I have a small, low profile port, but it is very visible. For the most part, I access it myself. I will allow a new nurse to try and access it since I once was in that situation (as a new nurse); of course, I only have let them try after I formed scar tissue so pain would be much less.
Not to start something, but I take offense to that statement "learn how to do your job" and "who misses a port shouldn't be accessing them." I am tired so maybe I am just over-reacting regarding this so I apologize in advance. Maybe I am interpreting the statements as being negative. I am not trying to stir up an argument. Just putting out my opinion (as both a patient with a port and a health care provider who does invasive procedures). So please no flames.
I know parents with children with chronic health conditions and patients with chronic health conditions are (for the most part) the most knowledgeable regarding the care of their children (or themselves).
How are the nurses going to learn their job if they don't get the opportunity to learn? There is a learning trajectory that occurs during all different disease processes and procedures that nurses engage in. You start out as a novice, gaining more knowledge and skill as time goes on, progressing through the various stages to reach expert. If no one allowed the new nurses to try and access a port, how would they learn? I am not advocating that we subject the children to undue pain. If a nurse has never accessed a port before, she should not be accessing it without having the proper supervision and the prior observations of experienced nurses accessing a port. Having a port (for the most part) means that you have experienced many IVs and many PICC lines. One reason to have a port is to avoid the painful lab draws, repeated IV placements, etc. So I can empathize why one wouldn't want a nurse, who has never accessed a port, to try on their child (or themselves).
I have a port so I am not immune to this and I am also a nurse (now nurse practitioner). I had a port since I was 18 yo. I missed several times (less than 5 times) on myself; either my angle was off, my port moved despite me holding it down, or the scar tissue changed my needle's course. I'm a pro at getting in my needle in minutes. However, I will allow a nurse to access my port to gain experience -- I guide them through the process, asking them questions of what they anticipate feeling, how they set up the field, what they feel when they palpate the port. By no means, am I quiet; it's still my body and I need to make sure they are going to do the procedure correctly. I don't recall anyone missing.
I know there are simulation labs to help prepare nurses for doing procedures. Nurses can feel real ports, try to access under "synthetic" skin. However, that's not like the real thing. It's different in a real patient. I have done central line placements using "fake" patients and on real patients. It is so different. The fake patient allows me to gain confidence in the ease of going through the prep to finalization of the procedure.
However, even with the BEST technique, procedures on real patients does not always turn out well. Does that make me incompetent and that I should not be doing line placements? I also had a few times when I missed ports in children because of the placement (deep, lots of scar tissue, etc) -- and this is after I have had my port 6 years (having accessed it 12 times per year!!). I, of all people, should not miss because I know what I should be feeling for and the angle of the huber needle, etc.
I guess what I am getting at is that there is always going to be nurses who don't know how to access a port... and will need the guidance and opportunity to learn and become competent at doing it. Some people will disagree in ever allowing a new nurse to be guided (by an experienced nurse) to access their child's port. And that is FINE - I am not saying you are wrong for saying no.
I just see both sides. If I never was given opportunities to do invasive procedures on children, I would not be the competent provider I am today. I know my boundaries. If I can't get a line in a child after trying a few times, then I call in my attending. Each child is different. The standard procedures only give the "ideal" anatomy of the blood vessels, which is fine for 95% of kids. Sometimes the child's vessels turn differently, collapse more easily, etc. Am I embarrassed if I can't get it in? Nope because most of the time, my attending has a hard time getting in the line. So I know I was doing it correctly.
Sorry for the long-winded response. I probably shouldn't have posted it since it probably doesn't make much sense.
Jenn
31 yo cf
