The Use Of The Huber Needle

There are several reasons for a patient to require the implant of a venous access port. If a vascular access will be needed for longer than a 6 week period, an implanted port is highly recommended. The procedure for implanting the venous access port is done in the operating room. Treatments such as chemotherapy, total parenteral nutrition or long term antibiotics, which need to be given to the patient on a regular basis, requires a stable venous access. In addition to these treatments, frequent blood samples will be required to be drawn. The Huber needle, is what is used to access these implanted ports.

The Huber needle is a hollow needle with a beveled tip. The implanted venous access is under the skin and this needle makes it easy to go through the skin and the silicon septum of the port. These needles come in different sizes in order to accommodate the size of the patient and the port. The use of the Huber needle, prevents the patient from having to endure many needle sticks, because the needle is left in the port for more than one use.

The Huber needles come straight or curved. When the port is only needing to be flushed, the straight needle is used. These are also used for any short-term application. The curved needles are the ones that are used for the delivery of such things as, medications, nutritional fluids, and chemotherapy. The curved needle is convenient, because it can be left in place for a few days, according to the policy of the facility and prevents the patient from having as many needle sticks.

The history behind the Huber needle, may be a slight bit surprising. This widely used needle was actually invented by a dentist in Seattle. He made the needle hollow and curved, making it more comfortable for his patients to endure injections. The Huber needle is today, the only needle that is used to access the implanted venous access port devices.

Most of the patients that have conditions requiring an implanted venous access port, have to have blood drawn several times a day. After a short period of time, their veins collapse. With the use of the implanted port and the Huber needles, the job can be done without having to go through the skin every time.

The Huber needle is safe and can be kept in place for several days. It makes life a lot better for the patient. The reality of having chemotherapy and being stuck so many times in a day, is made a slight bit easier by its use. The administration of the chemotherapy often damages the skin and tissues around peripheral insertion sites. A port that is surgically inserted in the chest wall, helps the patients by only having to endure one needle stick versus many.

Proper use of the Huber needle protects the patient from pain and infection. Huber needles optimize access to the port through the septum of the implanted port. The fluid flows through the reservoir of the port into the vascular system of the patient. Every facility has policies and procedures for the use of the Huber needles, be familiar with them and always follow the regulations.

Providing Nutrition With Enteral Feedings

Malnourished patients should be considered for enteral feedings. If the patient cannot maintain an adequate intake, the enteral feedings can be a life-saving procedure. Critically ill patients, post-operative patients that can only take limited amounts, and patients with problems such as severe pancreatitis, may require some assistance with nutrition in order to get better. There are instances when the enteral feedings are given along with the parenteral nutrition. This is done in order to reduce the likeliness of cholestasis and to maintain the gut function. Different routes are available for achieving this feeding. Nasogastric tubes are the most common form of delivery and are easy to insert. These tubes must be checked routinely because all though they are easy to insert they are also easy to become displaced.

Peg tubes are more common with patients that have had a stroke, Parkinson’s disease, motor neurone disease or esophogeal cancer. These tubes are inserted surgically directly through the stomach wall. There is a form of this tube that is referred to as the percutaneous jejunostomy tube. This tube is inserted through the stomach into the jejunum, using a surgical technique.

After the tube is inserted and the orders are received by the physician, you will need a feeding set, in order to start the feedings. One type of this is the gravity feeding set. This set will hold 1200ml and comes with a drip chamber, roller clamp, hanger, and a top-fill opening. This bag is leak proof and cuts down on formula spills and also waste. They come 30/case. A different type of tubing is the EnteralLife Infinity set. It comes with a 500ml delivery set and is compatible with the EnteralLife pump. This set has a large top fill opening and is leak proof. These sets do require an enteral infusion pump to operate and come 30/case.

The type and amount of the enteral feeding is usually ordered by the physician or in some cases, the physician will order for the dietician to regulate the enteral feedings. Oral, enteral, or parenteral nutritional support should be considered for any patient that is malnourished or at risk or becoming malnourished. Potential swallowing problems should always be taken into consideration when making the determination as to the route of the nutrition.

One of the complications that can arise from these feedings is infection from contamination of the enteral feeding. The feeding sets and feeding should be discarded every 24 hours to minimize the risk of bacteria growing. Other complications can include the erosion or displacement of tubes, reflux, and aspiration. Enteral feedings can be highly beneficial to the malnourished patient. Assess the patient per protocol and monitor the feeding, so that the patient will receive the correct amount of feeding safely.

Central Line Dressing Kits Improve Care

There are different types of sites for intravenous IV infusion. A lot depends on the condition of the patient and what type of infusions the patient needs. The peripheral IV site is the most common. The implanted venous port is surgically implanted in the chest wall and requires accessing with a Huber needles. The central venous catheter or central line, as it is often called, is a long line catheter, that is usually inserted into the chest wall. It is placed in a vein and is fed through this vein until it reaches the superior vena cava or the right atrium.

A central line is used for giving treatment for infections, heart, infusing blood, large amounts of fluids, kidney dialysis, cancer, nutrition or pain. This catheter can be left in place for an extended length of time. Because of this, it is very important that the central line dressing be changed per the hospital protocol, in order to decrease the chance of infection.

Anytime the central line dressing is changed, aseptic technique must be used. The use of the central line dressing change kits help to prevent infections. Everything that is needed is in the kit, which saves the nurse’s time. Technique does not have to be broken in order to gather more supplies and it is less time consuming. The site needs to be closely monitored. The handling of the line needs to be kept at a minimum, in order to reduce the risk of the line and site becoming contaminated. Any redness or discharge from the site should be reported immediately to the physician.

The Dressing Change Kits for central lines usually include these items:

• 1 mask
• 1 pr sterile gloves
• 1 drape 17″ x 19″
• 1 tape measure
• 1 Triple Swabsticks
• 2 alcohol prep pads
• 2 gauze sponges
• 1 pre-split sponge
• 1 non-stick pad
• 1 roll of take
• 1 tegaderm transparent dressing 4″ x 4 3/4″
• 1 label

 These kits are sterile, latex free, and come 30/case from Wolf-Pak.

In the United States alone, physicians place more than 5 million central lines per year. The complications that can arise from the insertion of these IV’s are mechanical, infections, and thrombolytic. Use of the central line dressing change kits for changing of the sites, per the protocol of the facility will improve the care of the patient. The nurse has the vital role to safeguard the patient against the risks that are associated with the central line IV’s.

The Convenient IV Kits

The infamous IV tray that used to be on every medical floor at the hospital has now been replaced with the convenient IV start kits. Everything that is needed is in this one sterile pack and can be easily obtained when needed. The use of the IV start kit saves on time and contains all the necessary supplies to start the IV. All that has to be done, is to grab the kit and an IV catheter and you are ready to go to the patient’s room.

The start kit includes these components:

• 1 pair of latex free exam gloves.
• 1 alcohol prep pad
• 1 latex free tourniquet
• 2 2 x 2″ gauze sponges
• 1 roll tape
• 1 transparent dressing 2-3/8″ by 2″
• 1 PVP pad
• 1 dressing change label

These kits are convenient and cost effective. They come 50/case. The nurses start the majority of the IV’s, so the nurses and IV’s seem to go hand in hand. When starting an IV, know the anatomy of the patient and don’t go rooting around looking for that magical vein. Remember that the ventral side of the forearm is sometimes the best place to look. Initially, do a survey, but don’t go in blindly.

Because you don’t see a vein does not mean there is not one there. Practice is the best way to sharpen your skills. When palpating for a vein, close your eyes and feel. If you have a patient that has really good veins, close your eyes and palpate. This will help you to learn how a vein feels by touch and when you have a patient that does not have good veins, it will be easier for you to feel their veins.

The vein you choose should feel round, firm, and engorged. Sometimes veins feel and look suitable, but when an IV catheter is inserted, they have irregular or narrow lumens. The advancement of the IV cannula will be difficult in this situation. Because of the fact that the arteries are deeper than the veins, they are rarely damaged when starting peripheral IV’s.

Always follow the protocol of the facility when starting the IV. The IV Start kit will save time in gathering the necessary equipment and will also let the patient know that you are prepared. This gives them more confidence in the IV therapy process. It is not the end of the world, if you miss an IV, nobody gets them all. Tell the patient you are sorry and go get someone to start the IV for the patient. Most hospitals have a policy that no more than 2 IV sticks are made and then the physician is called.