Identification Is a Requirement for Power Injection of Contrast Media through an Implanted Port

By Amber Brown, Bard

Power-injectable port systems are estimated to make up more than half of the implanted port market, and their use is rapidly growing. However, proper identification of these systems is critical for safe and efficacious use in the healthcare setting.

Power-Injectable Port Systems
Implanted ports are a preferred vascular access device given the unique ability to provide repeated access to a patient’s vascular system with little interruption to daily lifestyle, cosmetics, or comfort. In mid-2006, the utility of the port was further improved with the introduction of the first power-injectable port system. Power-injectable ports permit the injection of contrast media at a higher rate through a power injection machine versus the alternative hand injection or peripheral needle stick. The ability to access a patient’s port for power injection simplifies the CT scan procedure and eliminates the need and discomfort of a secondary peripheral IV needle stick in potentially exhausted veins. The benefits of a power-injectable port are clear; however, serious adverse events such as catheter rupture, extravasations, and catheter fragment emboli may occur with the use of an incompatible port and needle system or port mislabeling.

Distinct Product Identifiers for Accurate Identification
To reduce the risks associated with identification, it is essential for manufacturers to provide distinct product identifiers that reside outside of commonly used patient ID cards, wristbands and key chains as they require patients to actively keep records and advocate the utility of their port.

Examples of distinct product features include a CT marker that can be seen under x-ray or fluoroscopy guidance (Johnson, 2009), a unique triangular shape, and three bumps located on the port septum. Several of these distinct features are unique in that they are palpable by the clinician. Palpable identifiers allow for immediate and accurate identification not only before the power injection procedure is initiated, but at the “point of access” which is critical as it is the first identification juncture for proper port system labeling. This juncture also carries the greatest risk for error, thus requiring several forms of identification to help assist safe and efficacious use of power injection through a port. “Point of access” identification has also been developed for compatible pressure-rated needles. One example is a “Power Sticker” that is placed on the extension tubing of a pressure-rated needle after the clinician has verified that the patient has a power-injectable and patent port. This distinct feature allows for improved identification of a compatible system at the “point of access” thereby reducing the risk of port mislabeling or the power injection through an incompatible port system.

Effectiveness of Distinct Identification Features
In 2008, Bard Access Systems surveyed Oncology Nurses and CT technicians using the Bard* PowerPort* device and Power-Loc* Safety Infusion Set to determine the effectiveness of the included “point of access” identifiers. Results indicated that the palpable identification features of the port and the “Power Sticker” on the needle were not only the preferred measures of identification, but the most commonly used for both “point of access” and pre-power injection identification. When asked of the implications regarding an unidentifiable port system at the two noted junctures, 96% of the respondents stated the power-injection capabilities of the port system would remain unused; meaning the patient would receive a peripheral needle stick or no scan at all.

Conclusion
Power-injectable port use is growing quickly given their increased utility. However, it is critical to ensure these systems can be accurately identified for safe and efficacious use before the power injection procedure is initiated and more importantly at the “point of access.” This responsibility primarily falls to both the manufacturer and healthcare providers.

To improve identification of port systems, manufacturers should provide distinct product features for pre-power injection and “point of access” identification. Health care providers must also develop and implement safety procedures to ensure power-injectable port systems are accurately identified at both junctures to reduce the risk of adverse effects related to misidentification. This will ensure this technological advancement in the delivery of care is utilized in a safe and efficient manner.

Note: Before using a power-injectable port system, please consult product labels and inserts for any indications, contraindications, hazards, warning, cautions, and instruction for use.