Question

While visiting the area from another state, a client presents to the emergency room with severe pain secondary to a kidney stone. The physician orders an IV line started with \(125 \mathrm{ml}\) per hour of D5 \(1 / 4\) NS and morphine for pain. The client shows the nurse his chest where he states he has a Subcutaneous venous port and asks the nurse to start the IV there. Prior to starting an IV line in this port, the nurse would need to verify that the: A. Brand of subcutaneous port. B. Medications can be given by central line. C. Port internal tip lies in the superior vena cava. D. Intravenous fluids can be administered by central line.

Short answer

Prior to starting an IV line in the subcutaneous venous port, the nurse would need to verify that the port internal tip lies in the superior vena cava (Option C).

Step-by-step solution

Understand the Scenario

The patient presents with severe pain from a kidney stone and requires IV medication and fluids. He has a subcutaneous venous port, which might be used for central venous access. Understanding the patient's situation is critical for determining the necessary steps before starting an IV line.

Identify the Purpose of the Subcutaneous Venous Port

A subcutaneous venous port is typically used for central venous access. It provides a way to administer medications and fluids that may be irritating to smaller peripheral veins or require a larger vessel for infusion. Knowing the purpose and function of the port is necessary to answer the question.

Determine Key Considerations Before Using the Port

Before using the subcutaneous venous port, nurses must verify important aspects of its suitability for the ordered therapy. This includes confirming that the port is designed for the medications and fluids prescribed and ensuring its correct positioning in the venous system.

Review the Answer Options

Option A (Brand of subcutaneous port) is not directly related to the safety or efficacy of IV administration. Option B (Medications can be given by central line) and D (Intravenous fluids can be administered by central line) are important but are generic factors that apply to any central line access. Option C (Port internal tip lies in the superior vena cava) is the most specific to ensuring safe access through the port as accurate placement is critical to avoid complications and ensure proper delivery of IV substances.

Select the Most Appropriate Option

Based on an understanding of a subcutaneous venous port and its uses, the internal placement of the port in relation to the patient's central venous system is a crucial verification step before using the port. Therefore, the correct answer is option C.

Key concepts

Central Venous Access

Central venous access involves the placement of a catheter into a large vein to administer medications, fluids, blood products, or to perform certain medical tests and procedures. This venous access is of particular importance when peripheral veins are not suitable either due to their small size or because of the irritating nature of the medications being administered. Central venous catheters can also measure central venous pressure, which is an indicator of circulatory volume.

Central venous access is commonly obtained through veins like the internal jugular, subclavian, or femoral veins. The tip of the catheter should ideally rest in the superior vena cava, just above the heart, which guarantees that medications and fluids are quickly and effectively distributed throughout the body. Correct placement is critical to minimize risks such as catheter malposition, which can lead to complications like thrombosis or even a pneumothorax.

Subcutaneous Venous Port

A subcutaneous venous port is a type of central venous access device that is implanted under the skin. It consists of a port and a catheter, where the port is the area that can be palpated and accessed through the skin, and the catheter connects the port to a central vein. Typical locations for venous ports are the chest or the upper arm.

The main advantage of using a venous port is that it is less conspicuous and reduces the risk of infection, as it is entirely underneath the skin. It is designed for long-term use, making it ideal for patients who need frequent or continuous administration of medications, like chemotherapy. To access the port, a special non-coring needle, known as a Huber needle, is used to ensure multiple punctures without damaging the septum (the port's self-sealing membrane).

Intravenous Medication Administration

Intravenous (IV) medication administration is a method of delivering medications directly into the venous system, allowing for fast action and a higher bioavailability than oral medications. This method is used for a variety of treatments, including antibiotics, chemotherapy, pain management, and fluid replacement.

It's vital for healthcare professionals to understand the proper techniques for IV medication administration to ensure safety and efficacy. This includes calculating correct dosages, as well as the rate and duration of infusion. Medications must be compatible with the IV fluids, and the timing of administration should be carefully coordinated, especially when multiple drugs are being delivered. Monitoring for adverse reactions and ensuring sterility during the process are also crucial nursing considerations.

Nursing Considerations

When it comes to nursing considerations for central venous access devices like subcutaneous venous ports, safety is the top priority. Nurses should have a solid understanding of the anatomy and physiology related to the central venous system, as well as expertise in the device's function and maintenance.

• Verifying the correct placement of the catheter tip through radiological confirmation is critical before initiating use.
• Understanding the compatibility of the medications with the central line material to prevent adverse reactions.
• Ensuring all connections are secure to avoid air embolism or leakage of IV fluids.

Meticulous infection control measures are mandatory to prevent bloodstream infections. Nurses also need to be adept at recognizing and managing complications quickly, such as signs of infection around the port site, occlusion, or catheter displacement. Close monitoring of the patient's response to the therapy and teaching patients and their caregivers about the care and use of their central venous access devices are also integral aspects of comprehensive nursing care.