ACCESSING AND DEACCESING AN IMPLANTED PORT
Implantable central vascular ports will be maintained as ordered; when orders do not indicate, implantable central vascular ports will be maintained as follows:
- Dressing and needle change at least every 7 days when device is in use, or
- Access, flush, and de-access performed every 4-6 weeks when device is not in use.
ACCESSING PORT
Perform hand hygiene
Preparation: If local anesthetic is desired, apply anesthetic cream as ordered and in accordance with manufacturer’s instructions for application (typically ½ - 1 hour prior to accessing) and cover with transparent dressing
Physician order is required for the use of an anesthetic
Prior to access procedure, follow discontinue procedure if applicable
Gather necessary equipment and supplies:
Huber needle with attached extension set and clamp
Sterile central catheter dressing kit with chlorhexidine applicator or povidone-iodine swab sticks
0.9% sodium chloride pre-filled syringe (10ml)
If dressing kit has sterile normal saline attached to the outside of the kit, remember to open and drop within the sterile field prior to procedure
Heparin pre-filled syringe (5ml of 100 units/ml) in a 10ml syringe
10 units/ml for patient <2yo (2ml of10units/ml)
Needleless connector (cap)
Alcohol Swabs
Sharps container
Biopatch (if needed)
Non-sterile gloves
Inspect vascular access device (VAD) site for signs and symptoms of infection, irritation, or other problems
Prepare port needle and flush syringes, flush port needle extension with saline.
Position patient so port is easily palpated. Ask patient to wear a mask or turn head away from site.
Palpate implanted port to determine location.
Cleanse port site with ChloraPrepTM solution in a circular motion beginning at center of port; continue cleansing until port diameter has been reached
Allow to air dry or dry according to manufacturer’s recommendation
Access port by stabilizing the port with thumb and forefinger of nondominant hand and grasping Huber needle hub of gripper device with dominant hand and insert into center of port until needle touches bottom of the reservoir
Aspirate for blood return to confirm patency. If there is no blood return, contact agency to discuss next steps
Once blood return obtained, flush using a ‘push/pause” method
DO NOT attempt to flush if resistance is met, contact agency
Flush line as ordered
Observe site for resistance, swelling, discomfort, to patient. If any of these symptoms should occur, pull needle back slightly and attempt to flush
If still has any of these symptoms may reattempt access again by using a new Huber needle
Place dressing on site as per dressing Central Line Dressing
Document time, date, and initials on border of transparent dressing
Huber Needle and transparent dressing is to be changed at least every 7 days
If signs or symptoms of infection are present, no blood return is noted, or unable to access after 2 attempts, notify agency and document
Document procedure and patient's response to procedure in the clinical note.
DE-ACCESS PORT:
Perform hand hygiene
Supplies required:
0.9% sodium chloride pre-filled syringe (10ml) o
Heparin pre-filled syringe (5ml of 100 units/ml) in a 10ml syringe
(2ml of 10 units/ml) for patient <2 y.o.
Alcohol swabs
Non-sterile gloves
Sharps container
2x2 gauze sponge o Band-Aid (if needed)
If continuous infusion has been running, turn off pump, clamp tubing, and disconnect from needleless valve or cap.
Flush port with 10 ml normal saline followed by 5 ml heparin.
For pediatric patients, (<2y.o.) flush with 5 ml NS, then 5 ml heparin (10 units/ml) or per MD order.
Remove transparent dressing.
Remove existing Huber needle as follows:
Stabilize the port with thumb and finger of non-dominant hand.
Grasp needle hub with dominant hand and withdraw using a straight upward motion. Activate safety device
Discard in Sharps container
Apply gentle pressure with sterile 2x2 gauze sponge and apply Band-Aid, if needed
For patient with blood disorders, monitor for bleeding
Assess site for complications; record as needed
Document procedure and patient's response to procedure in the clinical note
ADDITIONAL INFO: HHC Policy: HHC-Policy 8C.6
Patient Education Sheet: How-to-Access-a-Port
Video: Access-Deaccess Port