Implanted Ports: Procedure for Access and Care

Objective The learner will be able to: 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 Topical anesthetic Gloves (nonsterile) 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 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. Few studies with limited data have been conducted assessing sterile vs. nonsterile glove use during access and deaccessing procedures. Research to date concludes that there is no significant difference in infections observed between sterile and nonsterile gloved procedures (Camp-Sorrell, 2009). However, use of sterile bundles during catheter insertion has reduced the introduction of pathogens during insertions, which may advocate for sterile technique during accessing (Eisenberg, 2011).

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. Flushing procedure (amounts) per institutional protocol. Flushing procedures may vary depending on institution and traditional practice.

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.

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.

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

Documentation Assessment Use of device 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).

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.