Implanted Ports: Procedure for Access and Care

1. Implanted Ports: Procedure for Access and Care

2. Objective The learner will be able to: • Demonstrate proper care of an implanted port.

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

4. Supplies • Noncoring needle • Straight for flushing only • 90° angled for infusions • Power needles for power ports • Usually 1922 gauge • Topical anesthetic • Gloves (nonsterile) • 2% chlorhexidine gluconate swabs • Gauze or transparent dressing • Syringes 10 cc or greater size • Heparinand normal saline injectables

5. 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.

6. 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 35 ml blood to check for patency. • Flush 120 ml normal saline into port. • Stabilize port with stabilization device and tape. • If short-term infusion, cover site with gauze and tape dressing.

7. During Infusion Continuous infusions: Dressings • Gauze/tape: Change q 48 hrs or when wet or soiled/nonocclusive. • Transparent: Change q 57 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.

8. Flushing • Maintenance • Every 48 weeks when not in use • Flush all lumens. • Heparin 100 IU/ml; 5 ml heparin solution • Flush with 1020 ml normal saline after infusing any medication or withdrawing blood.

9. 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.

10. 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.

11. 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 510 ml blood. • Draw specimen(s). • Flush with 1020 ml normal saline. • Reconnect infusate, or follow deaccessing procedure.

12. 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

13. 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).

14. References Camp-Sorrell, D. (2009). Accessing and deaccessing ports: Where is the evidence? Clinical Journal of Oncology Nursing, 13, 587590. 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, 925934. Eisenberg,S. (2011). Accessing implanted ports: Still a source of controversy. Clinical Journal of Oncology Nursing, 15, 324326. Smith, L. (2008). Alteplase for the management of occluded central venous access devices: Safety considerations. Clinical Journal of Oncology Nursing, 12, 155157. Smith, L. (2008). Implanted ports, computed tomography, power injectors, and catheter rupture. Clinical Journal of Oncology Nursing, 12, 809812.