Important Safety Information

Healthcare Provider Info
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You are your patients' best advocate. With that role comes the responsibility to recommend the appropriate vascular access device– one that suits both their immediate and long-term needs.

The VEINS FOR LIFE* awareness program is designed to help you weigh the advantages and disadvantages of implanted ports and other vascular access devices (VAD) over peripheral intravenous devices (PIV) and educate patients about implanted ports as a viable vascular access option.

Consider this:

According to a randomly selected, blinded U.S. national survey conducted by Bard Access Systems, Inc., 93% of responding oncology nurses surveyed ranked ports as their chemotherapy delivery method of choice, yet more than 27% of patients still receive chemotherapy via peripheral I.V.[1]

Help ensure that patients who are candidates for an implanted port are given the option most oncology nurses would choose for themselves.

A port can take your patient from beginning to the end of treatment.

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Making an informed decision
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When surveyed, nurses chose safety as the #1 factor in choosing a vascular access device for themselves. Yet when choosing a VAD for their patient, length of time the device would be needed was the leading factor in device selection.32

Nurses' perception of what a patient should know about VAD's What nurses felt the patient DID NOT need to know Top 3 characteristics nurses felt the patient should value in a VAD Top 3 characteristics nurses valued when choosing a device for themselves
Advantages & disadvantages of each type Nature of the infusions How long they would need the device Safety
Length of time the VAD will need to be indwelling Who would insert the VAD Prescribed medications that could be tolerated by the device How independent the VAD would permit them to be
Procedure for which the VAD is required Possible insertion site How easy was the required care of the VAD
The Appropriate VAD for the Appropriate Patient: Central Line Catheters vs Peripheral I.V. (PIV)
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Peripheral Intravenous Devices (PIV)
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Advantages:

  • Offer cost- benefits if four or fewer treatments are required45
  • Minimally invasive insertion procedure; time factor (can start treatment and not wait for surgical procedure)
  • No scar on patient's chest

Disadvantages:

  • Requires multiple needle sticks for treatment and blood draws4
  • Veins may rupture during treatment leaking caustic drugs into healthy tissue causing tissue breakdown5
  • Potential for collapsed veins, bruising, and painful restarts5
  • Patients may feel medication moving through the vein during a treatment
  • More than 50% of patients receiving chemotherapy have problems with I.V. needle starts and the drawing of peripheral blood work2
  • Cannot administer meds with osmolarity greater than 500 mOsm/L. Peripheral infusion requires a pH between 5 and 940
PICCs
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Advantages:

  • May be inserted by an RN who has attended an instructional course and has demonstrated clinical competence in insertion technique5
  • Insertion may be performed at the bedside or in an outpatient setting
  • Provides a safe, economical means of vascular access for therapies lasting six months or less5
  • Poses no risk of insertion-related pneumothorax or great vessel perforation5
  • Available in triple and single lumen5
  • Useful for the very young and the elderly because of small size 3
  • May be used in all settings for the administration of a variety of I.V. therapies and to obtain blood samples5
  • Less expensive than nontunneled short-term catheters, long-term catheters, or implanted ports5
  • Decreased stress exerted on the patient by the reduced number of venipunctures required to administer therapy5

Disadvantages:

  • The RN requires educational preparation and attainment of clinical competence5
  • May not be the access device of choice to meet a patient's special needs. PICCs should be considered one of several available vascular access devices from which to select.5
  • May limit arm movement because it is inserted in the antecubital area5
  • May not be able to draw blood with small gauge catheters5
  • Is more expensive than peripheral I.V.s5
  • May not be appropriate for patients with kidney disease
  • Poses risk of complications such as catheter related infection and thrombosis5
  • Requires routine exit site care (Access device guidelines)5
Tunneled CVCs Advantages & Disadvantages
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Advantages:

  • Can be used immediately after placement once radiographic confirmation is made.5
  • Preserves peripheral veins5
  • Provides a means for rapid hemodilution of infused solutions5
  • Provides a more reliable source of IV access5
  • Designed for long-term IV therapy for frequent venous access5
  • Available in single, double, and triple lumens3
  • Tunneling potentially decreases risk of microorganisms entering the venous systems because of anatomical distance between insertion and exit sites5

Disadvantages:

  • Requires routine exit site care5
  • Requires routine flushing of catheter lumen(s)5
  • Poses risk of complications such as catheter related infection and thrombosis5
  • Cost of maintenance supplies includes dressing, flushing solutions, injection caps, syringes and needles
  • Body image changes can affect patient5
  • Insertion is a surgical procedure5
Implanted Ports Advantages & Disadvantages
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Advantages:

  • Can remain in place and be functional for many years5
  • Ideal for intermittent access5
  • May have less potential for infection than external catheters5
  • No dressing required when the port is not accessed; therefore, ideal for patients with tape allergies5
  • Flushing is only required every four weeks when not in use5
  • Less potential for the catheter to fall out/migrate5
  • May be used to infuse all I.V. solutions and blood products5
  • Can be used to draw blood5
  • Has less effect on body image than external catheters5

Disadvantages

  • Must be placed in surgery5
  • Most expensive VAD to insert5
  • Must be accessed with a needle5
  • Needle can migrate out of septum, causing extravasation5
  • Presence of port may interfere with sleep patterns5
  • Requires a specially trained nurse to access and deaccess5
  • No availability of triple lumens
  • Over time, buildup of "sledge" (clotted blood and drug precipitates) may collect in the port reservoir and decrease flow efficiency5
  • Poses risk of complications such as catheter related infection and thrombosis5
Types of Ports
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There are many different types of ports that may help your patients meet their needs based on the types of treatments and tests they will undergo.

Single Lumen Ports have one entrance for medications. Single lumen ports come in different sizes and profiles to help fit different patient sizes.

This is one example of a single lumen port body.

Single lumen ports are indicated for patient therapies requiring repeated access to the vascular system. The port system can be used for infusion of medications, I.V. fluids, parental nutrition solutions, blood products and for the withdrawal of blood samples.9

Double Lumen Ports have two entrances for medication, and are used if your patient needs to have more than one type of infusion at the same time. Double lumen ports come in different sizes and profiles to help fit different patient sizes. Double lumen ports allow your patient to receive the delivery of simultaneous infusions, supportive therapies and incompatible medications, in conjunction with I.V. chemotherapy.41

This is one example of a double lumen port.

Power Injectable Ports offer the ability to provide access for infusions, and are also indicated for power-injected Contrast-enhanced computed tomography (CECT) or CT scans. CT scans produce quick, accurate images of your patient's body to help the medical team better manage their care. Not all ports are used or indicated for power injection of contrast media. Power injectable ports are available in both a single lumen port configuration, and a double lumen port configuration. Contrast-enhanced computed tomography (CECT) scans are simple, safe and non-invasive procedures that provide quick and accurate diagnostic information to help track tumor markers or diagnose pulmonary embolisms, for example. The scans are many times more sensitive than conventional X-rays.14

This is one example of a power injectable port.

Choosing the appropriate port
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Power injectable ports

When choosing a port for your patient it's important to also consider that power injectable ports offer the unique ability to provide access for power-injected Contrast-Enhanced Computer Tomography, or CT scans.12 Power injectable ports are available in single lumen and dual lumen configurations to help meet your parents needs.33

These are examples of power injectable port single lumen and dual lumen.

Dual Lumen Ports

When choosing a port, it is also important to consider the types of supportive therapies in conjunction with chemotherapy. A dual lumen port is ideal for patients who require chemotherapies, bloodwork, or transfusions, TPN, antibiotics, hydration, pain medicines, antiemetics, or incompatible medications or chemotherapies. A dual lumen port may also be indicated for power injection of contrast media and offers the benefits of providing access for power-injected CT scans.34 35

This is a photo of a Dual Lumen Port

Please refer to relevant product labeling, Instructions for Use for product specific information from the relevant product manufacturer.

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Facilitating Access: The Appropriate VAD for the Appropriate Patient
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To help you decide whether implanted ports – or another vascular access device – may be appropriate for your chemotherapy patients, consider the following:

PIV PICC Tunneled CVC PORT
May allow for fewer needle sticks relating to treatment, blood draws and CT scans5
May stay in place for several weeks or months depending on therapy needs[4]
Vesicant delivery[4]
Chemotherapy may be given slowly, potentially reducing side effects36
Convenient blood and platelet transfusions37
Allow for CT power- injection of contrast media38
Medicare/Medicaid and most private health insurance will cover costs39
External catheter can limit activities5
May require some lifestyle modification (swimming prohibited, showering requires waterproof covering)39
Monthly flushing when not in use37
Daily to weekly flushing depending on type of catheter and type of infusion38
Check Mark indicates applicability
Implanted ports vs. PICC's and tunneled CVC's
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Implanted ports:

  • May offer cosmetic and aesthetic benefits- hidden from view
  • Require no external dressing after chemotherapy6
  • May allow more patient activity – no external pieces to hinder normal active lifestyle6
  • Reduced care and maintenance6

A port is not for everyone - especially patients with a history of forming blood clots, who have had previous vascular access surgery, or who are not emotionally prepared to have an implanted medical device. Like any vascular access procedure, there is always a chance of complications with a port placement, like venous thrombosis, necrosis, infection, pneumothorax, and the formation of fibrin sheaths.

For additional safety information, please click here.

Who should not receive an implantable port?
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Patients should not receive a port:

  • When the presence of device-related infection, bactermia, or septicemia is known or suspected.
  • When the patient's body size is insufficient for the size of the implanted device.
  • When the patient is known or is suspected to be allergic to materials contained in the device.
  • If severe chronic obstructive lung disease exists.
  • If the prospective insertion site has been previously irradiated.
  • If the prospective placement site has previously suffered episodes of venous thrombosis or vascular surgical procedures
  • If local tissue factors will prevent proper device stabilization and/or access

What are the possible complications associated with an implantable port?
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Use of an implantable port carries the risks normally associated with local, general anesthesia, surgery, and post-operative recovery. The use of a subcutaneous port provides an important means of venous access for seriously ill patients. However, the potential exists for serious complications, including the following:

  • Air Embolism
  • Bleeding
  • Bracial Plexus Injury
  • Cardiac Arrhythmia
  • Cardiac Tamponade
  • Catheter or Port Erosion Through the Skin
  • Catheter Embolism
  • Catheter Occlusion
  • Catheter Occlusion, Damage or Breakage due to Compression between the Clavicle and First Rib
  • Catheter or port related Sepsis
  • Device Rotation or Extrusion
  • Endocarditis
  • Extravasation
  • Fibrin Sheath Formation
  • Hematoma
  • Hemothroax
  • Hydrothorax
  • Intolerance Reaction to Implanted Device
  • Inflammation, Necrosis, or Scarring of Skin Over Implant Area
  • Laceration of Vessels or Viscus
  • Perforation of Vessels or Viscus
  • Pneumothorax
  • Spontaneous Catheter Tip
  • Malposition or Retraction
  • Thoracic Duct Injury
  • Thromboembolism
  • Vascular Thrombosis
  • Vessel Erosion

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