1. A.M.I. Infusion Port Products Trouble shooting Vascular Access Devices (by Diane Welker / Rush University College of Nursing / Chicago / Illinois) 1

2. A.M.I. Infusion Ports – Trouble shooting Did you know? A vigorous infusion of flush solution is probably more important than the solution that is being used to thouroughly flush the catheter? Heparin is rapidly inactivated in the body. Therefore, the amount of heparin entering the circulation from flushing catheters does not alter normal coagulation. The majority of thrombosis occur in the vessel in the catheter resides. The greater the catheter lumen size, the greater the risk of thrombosis (remember our Vario Port povides a small 5 F catheter!) Heparin will prevent clot propagation, but will not cause clot dissolution. It is possible for residual amounts of Total Parenteral Nutrition (TPN) solutions containing calcium and phosphorus precipitate has been known to form 12 hours after infusion at 37°. 2

3. A.M.I. Infusion Ports – Trouble shooting Did you know? Use turbulent positive pressure flushing technique; push, pause, push, pause, to avoid blood build-up in the catheter. 10 – 20 ml of air is required to produce clinical symptoms of an air embolism. A rapid infusion of air is most likely to be fatal. The average lethal dose is 70 – 150 ml / second. A larger dose of air over a long period of time m(e.g.leaking catheter) may be tolerated without inducing clinical symptoms. It takes approximately 2 weeks to establish the tract of a tunneled catheter. Insertion of permanent catheters on the right side is preferred, since venous drainage to the superior vena cava is more direct. The preferred catheter tip location is in the superior vena cava, above ist junction with the right atrium. 3

4. A.M.I. Infusion Ports – Trouble shooting Did you know? The preferred catheter tip location is in the superior vena cava, above ist junction with the right atrium. Catheters extending too far into the artrium tend to impinge on the endocardium, this can cause withdrawal occlusion and arrhythmias! (A.M.I. Vario Port makes precise placement of catheter tip easy!) 4

5. A.M.I. Infusion Ports – Trouble shooting Infection facts? Candida albicans (fungus) grow extremly well in TPN and lipid solutions! An infected intravascular thrombus and intraluminal abscess may remain intact until after catheter removal, therefore infection may not manifest until after catheter is removed. Complicated high risk catheter related infections generally result in catheter removal. External catheters hav a higher rate of infection than implanted ports. Certain patients are at high risk for developing infection, e.g. obese patients and those with multiple-lumen catheters. The lumen of the port is the major source of colonization for long-term infections ! (A.M.I. Vario Port – flat bottom & tangential catheter outlet – provides safe and best flushing of the port and prevents all infusion residuals from the port inside!) 5

6. A.M.I. Infusion Ports – Trouble shooting Routine Maintenance? 6 Implanted Ports Solution used for flushingHeparin 100 IU/ml Amount of solution3ml to 5 ml Frequency of flushingOnce a month (or after use) and after every blood draw! Cap change / transparent dressing Once a week or as needed.