Subcutaneous port

Question 1

why use a SC port? indications:

Answer 1

1) impaired venous access
2) often PT cannot swallow oral (poor oral intake)
3) repeated inj are uncomfortable
4) IV can be uncomfortable, decrease mobility and make home DC difficult and expensive
5) easier to care for at home
6) intractable symptoms (cant be stopped)
7) reduces peaks and troughs of medication levels

SC port can be continuous or intermit

Question 2

what are factors to consider prior to initiating or administering SC?

Answer 2

1. what is causing the sympotoms
2. are the symptoms exasperated by anxiety/distress?
3. etiology of pain (nerve)?
4. what are the alternatives?
5. pre-existing conditions…
6. peripheral oedema, lymphoedema
7. appropriate?
8. PT choice

Question 3

what are advantages?

Answer 3

less invasive

site easier to find and access

can be used in a variety of settings, may prevent hospitalization

reduced risk of infection/thrombophlebitis (inflam of vein or blood clot)

continuous drug delivery

comfortable

Question 4

what are the disadvantages?

Answer 4

fluid vol and type limited

infusion rates limited

potential local site reaction

potential peripheral oedema

efficacy of drugs slower than IV

Question 5

describe assessment/observations bfr/during/after initiation

Answer 5

bfr:
> PT/family education on method, drug, rationale, potential SEs

> safety - site selection and pump

> resources avail

> PT comfort

during:
> site- inflam, leakage, disconnect/displace, infection

> SEs- efficacy of meds for symptom relief, constipation, drowsy…

> rate of infusion, prescript and lable

Question 6

where can you locate one?

Answer 6

> abd
subclavicular/upper anterior chest
upper lateral aspect of arm

Question 7

rotate site every?

Answer 7

6-7 days or prn

Question 8

monitor how often?

Answer 8

q 4-6 hrs, or with each use for intermit

be sure to document

Question 9

what is hypodermoclysis?

and indications?

Answer 9

Admin of fluids into the SC tissue to treat mild-mod dehydration

:
>persistent systematic dehydrate d/t vomit, decrease oral intake, fever, diarrhea

> cant take oral fluids

> IV accress diff or not rqrd

> PT/fam wishes

> systematic opioid toxicity

> hypercalcemia

> delirium d/t infection, dehydrate, pre-renal failure

> persistent nausea

Question 10

contraindications of hypodermoclysis

Answer 10

> gorss oedema
>++ fluid overload
> skin disorders 
> lyte imbalance
> severe HF, acute MI
> bleed/coagulate disorders

Question 11

Locations of hypoderm

Answer 11

**dont use breast tissue, bony or highly vascular areas

Question 12

solutions and rates of hypoderm

Answer 12

> NS, 2/3 1/3, D5W with 0.45 NS, RL
not D5W or D10W

> 40 mEq per litre maybe added to the solution

> usually admin overnight be could be continue

> 1.5L/ day / injection site
up to 3 L per day using 2 sites
may admin 1L / 8 hrs overnight
NO faster than 1L in 2 hrs

Question 13

how often change site, tubing and solution hypoderm?

Answer 13

site: 3-5 days or prn
tubing: 72 hrs (3 days)
solution: 24 hrs

Question 14

what is needed to insert?

Answer 14

1. 24-27 gauge needle/ winged catheter
2. alcohol swab
3. chlorhex with alcohol for site prep for 60 sec and allow to dry
4. tegaderm
5. needless inj cap***
6. prep med extra 0.4ml to prime

Question 15

how to initiate

Answer 15

1. turn the stylet (white cap) 360 degrees to unseat guidwire for easy removal
2. grasp wings and grasp at least 1 inch SC tissue
3. insert on 45 degree angle, with bevel up and pebble side wings down
4. remove stylet with straight motion
5. change inj cap to the approp needless inj cap***
6. label site, date, time, medication and dilution (morphine 10:1) and initial
7. hand hygiene
8. cleanse needless port and insert med (labeled syringe)
9. clamp tubing and remove syringe
10. document