Hi James,

Unfortunately, there is no "one size fits all" answer. It really depends on the specific patient and the specific emergency department. If peripheral access is easily and quickly obtained, then accessing the IVAD should not be performed. However, most patients with IVADs generally have poor peripheral access. In this case, it would be appropriate to access the IVAD only if the staff is adequately trained in doing so. The department should have a policy for accessing these devices along with a good training program so that they are accessed safely and sterile.

Hi James,

Unfortunately, there is no "one size fits all" answer. It really depends on the specific patient and the specific emergency department. If peripheral access is easily and quickly obtained, then accessing the IVAD should not be performed. However, most patients with IVADs generally have poor peripheral access. In this case, it would be appropriate to access the IVAD only if the staff is adequately trained in doing so. The department should have a policy for accessing these devices along with a good training program so that they are accessed safely and sterile.

I think establishing an IVAD in emergency setting is cumbersome and time-consuming. Central venous access could be done very quickly and it suffices. But, if time permits and there is a definite indication, then one can go for IVAD. It needs expertise. Thanks- Rabiul.

If quickly establishing central venous access is indicated, I suggest yes,

I do agree with you. Since there is a dearth in literature about this matter you cannot just draw a line and make a general rule. However, what I'm seeing in my department is that all patients who have a port a cath are getting it accessed even for baseline blood tests. As you said, I too believe that If a peripheral access is easily and quickly obtained, then accessing the IVAD should not be performed. Managing a CVC requires more attention and may carry higher risks of transmitting nosocomial infections. In the meantime, I'm curios about any existant algorithms or guidelines about accessing an IVAD in the ED.

Hi James,

As I understand, your question is about accessing the IVAD and is not about placing an IVAD in the ED. That is the perspective I took when replying to your question.

In terms of policy on this, perhaps you can reach out MSKCC (you may be able to find one of their practicioners on LinkedIn). MSKCC does not have an emergency department, but they do have an Urgent Care Clinic. Their urgent care clinic acts very much in the same fashion as an emergency department (except it is a closed system only to those who are already patients of MSKCC). They routinely access ports for their patients, even in the emergency setting.

In terms of risk, I think it is also very important to have trained staff to reduce the following:

- Infection (as you already mentioned). IVADs must be accessed under appropriate conditions (mask on both practicioner and patient, thorough cleansing of the skin, etc).

- Clotting within the IVAD. Many require heparin flush (and others do not). Practitioners needs to be well versed in type of VAD and how to maintain the IVAD.

- Inaccurate labs. Practitioners need to be educated on dead space volumes within the IVAD, to ensure that blood draw accurate reflects the blood within the systemic circulation. Blood drawn from IVADs have the potential to be diluted with normal saline, heparin, or other drugs recently infused through the line.

So, I would agree that there are risks to IVAD access and the benefit must always be weighed against the risks.

I am a nurse specializing in emergencies and also as an oncology patient having an IVAD

I believe that it is the emergency nurse who must evaluate and act according to the needs of each patient.

If I observe that I need and I can perform the venous access in a faster and more effective way for example to administer greater volume of fluids I access intravenously.

All nurses must be trained and have the equipment and comply with the measures to access IVAD safely.

For the safety of the patient I consider that it should not be used to draw blood samples or administer contrast for procedures such as tomography, if there is peripheral access

In emergency units in my country, Peru does not have the basic equipment such as Port Needles.

In my experience as a patient only in Oncology services I observed the trained professional and in some cases unfortunately they did not perform the procedure properly.