Message Image  

All ONS Member Community

Expand all | Collapse all

Multi-day vesicant therapy and Mediports

  • 1.  Multi-day vesicant therapy and Mediports

    Posted 6 days ago
    I'm trying to find evidence either supporting or advocating against leaving mediport needles in for multi-day vesicant therapy that is not administered via CADD pump (i.e., AIM).  Currently updating our policy, but was having a difficult time finding literature.  Patients often don't want to be stuck more than once, and elect to leave their needle in overnight.  There seems to be variation of practice, and was wondering if anyone had any info on this.  Thanks!

    ------------------------------
    Danielle Gabriel
    Clinical Nurse
    Memorial Sloan Kettering Cancer Center
    Lake Grove NY
    ------------------------------


  • 2.  RE: Multi-day vesicant therapy and Mediports

    Posted 6 days ago
    I don't have any written evidence to offer. However, I do have 16 yrs experience in oncology. I prefer to leave the patient accessed for multiple, consecutive days of treatment. This clearly cuts down on the risk for infection with each needle stick. Not to mention, it's not exactly cost effective to use all those supplies, new kits and hubers 3 to 5 days in a week, on one patient. Unless the patient is completely against going home accessed, I advocate to leave needle in.  Patients usually find it gets them in and out quicker too, not having to wait to be accessed each day.

    ------------------------------
    Lydia RN,OCN
    RN
    FL Cancer Affiliates
    Panama City, FL
    ------------------------------



  • 3.  RE: Multi-day vesicant therapy and Mediports

    Posted 3 days ago
    Exactly!
    best process both from an infection prevention stand point and a cost-savings stand point!

    I concur!!!

    ------------------------------
    Florence Okafor MPH, MSN, RN, NPD-BC, CPHON
    Professional Development Specialist:
    Adult Oncology; Ambulatory Infusion Center;
    Adolescent & Young Adult Oncology; &
    GYN-Oncology.
    Baylor All Saints Medical Center
    Fort Worth TX
    ------------------------------



  • 4.  RE: Multi-day vesicant therapy and Mediports

    Posted 6 days ago

    Danielle-I agree that it is convenient for the patients to remain accessed for the duration of treatment if possible. However for safety issues we do not let patients remain accessed over a weekend.  

    Implanted ports are an important lifeline for patients receiving antineoplastic treatments; however, despite vast nursing research on the maintenance and use of venous implanted ports, still so much remains to be learned. Many of the practices surrounding implanted ports remain controversial.

    ONS recently published Access Device Standards of Practice for Oncology Nursing, a comprehensive review of evidence-based recommendations and controversial issues surrounding access device use and maintenance. Here are some questions the ONS clinical inbox commonly receives surrounding venous implanted ports with the coinciding ONS standard or recommendation for care that addresses the issue.

    Are Sterile Gloves and a Mask Required for Accessing Implanted Ports?

    At this time, research is insufficient to support using sterile gloves while accessing implanted ports; therefore, either sterile or clean gloves are recommended. Additionally, research is lacking to mandate that a mask be worn while accessing implanted ports. What is known to prevent infection while accessing ports is thoroughly cleansing the access site with chlorhexidine (CHG) or a similar product in the event of an allergy. Once accessed, the implanted port site should be covered with a transparent dressing for long-term use or gauze and tape for short-term access.

    Does Evidence Support Use of CHG-Impregnated Patches With Implanted Ports?

    Several meta-analyses and randomized trials have found significant reductions in central line-associated bloodstream infections when CHG-impregnated patches or dressings are used on various types of central venous access devices. ONS does consider application of CHG-impregnated patches or dressings to all central catheters and ports to be a standard of care. Appendix 1 in Access Device Standards summarizes the evidence for access device-related recommendations.

    Do I Need to Deaccess Implanted Ports at the End of Each Treatment Day and Reaccess the Next Day?

    Evidence points to implanted ports being safe to leave accessed for seven days. However, because of other safety concerns with implanted ports and central venous access, each individual practice center must develop policies and procedures to stipulate whether patients may leave the care area with accessed ports. Risks and quality-of-life issues are associated with reaccessing ports daily, and the risk and benefit of each should be closely considered when developing policy and procedures.



    ------------------------------
    Tammy Litrico RN MSN OCN
    Nurse Navigator
    Asheville, NC
    ------------------------------



  • 5.  RE: Multi-day vesicant therapy and Mediports

    Posted 3 days ago
    True. One must always weigh the risk vs benefit.
    Regarding leaving port over the weekend, it is not really any different than leaving it in place over three days during the week. They both equate to the same number of days the needle dwells in place. if you the patient has a history of poor hygiene or management practices personally or you suspect the integrity of the CVAD will be compromised, then I will not recommend to leave the needle place (whether weekday or weekend) because the risk here outweighs the benefit.

    ------------------------------
    Florence Okafor MPH, MSN, RN, NPD-BC, CPHON
    Professional Development Specialist:
    Adult Oncology; Ambulatory Infusion Center;
    Adolescent & Young Adult Oncology; &
    GYN-Oncology.
    Baylor All Saints Medical Center
    Fort Worth TX
    ------------------------------



  • 6.  RE: Multi-day vesicant therapy and Mediports

    Posted 5 days ago
    Seems to me that as long as the port is assessed prior to daily therapy with demonstrated blood return and easy flushing that leaving the needle in would be perfectly acceptable.

    Sent from my iPhone