View Full Version : Infusion Nurse Standard of Care
06-20-2007, 10:03 AM
I hope anyone currently undergoing infusion though a port reads this and does not have to go through the nightmare I have indurred the past 3 days. I have an internal BARDport It has come to my attention there is a standard of care for Infusion room nurses (as far as in my town) is not being followed.
As I have now aquired a raging infection in my port (we believe because the port was left accessed all weekend and missed 2x's before that and or non sterile methods used). We as told by an ER nurse there is a Infusion nurse Standard that was not being followed, at least in my case.
First of all nurses should have on strerile gloves. Not the ones off the wall but the ones in the package. They should have on masks. A needle should be at least 20 gauge and 3/4".
Using a needle of less has resulted in my port being missed twice and saline injected into my chest as well as the needle being dug around in my chest(painful). As well as infection from either the port being left accessed for 4 days because they were having trouble accessing it(bad idea) and non-sterile methods used.
The ER nurse also said nurses should be wearing masks. which they aren't. There may be other standards I don't know about but these are the ones I know of.
06-20-2007, 01:13 PM
If you do have unpredictable complications from treatments, perhaps on weekends or holidays or when you don't feel like traveling very far, would you (or a significant other in your behalf) end up dealing with the local facility? No one wants to look for trouble, but you may want to consider those possibilities too in deciding what resources will be accessible to you.
Alaska, perhaps more than some other rural areas, is more prone to be less current and less likely to maintain newer practices simply because there are no major cancer centers here connected to research. The average person doing care in Alaska has fewer hands-on learning opportunities from others who are constantly involved in it. There is less motivation for highly qualified specialty practitioners to be located in Alaska because generally they want to be located where they don't become "stale".
Mine used the gloves with the pack. No masks, so I think the problem is with them missing and not knowing until you have gobs of whatever in your chest. Maybe there's something wrong with the port. If it were me I would not use that port again. My nurses definitely had a feel if everything was OK. Good luck, BB
06-21-2007, 12:36 AM
Never saw a chemo nurse at my center using masks... but there is a special needle required to use with a port. Can't imagine the port being 'missed'. Sounds like inexperience to me.
In order to be allowed to access a port, I've been told that nurses require special training. Without that training,they're not allowed to touch it. At my facility, chemo nurses are almost the only ones with that special training.
So missing a port to me would indicate untrained or inexperienced, and that would make me VERY nervous too. Good luck.
06-21-2007, 04:56 AM
It sounds like inexperience and nonsterile practices. The center I go the nurses use sterile gloves, always clean the area with betadine first, once the port has been accessed it is flushed with saline first. I would be concerned with contracting MRCA (staph infection) if sterile practices aren't adhered to. They don't wear masks at my clinic either. I had an infection in my port after it was first put in and was put on a antibiotic for a week. They think my body was trying to reject it works fine now and no infections has been in place since November. Sorry you are having such a tough time. My prayers are with you. Debbie in NC.
06-21-2007, 01:13 PM
well this is an issue I never considered until I got this staph infection. I don't think the mask is that big of a deal but there is no reason not to adhere to the basic sterile practices. I think putting saline into my chest two days in a row becaused they missed the port probly set me up for the rest. I just wondered how many new people know the procedure that should be used it's not like many of us have been through this before. First we need to know what kind of port we have and if we are not using our reg treatment team we need our port lit. with us ex: ER or any draws outside our infusion clinic. I think using the proper needle,
sterilization, being critical. I hope other newbies will read this and be proactive in their care. I was worried about other things and didn't think of this as being a big issue until now
thanks for all your prayers and support
06-21-2007, 07:00 PM
I echo what Janet said. The chemo nurse's where I go do not where masks...but they sure go out of their way to clean the entire area surrounding the port. Needle size depends on the person's port. There are different types. I have a port in my upper arm and my chemo nurse tells me mine is a *baby* port. (She teases me.) I guess its small considering some in the chest area.
As far as missing the port...as Janet said...totally in-experience! That would scare me to death. No excuse to miss if they know what their doing. They have to be specially trained to access a port. I know when I was in the hospital for my last mastectomy & then a ooph...both times they called for this guy Mark from the Port-a-Cath lab...no one else knew how to access my port for surgery.
06-26-2007, 12:40 PM
I don't have a port, but today I had a new chemo nurse, and I noticed that he was just about to give me the needle and he was not using gloves. It was very difficult for me but I asked him to put on gloves, and he did. This happened to me once before, and the person without gloves tried 3 times and failed. Perhaps inexperience, but it really is necessary to stay stop, rather than go home with huge bruises and fears of an infection.
06-26-2007, 02:04 PM
I have a new Onc. in Anchorage 45 miles away sucks to drive. However they have put my chemo off for 2 days while they test the port.Went in yesterday to get a blood draw from the port and my arm to check for staph. It took 8 hours! Infusion nurse could not get the port on 2 tries too much swell still. Called dr. He sent me to radiology where they completely numbed the area and had to get the port by floroscope. Went back to the infusion nurse still no blood. Parital occlusion, had to inject clot buster and wait 2 hours. What an ordeal. I wish they'd just take it out but no one wants to do taxetere w/o port up here.
On a better note it was the first time I have seen anyone up here use the proper technique to access port. She even had a mask on me. She was really on the ball. I was so grateful and very refreshed. We again did leave the port accessed for my treatment on Thurs. (accessed and bandaged impoperly is what caused the infection in the first place) it was interesting to see that she changed the way it was dressed from the first time. It does give me confidence in the new treatment team but I'll stay on my toes.
Have you noticed that it get easier to speak up to nurses and doctors with this disease. I have. It still is hard sometimes but later it makes me feel good! :)
06-26-2007, 02:11 PM
One last note I discovered via the surgeon who was upset 'his' port got infected that my port was improperly dressed when it was left accessed for 4 days. I told him right up front 'why are you installing these ports if the nurses are not experience to handle them'. He said it is a issue he is bringing up w/the hospt. here.
I will also be filing a greivance with the hospital and insist that they have nurses on duty who are trained in handling ports so someone else does not have to go through this.
06-26-2007, 07:34 PM
I am so sorry that you had this bad experience with your port. I had a port in my chest for about 3 weeks after starting chemo. It was accessed once for full chemo (TCH) and then twice for just Herceptin. I started having severe pain in my neck that radiated to my shoulder on the side with my port. I was sent for a port study that showed the port was working fine on a Friday. The pain continued over the weekend and worsened and then I spiked a fever of 102. I was miserable and was taking Lortab every 4 hours round the clock to tolerate the pain. I couldn't lay down and had to sleep (when I could) in my recliner. Called my surgeon and went in to see her. The port was infected and she took it out in the office. She said it looked like some Herceptin had infiltrated into my chest (it came out when she removed the port) and that the port probably got infected during that infusion. Once she removed the port and put me on some heavy duty antibiotics, I felt better in a day or two. I ended up getting another port a week later in my upper arm.
The nurses at my center wear gloves but no masks and clean the area really well. I have no idea how the infection occurred, but it would seem that during the infusion or just after was the most likely time. I am totally sympathetic to your situation. Port infectiions are a nightmare! All the best to you!
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