…it burns when you flush my port! In case you missed it…

“The Case of the Painful Port”  a very interesting article published by ONS Connect and  shared by a twitter colleague @ONSmark.  Read article here…

• This case is a very good reminder for us nurses to stop and listen to what our patients are saying. Often, when we are busy with our work, we think we are listening to our patients but we don’t  really “hear” what they are saying and/or don’t take action.

• When assessing for patency of a vascular access – checking for positive  blood return is a good sign that the device is in the right place and functional. Positive blood return means a free flowing blood return easily obtained on aspiration, and the color of whole blood. 

• Aside from a positive blood return, we should also assess for other symptoms such as swelling, redness or pain and comments from patients. As was the case described in this article, had the nurse not taken the extra step  when the patient complained of “burning sensation” after flushing with saline, the outcome would have been worse  especially with Doxorubicin, a known vesicant. (A vesicant is a chemical that causes extensive tissue damage and blistering if it escapes from the vein.)

• Kudos to the nurse for reporting to the physician and to the physician who took action and ordered a dye study. There were times in my career when I had the same scenario and reported it to the physician – only to be told to “flush ” gently the patient won’t feel the burn!  In another case, another physician told me to go ahead and use the device since I got a positive blood return!! No,  I didn’t give in and insisted on an x-ray or better yet, a dye study.

• This case had a good outcome but what if the nurse didn’t do anything and started administering the chemotherapy? That patient would have continued to feel the ‘burning” sensation and now a vesicant has leaked into the tissue. You know what would have happened – “extravasation”.  Taking the time and the appropriate steps prevented extravasation in this patient. Prevention is still the best medicine!