, change the needle every 48 hours.
  • Call your doctor right away if the site around the port shows bruising, swelling, redness, bleeding or pain, or if you have a fever over 101є F, have chills, or the port seems to have moved.
  • A port puts you at higher risk for an infection when getting dental work. Before and after dental work, you should be given antibiotics, so see your doctor first.
  • Look at the skin over the port every day. If the port stops working, or causes discomfort, return to the doctor’s office or hospital to have it checked as the port may be infected.
  • If you cannot flush the port, or cannot get a blood return:
    • Do not use force to flush the port. The pressure could loosen a plug so it is free to block a blood vessel. Forceful pressure could even break the port.
    • Make sure the tubing is not clamped.
    • Make sure the port needle is pushed in so it touches the back or the port.
    • Raise your arms over your head, or lay on your side, and try again.
    • If you still cannot flush the port or get a blood return, call your health care team.
  • Signs of infection can be drainage or oozing, such as pus, swelling, tenderness, soreness, warmth, pain, redness at the exit site, redness along the catheter path beneath the skin, a temperature above 101F orally (check with your health care provider), or odor from the exit site. If you see any of these signs, call your health care team right away.

Source: Phoenix Children’s Hospital Procedure Brochure #810

No-swell blessings to all,

Kat

DISCLAIMER: The above comments are based on the personal experiences and opinions of the writer, and any errors are unintentional oversights (or possibly just plain ignorance). Readers should always consult their own physician for current and official medical facts, advice and opinions. ALWAYS take everything anyone (including me) tells you with (preferably) two grains of salt (especially if aspirin upsets your stomach as this could result in an abdominal attack [grin!]) and please don’t call me in the morning if you don’t like what I say. Bright blessings for a happy and swell-free day.

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