talkBAC BEST EXPECTATIONS, WORSE OUTCOMES (PART III) Erik Samarpan, RN, VA-BC™, LNC | Board Certified in Vascular Access; Legal Nurse Consultant; Oncology Credentialed; Infusion Specialist; BACSIG (Beyond Acute Care SIG) Director-at-Large
Continued from the November 2020 and February 2021 IQ - Names changed for privacy I spoke directly with Jose’s neurologist, let’s call him Dr. Noble, who works at a large metropolitan children’s hospital. His specialty is Duchenne Muscular Dystrophy. Thanks to my training, learned knowledge from certification and hands-on participation in pre-conference skills workshops, I was able to explain my concerns regarding Jose’s malfunctioning port. This experience gave me the tools to justify why I felt Jose required a dye study to confirm location of the catheter tip termination, device patency, and the possibility of a vessel stricture near the lumen of the catheter. Dr. Noble quickly expressed his lack of knowledge when it came to implanted ports and problem solving when one is not functioning correctly. I assured him that I was knowledgeable. This brought up an issue that deserves discussion: the physician had never met me and had no knowledge of the VA-BC™ certification and what it means. When I explained my clinical expertise and steps I had taken to ascertain what I felt was the problem, the physician could only defer to the interventional radiologist as the only expert he had experience with… not a nurse or respiratory therapist! As part of leadership in our newly renamed BACSIG (Beyond Acute Care Special Interest Group), this encounter shows the need to educate physician-partners in the specialized certifications and continuing education 15 | IQ | INTRAVASCULAR QUARTERLY NEWSLETTER
provided by both the AVA and the INS. We need to educate other healthcare professionals on the skills of VA specialists and how we assist them in caring for patients. Back to the story: Dr. Noble agreed to the dye study but results were inconclusive. There was no indication of fibrin buildup either intraluminally or externally on the catheter tip. He spoke with a thoracic surgeon who convinced him that a port exchange was warranted. Upon removal of the old port, we saw a large section of the septum seal was missing and, therefore, the answer to many malfunctions was now explained. Thanks to AVA’s continuing education over the years, I had a seat at the table with problem identification, intervention and on-going monitoring of Jose’s new adult port. As a note of importance: the surgeon listened to my suggestions as to incision location and other techniques, including use of cyanoacrylates rather than sutures.
MOM’S IMPRESSIONS During this process, Jose’s vague symptoms surrounding a defective port were ignored as were those of his mother, Marie. Epigastric discomfort requiring intermittent calcium carbonate and slow infusion became unnecessary with his new port. Access difficulty was resolved by the surgeon with CONTINUED ON NEXT PAGE
