Port Care

Inhaltsverzeichnis

1. Frontmatter

2. 1. Interdisciplinary Cooperation in Port Care

   Roland Hennes, Gisela Müller

   Abstract

   In the implementation of necessary and appropriate treatment measures, port catheter systems have taken on a central role in modern oncology and nutritional medicine. The responsible and successful treatment of patients with a port catheter system poses particular requirements on nursing staff. First of all, we will explain what makes an implanted port catheter system so special and how this defines the demands for all professional groups and participants.

3. 2. Indications for a Port Catheter System, Basics of Port Surgery and Dealing with Complications from a Nursing Perspective

   Roland Hennes

   Abstract

   Patients who require a port catheter system for their treatment often come from the oncological and nutritional medicine sector. Here, the indications for the administration of chemotherapeutic agents, antibodies as well as nutritional solutions and other additive infusions and preparations are in the foreground. This chapter explains the indications for the insertion of a port catheter system, the possible locations as well as complications that can occur during implantation.

4. 3. Hygiene in Port Care

   Vanessa Eichel, Uwe Frank

   Abstract

   Infection is the most frequent complication of a port system and, in addition to antibiotics and port explantation, can mean intensive care requirements and be life-threatening for the patient. This illustrates the high importance of hygiene in handling the port. Disinfection can only be successful in conjunction with all other appropriate hygiene measures. The basis for hygiene in handling ports is the so-called standard or basic hygiene. This includes hand hygiene, protective equipment, behavior when coughing, sneezing and blowing one’s nose, cleaning/disinfection of the patient environment, correct preparation and safe injection technique.

5. 4. Legal Aspects of Performing Port Puncture by Nurses: Delegation of Medical Activities

   Katja Maier

   Abstract

   There are no specific legal regulations on the performance of port punctures by nurses. The general legal situation regarding the delegation of medical activities to nursing staff is currently unclear and not conclusively regulated. A uniform implementation of the delegation of certain medical activities is currently to be tested by the Heilkunde Transfer Directive (HÜR) within the framework of pilot projects.

6. 5. Expert Standard Port Care

   Barbara Fantl

   Abstract

   Since there are no uniform guidelines for the care of patients with central venous port systems in the Federal Republic of Germany to date, the recommendations formulated in the following chapter are based on guidelines of the Robert Koch Institute and on the many years of expertise of Universitätsklinikum Heidelberg (Heidelberg University Hospital). The standardized professional care of implanted port systems after port implantation is the most important measure to ensure permanent, complication-free and safe access for patients. A study conducted at Heidelberg University Hospital in which the reasons for port explantation were investigated in 385 patients clearly showed that port infection was the most frequent complication of implanted port systems and frequently led to explantation of the systems.

7. 6. Wound Care and Dressing Changes

   Barbara Fantl

   Abstract

   Wound care and dressing—just like the puncture—must be carried out according to hygienic guidelines. The dressing should always be applied under sterile conditions. This chapter explains the principles of wound care and dressing changes.

8. 7. Intraoperative and Postoperative Care of Port Patients

   Birgit Appelhoff, Lisa Moser

   Abstract

   Structured and well-organized management of responsible care is an important component of a successful course of treatment for a port patient. This chapter provides information on the crucial nursing measures.

9. 8. Special Features of Port Care for Oncological Patients

   Susann Eismann

   Abstract

   Oncology is the main field for application of port systems. Due to the severity of their disease, many patients are dependent on a permanently safe vascular access.

10. 9. Port Supply in Outpatient Care

    Halka Nehring, Anna Mindrup

    Abstract

    Not only in the inpatient setting, but also in the outpatient setting, the port as a vascular access that is available at any time and can often be punctured represents the basis for therapy with hyperosmolar infusions, as embodied by parenteral nutrition and cytostatic infusions. This enables patients to receive or continue their required therapy in their familiar environment. This is often accompanied by a better therapy outcome and a gain in quality of life. In order to make this possible, a well-networked cooperation of the professional groups involved in the care is required. A close-knit information and communication network is indispensable, in which the patient and his relatives are also integrated (Fig. 9.1).

11. 10. Care of Special Patient Groups

    Julia Winkler, Debora Stern, Bianka Walter, Damaris Weeber

    Abstract

    Handling a port system is a particular challenge for the caregiver, especially for cachectic or obese patients. The resulting difference in tissue thickness between the port chamber and the skin surface requires an adjustment of the port care.

12. 11. Port Care for Children

    Heiko Riemke

    Abstract

    Already in infancy and toddlerhood a port is a safe venous access system. Due to the agility of children, the fixation of the needle is very important. The tube system must also be checked regularly and, if necessary, replaced more frequently. Complications must be recognized in time and eliminated as quickly as possible. Expressions of pain by young patients should always be taken seriously and the causes should be investigated.

13. 12. Documentation, Patient Counseling and Information

    Margit Benz

    Abstract

    Das Deutsche Patienteninformationsgesetz (The German Patient Information Act) of February 2013 obliges the treating physician to explain to the patient “in an understandable manner at the beginning of the treatment and, if necessary, in the course of the treatment, all circumstances essential for the treatment, in particular the diagnosis, the probable health development, the therapy and the measures to be taken during and after the therapy”.

14. 13. Evidence of Port Care

    Reinhart T. Grundmann

    Abstract

    Evidence-based statements on port care are a rarity; most recommendations are based on empiricism. The most important measure in port care is compliance with hygiene guidelines. Only suitable special cannulas may be used for puncture. To reduce the risk of thrombosis and infection, blood sampling from the central venous line should be avoided. Ports should be flushed before and after fluid infusion or injection. There is no evidence for the type and amount of flushing solution, but usually only sterile saline is recommended for flushing and saline without added heparin may also be recommended for blocking the port.

15. Backmatter