Transcript Possible Causes

Problems and Complications
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Insertion Complications
Potential post-op complications to
monitor for include:
Infection
Pneumothorax
Hydrothorax
Cardiac tamponade
Arterial rupture
Bleeding
Air embolus
Nerve injury
Thoracic duct injury
Catheter displacement
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One-way Effect
Clinical Observations
You can flush but can’t withdraw blood from the
catheter
Possible Causes
• Catheter tip is against the vein
wall
Care and Treatment
• Reposition patient
• Catheter malpostion
• Ask patient to deep breath, cough
or valsalva
• Fibrin sheath formation
• Attempt to irrigate and aspirate
•A damaged catheter
• If the above is unsuccessful:
•Possible chest x-ray or fluoroscopy
•Possible use of potent hemolytic
agent such as TPA or Cathflo Activase
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Catheter Occlusion (Two-way Effect)
Clinical Observations
You can’t infuse fluids or aspirate blood from the catheter
Possible Causes
• External reason such as a clamp
or kink
Nursing Action
• Reposition patient
• Fibrin clot
• Ask patient to deep breath,
cough or valsalva
• Drug precipitate
• Attempt to irrigate and aspirate
•“Pinch-off ” syndrome (catheter is
being compressed between the first
rib and the clavicle)
•If the above is unsuccessful:
•Mediastinal tumor
•Possible chest x-ray or fluoroscopy
•Possible use of potent hemolytic
agent such as TPA or Cathflo
Activase
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Catheter Displacement
Clinical Observations
May not be able to aspirate or infuse, hypertonic solutions cause “pain”
At the new tip location, possible arrhythmias
Possible Causes
• Catheter has migrated to a smaller
vessel or unintended location
• Coughing, vomiting, changes in
intrathoracic pressure
• Rapid infusion
Nursing Action
• Notify MD
• Chest x-ray
• Await possible catheter migration
centrally
• Possible readjustment of the
catheter under fluoroscopy
• If unsuccessful, possible port
removal
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Catheter Damage/Fragmentation
Clinical Observations
May or may not be able to aspirate or infuse, peri-portal swelling while
infusing, possible leakage at the needle site.
Possible Causes
Nursing Action
• Force flushing
• Notify MD
• Using a small bore syringe for
flushing
• Chest x-ray
• Pinch-off syndrome
• Possible fluoroscopy
• Possible port removal
• Mediastinal tumor
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Pinch-off Syndrome
Clinical Observations
Unable to aspirate or flush the catheter that is alleviated by
repositioning the patient
Cause
Nursing Action
• Port catheter is being compressed
between the first rib and clavicle
• Reposition the patient by having
the patient lie in the supine
position while raising the arm and
shoulder
• NOTE:
Pinch-off syndrome can lead to
catheter damage or possible catheter
embolism. Catheter damage can
contribute to potential extravasation.
• Notify MD
• Chest x-ray to confirm portal
position
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Extravasation
Clinical Observations
Burning and pain experienced upon infusion. Affected area is
warm to the touch. Affected area becomes reddened.
Possible Causes
Nursing Action
• Infiltration of a caustic medication
• Stop the infusion
due to:
• Do not remove needle
• Needle is dislodged or too short
• Notify MD
• Catheter disconnection
• Contact pharmacy
• Split catheter
• Monitor and document site
appearance
• Thrombus or fibrin sheath that
allows infusion to back-up along
the catheter tract
• Administer antidote (if any) and
appropriate soaks to affected area.
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Prevention of
Extravasation
Key points:
1. Prior to any infusion always
check for good blood return
2. Carefully monitor peri-portal
region for potential swelling
while infusing saline prior to
any medication
3. Educate patient to notify staff
immediately if experiencing
any sensations of stinging,
burning, or pain during
infusion of medications
4. Monitor patient during the
initial minutes of the infusion
and afterwards
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Schulmeister and Camp-Sorrell. (2000). Chemotherapy extravasation from
implanted ports. Oncology Nursing Forum, 27(30), p. 534.
Importance of Prevention of
Extravasation
Prevention of extravasation can not be emphasized enough. An
extravasation related to:
Poor care
Poor technique
Failure to assess
Failure to provide prompt and appropriate care
Will result in deep tissue injury, scarring, prolonged
hospitalization or death.
This will likely lead to litigation, suspension or possible revocation of
you license.
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Local Infection
Clinical Observations
Swelling, redness, warmth, and tenderness at the
cut-down, portal site, needle site and/or tunnel tract.
May/may not have fever or drainage
Possible Causes
• Poor site care
• Tracking of skin flora during
needle insertion
• Low neutrophil count
Nursing Action
• Prevention by following infection
control guidelines
• Notify MD
• Obtain blood and site cultures
• IV antibiotics
• Monitor and document
•Possible port removal
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Systemic Infection
Clinical Observations
Fever, chills, and hypotension. There may or may not
be possible redness, swelling or tracking at the port site.
Possible Causes
Nursing Action
• Contamination of the tubing or
solution
• Prevention by following infection
control guidelines
• Introduction of bacteria by
opening the system
• Notify MD
• Tracking of skin flora during
needle insertion
• Fever work-up
• Fibrin sheath or thrombus serving
as a growth media for bacteria
• Possible port removal
• If cannulated leave needle in place
• Antibiotics
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Deep Vein Thrombosis
Clinical Observations
Swelling on affected size, dilated vessels at the peri-portal location,
one-way/two-way effect, possible fever and/or chills
Possible Causes
Nursing Action
• Fibrin sheath formation
• Notify MD
• Thrombus formation at catheter
tip
• If canulated, keep needle in
position
• Sheath or thrombus creating a
growth media for bacteria
• Possible anti-coagulant therapy
• If septic thrombosis, treat
infection
• Possible port removal
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Air Embolism
Clinical Observations
Sudden onset chest pain, Shortness of breath, lightheadedness,
tachycardia, pleuritic pain, anxiety, “mill-wheel” murmur
Possible Causes
Nursing Action
• Accidental disconnection of
tubing
• Reposition patient to left lateral
sims
• Severed or damaged catheter
• Consider trendelenberg position
• Opening the catheter system
without clamping
• Notify MD
• Administer oxygen
• Inspiration of air during port
placement
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Skin Erosion
Clinical Observations
Change at the port site possibly including erythema,
edema, tenderness, an open wound
Possible Causes
Nursing Action
• Tight port fit under the skin
• Notify MD
• Trauma at the port-site
• Use another IV site until problem
is alleviated
• Extravasation
• Poor nutrition
• Port-pocket infection
• Topical care
• Possible port removal
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Rotation or Turning of the Port
Clinical Observations
Unable to palpate portal septum. Unable to needle-access due to flat solid
side of port facing upward.
Possible Causes
• Port has rotated
• No sutures or clamps holding
portal body in position
Nursing Action
• May consider to attempt reaccess the port after examining the
site well.
•If unsuccessful:
•Notify MD
•Do not re-access the port
•Chest x-ray to confirm position
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Prevention of Complications
Monitor and assess the patient vigilantly
Proper maintenance and care avoids certain complications.
Use an intermittent positive pressure flushing
technique especially after the administration of TPN
Adhere to infection control guidelines
Always seek good blood return
Appropriate needle length
NEVER force-flush and use a syringe with a 10mL barrel
size
One-way and two-way effects should be assessed well
Notify MD during the early assessment of potential
complications
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You have completed the section on
complications. Close out this page to
return to the course. You can view many of
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“Complications” page of this course.
TH/TH 9/09
Dev. by T. Heithaus MSN, RN
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