CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 13 0000. ref SDS 12 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040507 -
040508 -
040509 -
040511 -  ..
0406 -
0407 -
0408 - Progress
040901 -  ..
040902 - Schedule Power Port Surgery on 080708 in Time for Next CT Test
040903 -
040904 - Follow up ref SDS 13 IT8V, ref SDS 12 IT8V.
040905 -
040906 - Nosheen called with the Kaiser Scheduling Department in Walunt Creek.
040908 -  ..
040909 - Telephone...
040910 -
040911 -                            925 295 7420
040913 -  ..
040914 - Nosheen is following up the surgeon's letter on 080609, ref SDS 13
040915 - IT8V, reporting that the Millie's letter to Kaiser on 080608 was sent
040916 - to the Scheduling Department coordinating the date for surgery prior
040917 - to the next CT test planned for mid-July. ref SDS 12 XS4S
040919 -  ..
040920 - Nosheen said that Millie's surgery to upgrade the port catheter to a
040921 - Power Port is scheduled at Kaiser in Walnut Creek on...
040922 -
040923 -                     080708
040925 -  ..
040926 - Doctor Riley-Paul will do the work.  This aligns with planning during
040927 - the meeting with the doctor on 080606. ref SDS 11 IT89
040928 -
040929 -        [On 080708 Millie gets surgery for Power Port. ref SDS 20 IT77
040931 -  ..
040932 - Kaiser will call a day or so before to disclose the time Millie should
040933 - arrive at the hospital to begin preparation.
040935 -  ..
040936 - July 8th is well in advance of the next CT test needed on 080718,
040937 - shown by planning discussed with the medical team at UCSF on 080529.
040938 - ref SDS 10 3F9O  This schedule enables using the Power Port to inject
040939 - contract medium for the CT test, as planned in the meeting with the
040940 - surgeon on 080606, ref SDS 11 IT8V
040942 -  ..
040943 - July 8th is on a Tuesday, 2 days before Millie's weekly infusion
040944 - treatments for cancer at UCSF on Thursdays.  During the meeting at
040945 - Kaiser on 080606, the surgeon planned to configure a Huber needle with
040946 - the Power Port on the day of surgery, which will remain in place for
040947 - Millie's cancer treatments on Thursday. ref SDS 11 IT40
040949 -  ..
040950 - Nosheen said she will note this requirement in the medical chart
040951 - planning the surgery on 080708 (Tuesday) to remind the surgeon about
040952 - accessing the port with a Huber needle for Millie's chemotherapy
040953 - treatment on Thursday.  Nosheen reminding the team who processes
040954 - Millie on the day of surgery that the doctor should install a Huber
040955 - needle.
040956 -
040957 -
040958 -
040959 -
040961 -  ..
0410 -
0411 -
0412 - 1451
0413 -
041301 - CT Test Scheduled 080718 After Surgery for Power Port
041302 -
041303 -
041304 - Cal called with the Imaging Department at Kaiser in Walnut Creek.
041306 -  ..
041307 - Millie's next CT test is scheduled for...
041308 -
041309 -                   080718 1100
041311 -  ..
041312 - This schedule aligns with planning discussed with the medical team at
041313 - UCSF on 080529. ref SDS 10 3F9O   Per above, getting the CT test on
041314 - 080718 allows enough time (10 days) after surgery on 080708 so that
041315 - the new port can be used to inject contrast medium.  On 080606 the
041316 - surgeon said the port can be accessed normally 4 days after surgery.
041317 - ref SDS 11 IT40
041318 -
041319 -        [...below Bella schedules Infusion Clinic to access the Power
041320 -        Port at 1030 in time for the CT Test Department to perform the
041321 -        Power Injection at 1100, ref SDS 0 OQ61; Bella presents
041322 -        protocol and certification issues to be resolved over next 4
041323 -        weeks in time for CT test on 080718. ref SDS 0 OQ67
041325 -         ..
041326 -        [On 080619 Millie notified medical team at Kaiser and UCSF that
041327 -        CT test is scheduled to use the Power Port on 080718,
041328 -        ref SDS 16 YU6X; cites requirements to resolve protocol and
041329 -        certification issues over next 4 weeks. ref SDS 16 YV4R
041331 -         ..
041332 -        [On 080702 Millie's letter to medical team confirms that on
041333 -        080627 the primary care physician coordinated support by the
041334 -        Infusion Clinic to access the Power Port on 080718 in time
041335 -        for CT test at 1100; and further initiated planning that, if
041336 -        no one else is assigned, the primary care physician will
041337 -        personally press the button for the CT test using the Power
041338 -        Port on 080718. ref SDS 19 EQ3T
041340 -         ..
041341 -        [On 080711 Ike in the CT Test Department did not receive
041342 -        Millie's letter on 080619 notifying Kaiser on coordinating
041343 -        today for the CT test on 080718 using the Power Port with a
041344 -        Huber needle, ref SDS 21 7K8I; Paula, Director of Infusion
041345 -        Clinic Services, disclosed that nobody has contacted the
041346 -        Infusion Clinic with assignments for Millie's CT test on
041347 -        080718. ref SDS 21 RW42
041349 -         ..
041350 -        [On 080715 Arlette called and reported the doctor solved
041351 -        coordination problems by arranging for a nurse in radiology
041352 -        with certificate to support CT testing with Power Ports;
041353 -        Millie's CT test is good to go on 080718. ref SDS 22 RB4N
041355 -  ..
041356 - Cal said Millie should call the Infusion Clinic for scheduling a nurse
041357 - to access the Power Port with a Huber needle at 1030, half an hour
041358 - before the test in the CT Department.  Millie will then walk over to
041359 - the CT Department for the test at 1100.  The CT technologist will
041360 - connect the equipment to the Huber needle to inject contrast medium
041361 - and do the CT scan.  After the test, Millie will return to the
041362 - Infusion Clinic and the nurse will flush the port according to Kaiser
041363 - protocol, and remove the Huber needle.
041365 -         ..
041366 -        [On 080716 Kaiser changes plan, access to Power Port and
041367 -        removing the Huber needle after the test will be performed in
041368 -        the CT Department; Millie's meeting in the Infusion Clinic on
041369 -        080718 1030 was cancelled by the CT Department. ref SDS 23 AN5I
041371 -  ..
041372 - This will solve problems using a conventional IV that occurred during
041373 - last CT test on 080425. ref SDS 6 FP6F
041375 -  ..
041376 - Cal said to ask the Infusion Clinic to schedule "port access."
041377 -
041378 -        [On 080718 Kaiser had difficulty accessing the Power
041379 -        Port causing CT test to fail with complications.
041380 -        ref SDS 24 LK3R
041381 -
041382 -        [On 080724 UCSF disclosed that Huber needles injecting
041383 -        contrast medium under high pressure for CT tests have a
041384 -        higher standard of construction and safety than Huber
041385 -        needles used for blood draws and chemotherapy in the
041386 -        Oncology Infusion Clinic, ref SDS 25 OK63, this could
041387 -        mean that, if Millie's port was accessed in the Kaiser
041388 -        Oncology Infusion Clinic, and if the needle for high
041389 -        pressure injection, cited in manufacturer's Instructions
041390 -        for Use on Power Injection Procedures, reported 080708,
041391 -        ref SDS 20 JE7N, was not used, then problems doing the
041392 -        CT test on 080718 may not have been avoided simply by
041393 -        accessing the port in the Infusion Clinic. as scheduled
041394 -        on 080617 by Cal in the CT Department. ref SDS 15 DF6Y
041396 -  ..
041397 - Cal explained "port access" is the commonly used phrase for inserting
041398 - a Huber needle in the Power Port for injecting CT test contrast
041399 - medium, or to perform chemotherapy infusion treatments, draw blood,
041400 - etc.
041402 -  ..
041403 - Cal advised that the Imaging department has coordinated with the
041404 - Kaiser Pharmacy to order the contrast medium Gastrografin, which
041405 - patients drink an hour or so before the CT test, as reported for the
041406 - prior test on 080425. ref SDS 6 XM30  Gastrofrafin test preparation
041407 - treatment is listed on Millie's current medications received from the
041408 - primary care physician during the meeting on 080502. ref SDS 9 T38N
041409 - Millie can get Gastrografin prescription at the Kaiser Park Shadelands
041410 - pharmacy in Walnut Creek.  Millie takes 1 glass of this 2 hours before
041411 - the test, and 2 glasses 1 hour before the test.
041412 -
041413 -        [On 080718 Millie drank Gastrografin contrast medium to prepare
041414 -        for CT test. ref SDS 24 2U6L
041416 -         ..
041417 -        [On 080822 Barium Sulfate suspension replaces Gastrografin for
041418 -        oral contrast medium to support CT tests. ref SDS 27 VY6J
041420 -         ..
041421 -        [On 080911 after the CT test, and through the evening new
041422 -        Barium Sulfate suspension contrast medium for the CT test on
041423 -        080911 may cause upset stomach. ref SDS 28 S59G
041425 -         ..
041426 -        [On 081107 Barium Sulfate suspension side effects less
041427 -        pronounced for CT test on 081107, possibly because Millie had
041428 -        no treatments for cancer for several weeks. ref SDS 29 BG4J
041430 -         ..
041431 -        [On 081210 CT test ordered and Barium Sulfate suspension
041432 -        contrast medium prescribed. ref SDS 30 VZ9K
041434 -         ..
041435 -        [On 081230 Barium Sulfate suspension contrast medium for CT
041436 -        test in combination with sunitinib treatment for cancer has
041437 -        severe side effects, ref SDS 31 FF4K; Millie considers changing
041438 -        back to Gastrografin. ref SDS 31 N66M
041440 -  ..
041441 - There was discussion about the Imaging Department coordinating
041442 - Millie's care to schedule port access in the Oncology Infusion Clinic.
041443 - Can't this essential work for Millie's CT test be coordinated by
041444 - telephone and scheduled in the computer with notice to the customer,
041445 - like Cal did with Gastrografin and the Pharmacy? ref SDS 0 DF64
041447 -  ..
041448 - Cal indicated that the Imaging Department is not trained and equiped
041449 - to coordinate support work with the Infusion Clinic.  He indicated
041450 - that coordinating with other departments is hard work that takes a lot
041451 - of time, and sometimes gets very complicated.  The Imaging Department
041452 - therefore asks patients to perform this part of case management.
041453 -
041454 -        [On 080716 Kaiser changes plan, access to Power Port and
041455 -        removing the Huber needle after the test will be performed in
041456 -        the CT Department; Millie's meeting in the Infusion Clinic on
041457 -        080718 1030 was cancelled by the CT Department. ref SDS 23 AN5I
041459 -  ..
041460 - Advised Cal that Mil has a meeting today for an eye examination with
041461 - the optomitrist at the Park Shadelands Clinic.  She will get the
041462 - prescription for Gastrografin while at the clinic for the eye exam
041463 - meeting.
041464 -
041465 -
041467 -  ..
0415 -
0416 -
0417 - 1511
0418 -
041801 - Infusion Clinic Schedule Configure Huber Needle for CT Test
041802 -
041803 - Called Kaiser to schedule meeting with the Infusion Clinic for
041804 - installing the Huber needle in the Power Port on 080718 1030, in time
041805 - for the CT test at 1100, as instructed by Cal, per above. ref SDS 0
041806 - DF6Y
041808 -  ..
041809 - Clinic is closed until 1330 for lunch.
041810 -
041812 -  ..
0419 -
0420 -
0421 - 1532
0422 -
042201 - Called Infusion Clinic back.
042202 -
042203 - Got an answering machine saying to leave message with patient account
042204 - number.
042206 -  ..
042207 - Left message that Millie needs meeting with Infusion Clinic on 080718
042208 - 1030 for "port access" in time for CT test at 1100, per Cal's
042209 - instructions earlier today, above. ref SDS 0 NU5O
042211 -  ..
042212 - Advised that Power Port work will be completed on 080708, per above.
042213 - ref SDS 0 DF8N
042215 -  ..
042216 - Kaiser's message said that the staff should respond within 48 hours.
042217 -
042218 -
042220 -  ..
0423 -
0424 -
0425 - 1626
0426 -
042601 - Infusion Clinic Proposes IV Needle Rather than Power Port for CT Test
042602 -
042603 - Bella called back.
042605 -  ..
042606 - She schedules work for the Infusion Clinic in the Oncology Department
042607 - at Kaiser in Walnut Creek.
042609 -  ..
042610 - Bella talked to Millie.
042612 -  ..
042613 - She said the Imaging Department made a mistake scheduling to use
042614 - Millie's Power Port with a Huber needle to inject contrast medium for
042615 - the CT test, as Cal planned earlier today, per above. ref SDS 0 DF6Y
042616 - Bella advised that technicians in the Imaging department cannot use a
042617 - Huber needle to inject contrast medium.
042618 -
042619 -        [On 080626 Catherine the nurse in the Infusion Clinic at UCSF
042620 -        reported experience accessing Power Ports for CT tests, this
042621 -        does not require a nurse or doctor to be on site during the
042622 -        test process. ref SDS 17 MZ5N
042624 -  ..
042625 - Millie asked what went wrong?  She related a lot of work the past few
042626 - months to use a Power Port for injecting CT test contrast medium in
042627 - order to avoid further injury to Millie's arm from needle puncture
042628 - wounds using a conventional IV, reported on 080425. ref SDS 6 FP6F  On
042629 - 080429 the primary care physician at Kaiser reported that specially
042630 - trained nurses in the Infusion Clinic can access the Power Port with a
042631 - Huber needle, which can then be used by the technicians in the Imaging
042632 - Department to inject contrast medium for CT tests. ref SDS 7 C85H
042633 - Planning to use a Huber needle with a Power Port to inject CT contrast
042634 - medium was reviewed a few days later by the medical team at UCSF on
042635 - 080501. ref SDS 8 TQ6F  The next day on 080502 The primary care
042636 - physician made a referral to the surgery department for upgrading
042637 - Millie's port catheter to a Power Port to inject CT test contrast
042638 - medium. ref SDS 9 VG5J  On 080606 the surgeon concurred, and planned
042639 - to put a Huber needle in the Power Port if surgery occurred less than
042640 - 4 days prior to the day required for port access. ref SDS 11 IT40
042642 -  ..
042643 - Bella said she was very sorry.  She proposed that Millie come into the
042644 - Oncology Infusion Clinic at 1030 before her CT test on July 18th, as
042645 - prescribed by the doctor, but instead of following the doctor's plan
042646 - for a specially trained nurse to access the Power Port with a Huber
042647 - needle in order to avoid puncturing her arm with a conventional IV
042648 - needle, Bella said the nurse will puncture Millie's arm with a
042649 - conventional IV needle, which can then be used to inject contrast
042650 - medium rather than the Huber needle planned by the doctor on 080429.
042651 - ref SDS 7 1H6Y
042653 -  ..
042654 - Millie was shocked, and began crying.  This is a very emotional issue
042655 - for reasons reported on 080425. ref SDS 6 FP6F  She asked Bella to
042656 - explain the reason for changing the work plan to the patient
042657 - assistant.
042659 -  ..
042660 - Patient stress and anxiety working with the Infusion Clinic, the
042661 - Oncology, Surgery, and Imaging Test departments reflected in Bella's
042662 - call today, fits the confusion and stress that occurred on 080609
042663 - working out the prescription for Millie's Neupogen treatments.
042664 - ref SDS 14 028F
042666 -  ..
042667 - Bella indicated that all of the patients who have problems with needle
042668 - injections for CT tests at Kaiser in Walnut Creek use the procedure
042669 - she outlines today of having a nurse in the Infusion Department hunt
042670 - for a vein and make a conventional needle puncture in the arm.
042672 -  ..
042673 - Bella related that nurses in the Infusion Clinic at Kaiser in Walnut
042674 - Creek are specially trained to find veins for patients who suffer
042675 - trauma from multiple needle punctures due to difficulties configuring
042676 - needle IVs.  She feels that Millie can come into the Infusion Clinic
042677 - and a specially trained nurse will configure a conventional IV needle
042678 - in Millie's arm without causing injury.
042680 -  ..
042681 - Bella was not familiar with Millie's patient history.  The primary
042682 - care physician found evidence from examination on 040318 that nurses
042683 - in the Infusion Clinic had difficulty finding veins for chemotherapy
042684 - drug treatments, performing blood draws, and tests, and this caused
042685 - severe trauma to Millie's arm. ref SDS 2 CO3G  As a result, at that
042686 - time on 040318 the primary care physician made a referral for the
042687 - surgery deparmtent to install a port catheter to solve the problem.
042688 - ref SDS 2 4G5G  Subsequently, on 040419 the surgeon implanted a port
042689 - catheter. ref SDS 3 PPSW  Thereafter, nurses in the Infusion Clinic at
042690 - Kaiser in Walnut Creek used the port for chemotherapy infusions and
042691 - blood draws, rather than conventional needle IV.  There was never a
042692 - report of any nurse in the Infusion Clinic ignoring the port and using
042693 - a needle in Millie's arm for chemotherapy infusion treatment, as
042694 - Bella seems to be proposing today.
042696 -  ..
042697 - Bella said the problem is that CT test technicians in the Imaging
042698 - Deparement are not trained to inject contrast medium with the Huber
042699 - needle.  She said Millie needs to have a nurse in the Infusion Clinic
042700 - perform that work.  The primary care physician noted on 040318 issues
042701 - that require specially trained nurses for port access. ref SDS 2 XU4L
042702 - Bella's concerns today were addressed in the doctor's recent letter on
042703 - 080429 proposing that Millie come into the Infusion Clinic to have
042704 - specially trained nurses do the "port access" work. ref SDS 7 C85H
042705 - Cal in the Imaging Department insisted today that Millie schedule port
042706 - access in the Infusion Clinic, per above. ref SDS 0 DF6Y  Why isn't
042707 - this sufficient?
042709 -         ..
042710 -        [On 080708 Power Port documentation cites warning that trained
042711 -        clinician should evaluate health of patient for getting CT test
042712 -        contrast medium injections through the Power Port. ref SDS 20
042713 -        EE5T
042715 -  ..
042716 - Bella said that "port access" with the Huber needle by nurses in the
042717 - Infusion Clinic is not sufficient protection for the patient.  She
042718 - feels patients should have a trained doctor or nurse make the actual
042719 - injection of contrast medium that flows through the Huber needle.
042720 - This makes sense, because on 080501 UCSF reported that port catheters
042721 - failed several years ago performing injections for CT test contrast
042722 - medium.  At that time, on 080531 UCSF reported changing equipment in
042723 - June of 2007 in order to solve the problem of patient safety, which
042724 - Bella describes today. ref SDS 8 TQ6F
042725 -
042726 -        [On 080626 Catherine the nurse in the Infusion Clinic at UCSF
042727 -        reported experience accessing Power Ports for CT tests, this
042728 -        does not require a nurse or doctor to be on site during the
042729 -        test process. ref SDS 17 MZ5N
042731 -         ..
042732 -        [On 080811 Kaiser reorganization took nurses trained to support
042733 -        Power Port technology from the Infusion Clinic to work in a new
042734 -        Interventionary unit, rather than use the Infusion Clinic staff
042735 -        to support CT tests. ref SDS 26 DE74
042737 -  ..
042738 - We considered having a nurse in the Infusion Clinic do the work as
042739 - Bella proposes.  Kaiser can schedule a meeting for Millie to get the
042740 - Huber needle port access and inject the contrast medium at that time?
042742 -  ..
042743 - Bella said that won't work because CT contrast medium has to be
042744 - injected in the Imaging Department as part of a continuous CT test
042745 - process.  She said this work must be supervised by a trained doctor or
042746 - nurse, because CT test technicians are not trained to use a Huber
042747 - needle for injecting CT test contrast medium.
042749 -  ..
042750 - Bella feels patient care is paramount.
042752 -  ..
042753 - We considered sending a specially trained doctor or nurse from the
042754 - Infusion Clinic to the Imaging Department to supervise the work on the
042755 - CT test in the manner Bella explains.
042757 -  ..
042758 - Bella said that would solve the problem, but Kaiser will not authorize
042759 - this procedure.
042760 -
042761 -        [On 080626 Catherine the nurse in the Infusion Clinic at UCSF
042762 -        reported experience accessing Power Ports for CT tests, this
042763 -        does not require a nurse or doctor to be on site during the
042764 -        test process. ref SDS 17 MZ5N
042766 -         ..
042767 -        [On 080811 Kaiser reorganization took nurses trained to support
042768 -        Power Port technology from the Infusion Clinic to work in a new
042769 -        Interventionary unit, rather than use the Infusion Clinic staff
042770 -        to support CT tests. ref SDS 26 DE74
042772 -  ..
042773 - There was discussion about the level of effort, skill, and experience
042774 - required to connect CT contrast equipment to a conventional IV, as
042775 - proposed for the first time today, compared with connecting to a Huber
042776 - needle, planned by the medical team?
042778 -  ..
042779 - Bella seemd to say these are identical connections.
042781 -  ..
042782 - Bella indicated the Infusion Department is concerned about patient
042783 - safety.
042785 -  ..
042786 - Kaiser's concern for safety deserves support, similar to Zan's
042787 - explanation a few days ago that patient safety required cancelling the
042788 - initial order for Neupogen using home care self-injection, and
042789 - required Millie to return drug vials for the cancelled order to the
042790 - Outpatient Pharmacy so that the Oncology Pharmacy could implement the
042791 - doctor's prescription for Millie to get Neupogen treatments by
042792 - professionals in the Infusion Clinic that avoid mistakes which occur
042793 - with home care self-injections due to lack of training, illustrated by
042794 - patient history in this case on 080609, ref SDS 14 IL6I, and cited as
042795 - a concern by Bella again today.  At that time, on 080609 Zan said
042796 - Kaiser policy and procedures are very strict to avoid double
042797 - prescriptions so that patients do not over medicate. ref SDS 14 K195
042799 -  ..
042800 - This seems to be a training and experience issue for nurses and
042801 - technicians about who can use a Huber needle.  A distinction that
042802 - affects patient care and safety between at CT test technician using a
042803 - Huber needle in a Power Port, rather than a conventional needle
042804 - puncture in the skin for injecting CT test contrast medium is not
042805 - clear in the record.  The record is clear that using conventional
042806 - needle IV punctures, as Bella proposes today, causes injury to the
042807 - patient, reported on 080425. ref SDS 6 FP6F
042809 -  ..
042810 - Bella went ahead and scheduled work in the Infusion clinic for "port
042811 - access" with a Huber needle on...
042812 -
042813 -              080718 1030
042815 -  ..
042816 - This schedule allows 30 minutes for a 5 minute job, leaving time for
042817 - delays and for Millie to walk over to the Imaging Department in time
042818 - for the CT test at 1100, per the schedule reported by Cal earlier
042819 - today. ref SDS 0 DF55
042820 -
042821 -        [On 080716 Kaiser changes plan, access to Power Port and
042822 -        removing the Huber needle after the test will be performed in
042823 -        the CT Department; Millie's meeting in the Infusion Clinic on
042824 -        080718 1030 was cancelled by the CT Department. ref SDS 23 AN5I
042826 -  ..
042827 - Bella feels work should be done over the next 4 weeks to coordinate
042828 - resolution of the assignment and responsibilities performing tasks
042829 - that overlap the CT test department and the Oncology Infusion Clinic.
042830 - If we need a doctor or nurse to show up for the test, these
042831 - arrangements can be made in time for the work to be performed on
042832 - 080718 at 1100.
042833 -
042834 -        [On 080619 Millie notified medical team at Kaiser and UCSF that
042835 -        CT test is scheduled to use the Power Port on 080718,
042836 -        ref SDS 16 YU6X; cites requirements to resolve protocol and
042837 -        certification issues over next 4 weeks. ref SDS 16 YV4R
042839 -         ..
042840 -        [On 080626 Catherine the nurse in the Infusion Clinic at UCSF
042841 -        reported experience accessing Power Ports for CT tests, this
042842 -        does not require a nurse or doctor to be on site during the
042843 -        test process. ref SDS 17 MZ5N
042845 -         ..
042846 -        [On 080627 primary care physician plans to support Millie's CT
042847 -        test on 080718 if nobody else is designated with skills and
042848 -        experience to access Millie's Power Port for injecting contrast
042849 -        medium. ref SDS 18 GO3G
042851 -         ..
042852 -        [On 080702 Millie's letter to medical team confirms that on
042853 -        080627 the primary care physician coordinated support by the
042854 -        Infusion Clinic to access the Power Port on 080718 in time
042855 -        for CT test at 1100; and further initiated planning that, if
042856 -        no one else is assigned, the primary care physician will
042857 -        personally press the button for the CT test using the Power
042858 -        Port on 080718. ref SDS 19 EQ3T
042860 -         ..
042861 -        [On 080708 Power Port documentation cites warning that trained
042862 -        clinician should evaluate health of patient for getting CT test
042863 -        contrast medium injections through the Power Port. ref SDS 20
042864 -        EE5T
042866 -         ..
042867 -        [On 080711 Bella in the Infusion Clinic did not receive
042868 -        Millie's letter coordinating the work on 080709, ref SDS 21
042869 -        RW4R; Paula, Director of Infusion Clinic Services, disclosed
042870 -        that nobody has contacted the Infusion Clinic with assignments
042871 -        for Millie's CT test on 080718. ref SDS 21 RW42
042873 -         ..
042874 -        [On 080715 Arlette called and reported the doctor solved
042875 -        coordination problems by arranging for a nurse in radiology
042876 -        with certificate to support CT testing with Power Ports;
042877 -        Millie's CT test is good to go on 080718. ref SDS 22 RB4N
042879 -         ..
042880 -        [On 080715 Millie's letter notifies Kaiser that UCSF will leave
042881 -        the Huber needle accessing the Power Port for chemotherapy
042882 -        treatment on 080717 in place for the CT test the next day at
042883 -        Kaiser on 080718, so the schedule today for the Infusion Clinic
042884 -        at Kaiser to access the port is not needed. ref SDS 22 AW9S
042886 -         ..
042887 -        [On 080718 Kaiser had difficulty accessing the Power
042888 -        Port causing CT test to fail with complications.
042889 -        ref SDS 24 LK3R
042891 -         ..
042892 -        [On 080724 UCSF disclosed that Huber needles injecting
042893 -        contrast medium under high pressure for CT tests have a
042894 -        higher standard of construction and safety than Huber
042895 -        needles used for blood draws and chemotherapy in the
042896 -        Oncology Infusion Clinic, ref SDS 25 OK63, this could
042897 -        mean that, if Millie's port was accessed in the Kaiser
042898 -        Oncology Infusion Clinic, and if the needle for high
042899 -        pressure injection, cited in manufacturer's Instructions
042900 -        for Use on Power Injection Procedures, reported 080708,
042901 -        ref SDS 20 JE7N, was not used, then problems doing the
042902 -        CT test on 080718 may not have been avoided simply by
042903 -        accessing the port in the Infusion Clinic. as scheduled
042904 -        on 080617 by Cal in the CT Department. ref SDS 15 DF6Y
042906 -         ..
042907 -        [On 080811 Kaiser reorganization took nurses trained to support
042908 -        Power Port technology from the Infusion Clinic to work in a new
042909 -        Interventionary unit, rather than use the Infusion Clinic staff
042910 -        to support CT tests. ref SDS 26 DE74
042912 -  ..
042913 - Options seem to be...
042914 -
042915 -        1.  Infusion Clinic makes port access with Huber needle and
042916 -            patient goes to Imaging Department; technicians connect the
042917 -            test equipment to the Huber needle, as they normally
042918 -            connect to a conventional IV needle, following planning by
042919 -            the doctor and the surgeon.
042921 -             ..
042922 -        2.  Same as step 1, except add a doctor or nurse from the
042923 -            Infusion Clinic to monitor work and recommend steps deemed
042924 -            necessary for safely using the Huber needle with the Power
042925 -            Port for injecting CT test contrast medium.  This would
042926 -            have the effect of training up the test technicians in the
042927 -            Imaging Department.  Nurses can report findings from
042928 -            experience to strengthen practices and procedures using
042929 -            Huber needles.
042931 -             ..
042932 -        3.  Perform the CT test at another Kaiser location, e.g.,
042933 -            Pleasanton, San Francisco, or at UCSF, where the protocol
042934 -            for using Power Port technology accessed with Huber needle
042935 -            for injecting contrast medium has already been developed.
042936 -
042937 -                [On 080711 Kaiser starting to work on protocol for CT
042938 -                tests with Power Ports and Huber needles, ref SDS 21
042939 -                JQ55; Kaiser proposes delaying CT test to have more
042940 -                time for the protocol and certification process,
042941 -                ref SDS 21 JR30; there seem to be 11 ways in which
042942 -                Kaiser can perform the CT test with the Power Port on
042943 -                080718. ref SDS 21 JR88
042945 -                 ..
042946 -                [On 080718 Kaiser had difficulty accessing the Power
042947 -                Port causing CT test to fail with complications.
042948 -                ref SDS 24 LK3R
042950 -                 ..
042951 -                [On 080811 Millie's next CT test was scheduled at
042952 -                Kaiser in Oakland where the CT Department has
042953 -                experience using Power Port technology. ref SDS 26 L543
042954 -
042955 -
042956 -
042957 -
042958 -
042959 -
042960 -
042961 -
0430 -