From the Guidelines
An implanted port may not be accessible for a lab draw due to several reasons, including clotting, mechanical issues, infection, or improper positioning, as outlined in the management of central venous access devices 1. When considering the accessibility of an implanted port for lab draws, it's crucial to evaluate the potential causes of inaccessibility. These causes can be broadly categorized into mechanical, infectious, and procedural issues.
- Mechanical issues such as catheter displacement, migration, or pinch-off syndrome can impair access to the port.
- Infection at the port site, indicated by signs like redness, swelling, or drainage, necessitates avoiding the use of the port until the infection is treated.
- Procedural issues, including improper positioning during access attempts or the use of an inappropriate needle, can prevent successful draws.
- Additionally, failure to regularly flush the port with heparin or saline can lead to occlusions, further complicating access. Given these potential issues, it's essential to follow guidelines for the insertion and maintenance of central venous access devices, as recommended by studies such as 1, to minimize complications and ensure the port remains accessible for necessary procedures like lab draws. In cases where a port cannot be accessed, alternative venipuncture sites should be utilized for lab draws, and the issue with the port should be promptly addressed by healthcare providers to prevent further complications and ensure patient safety.
From the Research
Reasons for Inability to Access an Implanted Port for Lab Draw
- Clotting or occlusion of the catheter, which can be caused by various factors such as poor blood flow, infection, or thrombosis 2, 3, 4
- Venous occlusion from prior catheter placement, as seen in one patient in the study by 2
- Fibrin-sheath-related catheter occlusions, which can be treated with intra-catheter tissue plasminogen activator (tPA) instillation 2
- Central-line-associated bloodstream infections (CLABSIs), which can lead to removal of the port 2, 5
- Bleeding complications, which can occur due to the use of anticoagulants or thrombolytic agents 3, 4
- Technical difficulties, such as catheter tip position or age of clot, which can make it challenging to access the port 4
- Inadequate nursing management or care of the implanted port, which can lead to complications and make it difficult to access the port for lab draws 6, 5