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| Contents |
| 🔹 1. Understanding Central Venous Catheters (CVC), PICC Lines, and Chemoports 💡 Central venous catheters, peripherally inserted central catheters (PICC), and chemoports are used based on the patient's clinical condition. 📌 This section explains the insertion sites, maintenance protocols, and essential infection prevention measures for each type. 🔹 2. Aseptic Technique and Infection Prevention Essentials 💡 One of the most critical aspects of catheter care is infection prevention! 🧴 This segment provides a step-by-step guide on proper hand hygiene, disinfection, and dressing change techniques through practical demonstrations. 🔹 3. Hands-on Simulation: Catheter Insertion and Maintenance 🩺 Simulating real hospital settings, this part walks you through the procedures of central line insertion and ongoing maintenance. 👀 It thoroughly covers fluid administration, medication delivery, and blood sampling using central lines. 🔹 4. Emergency Response: Occlusion, Infection, and Bleeding 🚨 What should you do when a central line becomes occluded or infected? 🔎 This section offers emergency management guidelines for dealing with catheter blockages, infection control, and bleeding complications. 🔹 5. Chemoport Management – A Critical Component of Chemotherapy 💉 Learn the structured process for administering medications and maintaining implanted chemoports. 💡 This includes detailed steps for chemoport insertion and removal, as well as heparin flushing techniques to prevent thrombosis. |
🔹 1. Understanding Central Venous Catheters (CVC), PICC Lines, and Chemoports
| Scenario 1: Understanding CVC Placement and Purpose |
[Patient admitted to ICU for sepsis, requiring a central venous catheter (CVC)]Nurse: Good morning, Mr. Johnson. I'm your nurse today. The doctor has decided to insert a central venous catheter (CVC) to help manage your treatment. This will allow us to give you medications and fluids more effectively.Patient: I already have an IV in my arm. Why do I need another one? Nurse: That's a good question. The IV in your arm is a peripheral line, which works well for short-term fluids and medications. But since you're receiving strong antibiotics and multiple infusions, a central line is safer and more effective. It reduces irritation to your veins and allows us to monitor your central venous pressure (CVP), which helps us assess your hydration status. Patient: I see. Where will it be placed? Nurse: The doctor will insert the catheter into a large vein—either in your neck (internal jugular vein), chest (subclavian vein), or groin (femoral vein). It will be guided using ultrasound to ensure proper placement. Patient: That sounds serious. Is it painful? Nurse: You'll receive local anesthesia to numb the area, so you shouldn't feel much pain. After the procedure, you might feel some pressure or mild discomfort, but we’ll manage it with medication if needed. Patient: Okay, I trust you. Nurse: Great. We’ll monitor the catheter site closely for any signs of infection, such as redness, swelling, or drainage. If you notice anything unusual, let us know right away. |
| Scenario 2: Educating a New Nurse About PICC Line Care |
[A new nurse is receiving training on PICC line maintenance in the oncology ward]Nurse: Welcome to the oncology unit, Emily. Today, we’re focusing on peripherally inserted central catheters (PICC lines). These are often used for patients receiving long-term IV therapy such as chemotherapy.New Nurse: I’ve seen PICC lines before, but I’m not sure how to manage them properly. Nurse: The most important thing is preventing infection and ensuring patency. PICC lines are inserted into the basilic or cephalic vein in the arm and extend to the superior vena cava. Since they stay in for weeks or even months, they require special care. New Nurse: How often do we flush them? Nurse: We flush PICC lines with normal saline (sodium chloride 0.9%) at least once a shift and after every medication administration. Some protocols also require heparin flushing to prevent clot formation. New Nurse: What if a PICC line gets blocked? Nurse: If there’s resistance while flushing, never force it. First, check for kinks in the line, reposition the patient, and try again. If it remains blocked, we may need to use a thrombolytic agent like alteplase. New Nurse: Got it. And how do we prevent infections? Nurse: We perform sterile dressing changes every 7 days or sooner if the dressing becomes soiled or loose. Also, we scrub the hub for at least 15 seconds before accessing the line. New Nurse: Thank you! I feel much more confident now. |
| Scenario 3: Chemoport Access for Chemotherapy |
[An oncology patient is about to receive chemotherapy through a Chemoport]Nurse: Hello, Mrs. Lee. How are you feeling today?Patient: A bit nervous. This is my first chemotherapy session using the Chemoport. Nurse: I understand. Let me explain the process so you know what to expect. The Chemoport is a small, implanted device placed under your skin, usually in your chest. It allows us to safely administer chemotherapy without repeatedly inserting IVs. Patient: Will it hurt when you access it? Nurse: It may feel like a small pinch when we insert the Huber needle, but we can apply a numbing cream beforehand to make it more comfortable. Patient: That sounds helpful. Nurse: I’ll first clean the area with chlorhexidine to prevent infection. Then, I’ll insert the needle into the port and confirm blood return to ensure proper placement. Patient: What happens if there’s no blood return? Nurse: Sometimes, the catheter tip may be against the vein wall, or there might be a small clot. We may ask you to cough, raise your arms, or reposition. If that doesn’t work, we can use a mild thrombolytic agent to clear the line. Patient: Okay, that makes sense. Nurse: Once we confirm the port is working, we’ll start your chemotherapy infusion. We’ll monitor for any reactions, so let us know if you feel anything unusual, like dizziness or nausea. |
| Scenario 4: Recognizing and Managing a CVC Infection |
[A nurse notices signs of infection at a CVC insertion site]Nurse: Mr. Smith, I’m checking your central line site, and I notice some redness and swelling. Have you felt any fever or chills?Patient: Now that you mention it, I did feel a bit feverish last night. Nurse: That’s concerning. You may have an infection at the catheter site. I’m going to take a blood culture and swab the area to check for bacteria. Patient: Does this mean the catheter has to be removed? Nurse: Not necessarily. If it’s a mild infection, we can start antibiotics and monitor it closely. But if the infection spreads, the doctor may recommend removing the line. Patient: I hope it’s nothing serious. Nurse: We’ll keep a close eye on you. If you feel worse or notice pus, worsening redness, or increasing pain, let me know immediately. |
| Scenario 5: Troubleshooting a PICC Line Occlusion |
[A patient’s PICC line is not flushing properly]Nurse: Mr. Carter, I’m about to flush your PICC line, but I’m feeling some resistance. Have you noticed any issues when receiving IV medications?Patient: Yes, the last nurse said it was a little slow. Nurse: Okay, let me try a few things. I’ll check for kinks in the tubing and reposition your arm. Patient: Will that fix it? Nurse: Sometimes, yes. If not, I’ll use a push-pause technique while flushing with saline to see if it clears. Patient: What if it stays blocked? Nurse: If it’s still occluded, we may need to use a clot-dissolving medication like alteplase. I’ll also check with the doctor if we should send a blood clot test. Patient: I appreciate you explaining everything. Nurse: Of course! I’ll make sure we resolve this safely. |
🔹 2. Aseptic Technique and Infection Prevention Essentials
| Scenario 1: Performing Hand Hygiene Before Catheter Access |
[Before administering IV medication through a PICC line]Nurse: Hi Mr. Lee, I’m here to give you your IV antibiotics through your PICC line. Before I begin, I’ll perform proper hand hygiene using alcohol-based hand rub.Patient: Why do you always clean your hands first? Nurse: Great question. Hand hygiene is the single most important step to prevent infections. I’ll apply 3 mL (milliliters) of hand rub and rub my hands thoroughly for at least 20 seconds. Patient: That’s very precise. Nurse: Yes, because bacteria and viruses can live on our hands without us knowing. Even if I wear gloves later, clean hands are essential first. |
| Scenario 2: Aseptic Technique During Dressing Change |
[Scheduled dressing change for a CVC line in a post-op patient]Nurse: Good morning, Ms. Sanders. I’m going to change the dressing on your central line today. I’ve already washed my hands and prepared a sterile field.Patient: Do you always use those big gloves and the blue sheet? Nurse: Yes, those are part of aseptic technique. I’ll use sterile gloves and a chlorhexidine swab to clean around the site for 30 seconds, then let it air dry. Patient: That feels cold! Nurse: I know—it means it's working. This kills bacteria that can cause bloodstream infections. I’ll place a transparent dressing afterward so we can monitor the site easily. |
| Scenario 3: Reinforcing Hand Hygiene with a New Staff Member |
[Preceptor nurse guiding a newly hired nurse on infection prevention protocol]Nurse: Alex, before accessing the patient’s Chemoport, remember our protocol—always perform hand hygiene, even if you just entered the room.New Nurse: Even if I didn’t touch the patient yet? Nurse: Exactly. Pathogens spread fast. Use alcohol-based hand rub for 20 seconds, and let it dry fully before putting on gloves. New Nurse: Got it. And I should scrub the port with alcohol swab for 15 seconds too, right? Nurse: Correct! That’s called scrub the hub. Never skip it. Infection prevention is non-negotiable here. |
| Scenario 4: Explaining Dressing Change Frequency to a Patient |
[Outpatient Chemoport patient asking about dressing schedule]Patient: Nurse, how often do I need to get this dressing changed?Nurse: For your Chemoport, we do dressing changes every 7 days, or earlier if it becomes wet or starts peeling off. Patient: Why not leave it longer? It still looks clean. Nurse: Even if it looks clean, bacteria can grow under the dressing. And we always use sterile gloves and chlorhexidine to clean the area before applying a new dressing. It’s our way of stopping infections before they start. |
| Scenario 5: Responding to a Patient Touching the Catheter Site |
[Patient recovering from surgery touches their CVC site]Nurse: Mr. Davis, I saw you touching around your catheter site. Is it bothering you?Patient: A little. It felt itchy, so I scratched it. Nurse: I understand, but touching the site with bare hands can introduce bacteria. Let me take a look. I’ll clean it again with chlorhexidine, and if the itching continues, we can apply a non-irritating barrier film under the dressing. Patient: I didn’t think it was a big deal. Nurse: It happens, but keeping the site clean is critical. If you feel discomfort again, please call me before touching it. |
🔹 3. Hands-on Simulation: Catheter Insertion and Maintenance
| Scenario 1: Preparing a Patient for CVC Insertion in the ICU |
| Nurse: Good morning, Mr. Johnson. I’m your nurse today. The doctor has decided to place a central venous catheter, or CVC, to help manage your medications and monitor your condition more closely. Patient: What exactly is that? Nurse: A CVC is a long, flexible tube that will be inserted into a large vein—usually in your neck, chest, or groin. It allows us to deliver medications, fluids, and even draw blood without using multiple peripheral IVs. Patient: How do you put it in? Nurse: The doctor will insert the catheter using ultrasound guidance. First, I’ll help position you flat and turn your head slightly to the side. Then I’ll clean the site with chlorhexidine for 30 seconds, and apply sterile drapes all around. The doctor will numb the area with local anesthetic, then insert the catheter into your internal jugular vein using a needle. Once the vein is accessed, the catheter will be threaded in place and secured with sutures. Patient: Will it hurt? Nurse: You may feel some pressure, but the area will be numb. We’ll monitor your heart rhythm during the procedure and take a chest X-ray afterward to confirm the placement. Patient: Okay, thank you for explaining. Nurse: You’re welcome. I’ll be with you throughout the procedure to monitor your vitals and make sure everything goes smoothly. |
| Scenario 2: Starting IV Fluids and Electrolytes via a CVC |
| Nurse: Ms. Thompson, your potassium level is low and your blood pressure is a bit unstable. We’ll be starting IV fluids and potassium replacement through your central line. Patient: Is it different from a regular IV? Nurse: Yes, your central line allows us to deliver fluids and medications directly into a large vein, which reduces irritation and ensures faster absorption. I’ve already washed my hands and am using sterile gloves. I’ll first scrub the port for 15 seconds using alcohol, then flush the line with 10 mL (milliliters) of saline to check patency. Patient: Will I feel anything? Nurse: You might feel a cool sensation as the fluid enters. I’m going to hang 500 mL (milliliters) of normal saline with 20 mEq (milliequivalents) of potassium chloride, and it will infuse over the next 2 hours. I’ll monitor your cardiac rhythm and check for any signs of discomfort. Patient: Alright. Nurse: I’ll stay nearby and come back frequently to check your vitals. Let me know immediately if you feel any burning, chest pain, or tightness. |
| Scenario 3: Administering IV Antibiotics via a PICC Line |
| Nurse: Mr. Evans, it’s time for your next dose of antibiotics. I’ll be giving it through your PICC line in your upper arm. Patient: Okay. What are you going to do? Nurse: First, I’ll perform hand hygiene and put on clean gloves. Then, I’ll remove the old cap and scrub the hub of the catheter for 15 seconds with alcohol. I’ll flush the line with 10 mL (milliliters) of saline and confirm blood return. That tells me the line is patent and functioning correctly. Patient: What if you don’t get blood back? Nurse: I’ll try repositioning your arm, asking you to cough, or have you take a deep breath. If those don’t help, we might need to use a small dose of a clot-dissolving medication. But so far, your line has been working well. Nurse: Now I’m connecting the pre-filled antibiotic syringe, which contains 1 gram of vancomycin. I’ll infuse it slowly over 60 minutes using a programmable pump. Afterward, I’ll flush the line again with saline and lock it with 2 mL (milliliters) of heparin to prevent clotting. Patient: That’s really thorough. Nurse: Yes, keeping PICC lines sterile and patent is essential for safe treatment. |
| Scenario 4: Drawing Blood from a Central Line for Lab Tests |
| Nurse: Mr. Carter, we need to draw blood for your routine labs. I’ll use your central line to do it, so you won’t need another needle stick. Patient: That’s good to hear. Nurse: First, I’ll perform hand hygiene and gather my sterile supplies. Then I’ll put on clean gloves, scrub the injection port with alcohol for 15 seconds, and flush the line with 10 mL (milliliters) of saline. I’ll then discard the first 5 mL (milliliters) of blood to prevent dilution. Patient: What happens next? Nurse: I’ll draw the needed samples into vacuum tubes, label them immediately, and send them to the lab. Once done, I’ll flush the catheter again with 10 mL (milliliters) of saline, followed by 2 mL (milliliters) of heparin if it’s a non-valved catheter. Patient: Sounds efficient. Nurse: It is. And this method minimizes discomfort and preserves your peripheral veins. |
| Scenario 5: Responding to Occlusion in a Chemoport During Chemotherapy |
| Nurse: Mrs. Lee, I’ve noticed that your chemotherapy infusion is slowing down, and there’s resistance when flushing the port. I’ll troubleshoot your Chemoport now. Patient: Is it blocked? Nurse: Possibly. I’ll start by checking the tubing for any visible kinks. Then I’ll ask you to change positions—try lifting your arm or turning your head slightly. Sometimes a change in posture restores flow. Nurse: I’ll scrub the port with alcohol, then gently aspirate to check for blood return. If that fails, I’ll flush the line with 10 mL (milliliters) of saline using a push-pause technique. Patient: What if it still doesn’t work? Nurse: I’ll notify the doctor. We may need to use alteplase, a clot-dissolving medication. Meanwhile, I’ll stop the infusion and keep the port sealed. Patient: Thank you for taking care of it. Nurse: You’re welcome. We’ll make sure the line is safe and ready for your next treatment. |
🔹 4. Emergency Response: Occlusion, Infection, and Bleeding
| Scenario 1: Central Line Occlusion During Medication Administration |
| Nurse: Mr. Daniels, I’m about to administer your scheduled antibiotic—cefepime—through your central line. Let me flush it first with 10 mL (milliliters) of normal saline to ensure it's patent. Nurse: Hmm. I’m noticing some resistance when flushing, and I’m not getting any blood return either. Let me pause for a moment. Patient: Is something wrong with the line? Nurse: It seems your central line may be partially occluded. Don’t worry—it’s not uncommon. Let me take a few steps to troubleshoot it safely. First, I’ll inspect the tubing to ensure there are no clamps closed or kinks. All looks good there. Nurse: Now, I’d like you to try raising your right arm above your head and take a deep breath. Sometimes changing your position helps reposition the catheter tip inside the vein. Nurse: I’ll try flushing again using the push-pause technique. Still no return. Since we’ve confirmed occlusion, I’m going to document this in your chart, hold the medication, and contact Doctor Lee for an order of alteplase 2 mg (milligrams). It’s a clot-dissolving medication we instill into the line. Patient: Will it hurt? Nurse: Not at all. It’s just left inside the catheter to break up any blockage. We’ll allow it to dwell for 30 to 60 minutes, and I’ll reassess patency afterward. You won’t feel anything, but I’ll stay with you and check your vitals regularly during the process. Nurse: I’ll also update the MAR to reflect the delay in antibiotic administration and notify pharmacy to adjust the timing. Let me know if you feel discomfort, pressure, or anything unusual in your arm or chest while we manage this. |
| Scenario 2: Early Signs of Catheter-Related Bloodstream Infection |
| Nurse: Ms. Han, during your morning assessment, I noticed that the area around your PICC line looks a little red and slightly swollen. Also, your temperature has spiked to 38.8°C (degrees Celsius). Did you notice any chills or sweating overnight? Patient: Yes, I woke up in the middle of the night feeling really cold and a bit nauseated. Nurse: Thank you for sharing that. These are early signs of a possible catheter-related bloodstream infection, or CRBSI. This can happen if bacteria enter through the insertion site or the catheter hub. But don’t worry—we’ll act quickly. Nurse: I’m going to draw two sets of blood cultures—one from the PICC line and another from your peripheral vein in the other arm—to check if there’s any bacteria in your blood. I’ll also collect a CBC, CRP, and Procalcitonin, which help assess infection and inflammation. Nurse: In the meantime, I’ll notify Doctor Kim, who may start you on broad-spectrum IV antibiotics like vancomycin or piperacillin/tazobactam right away while we wait for culture results. Patient: Will I have to get this line removed? Nurse: If the infection is localized to the skin and we catch it early, we might be able to keep the line. But if cultures confirm bacteria in the bloodstream, or if you don’t respond to antibiotics, the line may need to come out. Either way, we’ll explain each step. Nurse: I’ll clean the site again with chlorhexidine, apply a fresh sterile dressing, and continue to monitor the area and your temperature. I’ve documented everything in your chart and flagged your condition as a potential infection. We’ll reassess every 4 hours. |
| Scenario 3: Active Bleeding From a Central Line Site |
| Nurse: Mr. Lewis, while changing your dressing, I noticed that your CVC site is actively bleeding. The gauze is saturated, and I’m seeing fresh oozing along the insertion site. How are you feeling—any dizziness or weakness? Patient: A little dizzy when I sat up earlier, but I thought I just stood too fast. Nurse: I’m going to lay you back down to reduce strain and apply firm, sterile pressure with gauze to the site. I’ll also lower the head of the bed slightly and keep your arm still. Bleeding like this could be related to your blood thinners or platelet levels. Nurse: I’m going to check your most recent labs—INR, PT, aPTT, hemoglobin, and platelet count—and I’ll call Doctor Chen to report this. In the meantime, I’ll reinforce the dressing with a pressure bandage to stabilize the bleeding. Patient: Do I need blood or something? Nurse: Not unless your hemoglobin has dropped or bleeding continues. If your INR or aPTT is elevated, we may need to hold your heparin or aspirin. I’ll keep you monitored and recheck the dressing every 30 minutes. Nurse: I’ve recorded the estimated blood loss and charted the bleeding episode. If it worsens, we’ll escalate the intervention. |
| Scenario 4: Air Embolism Suspicion After Line Manipulation |
| Nurse: Mr. Garcia, I noticed you look pale, and your oxygen level just dropped to 89%. Are you feeling lightheaded or short of breath? Patient: Yeah, all of a sudden, I feel faint, and my chest is kind of tight. Nurse: I’m clamping your central line right away and placing you into the left lateral Trendelenburg position. This positioning helps trap any air in the right atrium to prevent it from traveling to your lungs or brain. Nurse: I’m starting 100% oxygen via non-rebreather mask, and I’m calling the Rapid Response Team immediately. I’ll also notify Doctor Ahmed. Patient: What happened? Did something go wrong with my line? Nurse: There may have been a small air entry into the catheter—possibly if the cap was open or loose while you were changing position. It’s rare, but when it happens, we act fast. You did the right thing by telling me how you felt. Nurse: I’ve recorded the time symptoms started, placed you on ECG and SpO₂ monitoring, and will document a full event note. You’ll likely get an urgent EKG and a stat chest X-ray as well. Just keep breathing slowly—I’ll stay right here with you. |
| Scenario 5: Delayed Bleeding From Chemoport Site Post-Access |
| Nurse: Mrs. Collins, I was checking your chemoport site and noticed some delayed oozing through the dressing. It's been more than 2 hours since your access, but there’s still blood soaking through. Have you been feeling lightheaded or dizzy? Patient: Yes, a little shaky and tired, but I thought it was from the chemo. Nurse: I’m going to stop the infusion, remove the current dressing, and apply pressure with sterile gauze. I’ll keep your arm elevated and flat. Nurse: I’ll also review your latest labs—platelet count, INR, aPTT, and check your medication record. I see you’re on warfarin, which could be contributing. I’ll contact Doctor Patel to review whether we need to hold your anticoagulant dose. Nurse: For now, I’ll reinforce the dressing with a pressure wrap, document the bleeding as “moderate delayed site oozing,” and schedule hourly site checks. Patient: Is my port still okay? Nurse: Yes, the port itself seems stable. We’ll continue monitoring. If bleeding stops and labs improve, we’ll resume chemo tomorrow. Let me know immediately if you feel more dizzy or if the bleeding worsens. |
🔹 5. Chemoport Management – A Critical Component of Chemotherapy
| Scenario 1: Initiating Chemotherapy via Chemoport (First Use) |
| Nurse: Good morning, Mrs. Lee. Today we will begin your chemotherapy through your new chemoport. Before we begin, let me explain each step so you know what to expect. Patient: I'm a bit nervous. Is it going to be painful? Nurse: It’s completely normal to feel nervous. You might feel a pinch during the needle access, but I will apply a topical anesthetic cream to numb the area first. We'll give it around 30 minutes to take effect. While we wait, I’ll verify your identity, check your chemotherapy orders, and review your labs from this morning — including CBC, LFTs, and renal function. Nurse: Now I’m donning sterile gloves. I’ll cleanse your port site using chlorhexidine in a circular motion for 30 seconds and allow it to dry completely. Next, I’ll insert the Huber needle into the port. Let me know if you feel any discomfort. Patient: Just a bit of pressure, but it’s okay. Nurse: Good. I’ve confirmed blood return, so the port is functioning. I’ll now flush with 10 mL (milliliters) of saline using the push-pause technique and then with 5 mL of heparin 100 units/mL (units per milliliter) to maintain patency. Nurse: Everything looks good. I’m starting the infusion now with ondansetron 8 mg (milligrams) IV as premedication. I’ll stay with you for the first 15 minutes to monitor for any adverse reaction. Please report any dizziness, chest pain, or flushing. Patient: Okay, I feel better knowing all the steps. Nurse: I’ll document all assessments, medication times, and your response in the MAR and progress notes. Doctor Kim will also check in later during rounds. |
| Scenario 2: Routine Chemoport Flush and Maintenance |
| Nurse: Hello Mr. Thompson. You’re not scheduled for chemo today, but we're going to flush your chemoport to keep it patent and prevent clot formation. Patient: Why do we need to flush it if I'm not getting treatment? Nurse: That’s a great question. Chemoports should be flushed every 4 weeks if not in active use to prevent occlusion and catheter-related complications. Nurse: I’ve confirmed your last access date and orders. I’m now performing hand hygiene and donning sterile gloves. After scrubbing the hub with alcohol for 15 seconds, I’ll attempt to aspirate to confirm blood return. There we go — we have return. Nurse: Now flushing with 10 mL of saline followed by 5 mL of heparin (100 units/mL). The push-pause technique ensures turbulence, helping reduce clot buildup. Nurse: Dressing remains dry and intact. I’ll document the flush and your tolerance. If you ever notice redness, swelling, or pain at the port site, report it immediately. |
| Scenario 3: Managing a Chemoport Occlusion (No Blood Return) |
| Nurse: Mrs. Carter, I’m attempting to access your chemoport for your infusion, but I’m unable to get a blood return. That could mean a small clot or catheter tip misplacement. Patient: Is that dangerous? Nurse: It’s not uncommon, but we need to resolve it before starting your chemo. First, I’ll have you raise your arm, turn your head, and cough. No luck? Let me try the push-pause flush with 10 mL of saline again. Nurse: Still no return. I’ll hold the infusion and notify Doctor Patel. He may order alteplase 2 mg to clear the blockage. I’ll document this as "suspected occlusion" in the nursing notes and MAR. Nurse: We’ll allow alteplase to dwell for 30 to 60 minutes and reassess. I’ll also recheck your coagulation profile just to be safe. |
| Scenario 4: Chemoport Removal Preparation |
| Nurse: Mr. Park, congratulations on finishing your treatment. Today, we’ll be preparing you for port removal. Patient: Do I need to be sedated? Nurse: No, it’s a minor procedure done under local anesthesia. I’ve confirmed your recent labs: CBC, INR, and no active infections. Let’s position you supine and prep the area with povidone-iodine. I’ll also attach cardiac monitoring. Nurse: Doctor Lee will perform the removal. I’ll assist by maintaining sterile field, monitoring vitals every 5 minutes, and preparing pressure dressing supplies. If you feel any pain or lightheadedness, let me know immediately. Nurse: After the procedure, I’ll monitor for bleeding, check the site every 15 minutes for 1 hour, and document the removal time and condition of the port. |
| Scenario 5: Managing Chemoport Infection (Localized Erythema) |
| Nurse: Ms. Nguyen, I’m checking your port site before accessing it for your chemotherapy. I see some redness and warmth around the area. Do you feel any pain or fever? Patient: Yes, it’s been a little sore since yesterday, and I felt feverish overnight. Nurse: Your temperature is 38.2°C (degrees Celsius). I’ll hold off on accessing the port and notify Doctor Choi immediately. This could be a localized port infection. Nurse: I’ll draw blood cultures from a peripheral site and order a CBC and CRP. I’ll also swab the skin around the port for culture. We may initiate empiric antibiotics per protocol. Nurse: Meanwhile, I’ll apply a cool compress, monitor your vitals every 4 hours, and document this as "suspected port site infection" with onset and findings in the EHR. Patient: I’m worried the port will have to come out. Nurse: If the infection is superficial, we might treat it without removal. Let’s wait for the labs and Doctor’s evaluation. |
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