Implanted Ports: Procedure for Access and Care

Objective

The learner will be able to:1.Demonstrate proper care of an implanted port.

Patient Selection and Preparation

• Requiring intermittent, long-term IV therapy• Active lifestyles (swimming/outdoor)• Unable to care for an external catheter• Inadequate peripheral veins

Supplies• Noncoring needle– Straight for flushing only– 90° angled for infusions– Power needles for power ports– Usually 1922 gauge

• Topical anesthetic• Gloves (nonsterile)• 2% chlorhexidine gluconate swabs• Gauze or transparent dressing• Syringes 10 cc or greater size• Heparin and normal saline injectables

Accessing• Wash hands. Apply gloves. Remove dressing.• Maintain strict aseptic technique at all times.• Assess site for signs of tenderness, leakage,

erythema, and drainage. Observe neck veins, extremity, and ipsilateral chest for swelling.

• Palpate portal body.• Rewash hands and apply new gloves.• Clean area over port diaphragm using a circular

motion, starting in the center and working outward, using 2% chlorhexidine gluconate swab.

• Allow to air dry.

Accessing (cont.)• Apply topical anesthetic (if used).• Stabilize port body edges firmly with one hand. • Insert needle into septum with the other hand,

stopping when the bottom of the reservoir is reached.

• Aspirate 35 ml blood to check for patency.• Flush 120 ml normal saline into port.• Stabilize port with stabilization device and tape.• If short-term infusion, cover site with gauze and

tape dressing.

During InfusionContinuous infusions: Dressings•Gauze/tape: Change q 48 hrs or when wet or soiled/nonocclusive.•Transparent: Change q 57 days or prn.•Occlusive dressing to any site when needle is left in; should be changed along with the needle once per week at minimum.•Light gauze/tape dressing is permissible during short-term infusions.•Ensure secured needle during infusion to decrease risk of extravasation.

Flushing

• Maintenance– Every 48 weeks when not in use– Flush all lumens.– Heparin 100 IU/ml; 5 ml heparin solution

• Flush with 1020 ml normal saline after infusing any medication or withdrawing blood.

Deaccessing

• Wash hands and apply gloves.• Maintain strict aseptic technique at all times.• Remove dressing and assess. Remove gloves.• Rewash hands and apply new gloves.• Flush all lumens.– Flush with 20 ml normal saline, then– Flush with 100 IU/ml; 5 ml heparin solution.

Deaccessing (cont.)• Stabilize port with one hand. • Maintain positive pressure while deaccessing by

flushing while withdrawing the needle from the septum.– During last 1 ml of flush, pull the needle from the port

septum.– Take care to push down on port edges to prevent

tugging it upward.• Apply pressure to site. Apply bandage prn.

Blood Drawing• Access port if not already accessed.• If already accessed, disconnect any infusate running

for at least one minute prior to drawing sample.• Remove and discard 510 ml blood.• Draw specimen(s).• Flush with 1020 ml normal saline.• Reconnect infusate, or follow deaccessing procedure.

Documentation• Assessment– Need for device – Systemic assessment of patient

• Use of device– Date, time, purpose of use– Assessment of device function and location prior to

use– Complications, if any– Confirmation of port access/blood return– Infusate information, if any

Patient Education

• Assess for learning needs and preferred learning format (verbal vs. written vs. visual).

• Teach signs and symptoms of infection and other complications to report to healthcare team.

• Teach home maintenance care (especially for external catheters).

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Camp-Sorrell, D. (Ed.). (2011). Access device guidelines: Recommendations for nursing practice and education (3rd ed.). Pittsburgh, PA: Oncology Nursing Society.

Cummings-Winfield, C., & Mushani-Kanji, T. (2008). Restoring patency to central venous access devices. Clinical Journal of Oncology Nursing, 12, 925934.

Eisenberg, S. (2011). Accessing implanted ports: Still a source of controversy. Clinical Journal of Oncology Nursing, 15, 324326. Smith, L. (2008). Alteplase for the management of occluded central venous access devices: Safety considerations. Clinical Journal of Oncology Nursing, 12, 155157.

Smith, L. (2008). Implanted ports, computed tomography, power injectors, and catheter rupture. Clinical Journal of Oncology Nursing, 12, 809812.