An implanted port, often called a Port-a-Cath, is a central venous access device entirely situated beneath the skin. It provides a long-term, reliable entry point into the patient’s bloodstream. Typically placed in the chest area, the device connects a small reservoir (portal chamber) to a catheter threaded into a large central vein, such as the superior vena cava. Ports are used for repeated, prolonged treatments like chemotherapy, frequent blood draws, or long-term antibiotic administration, which would otherwise damage smaller peripheral veins. Accessing this device requires a strictly sterile technique and must only be performed by trained healthcare professionals, usually nurses, to maintain patient safety and prevent serious infection.
Pre-Procedure Preparation and Site Assessment
The nurse must ensure all necessary equipment is gathered and the patient is fully prepared before beginning the access procedure. Required supplies include a specific non-coring needle (Huber needle), a sterile dressing kit, an antiseptic solution, flushing syringes containing normal saline, and sterile gloves. The non-coring design of the Huber needle is essential because it prevents the needle tip from removing a core of the silicone septum upon insertion, preserving the port’s integrity for repeated use. Huber needles come in various gauges and lengths, which are selected based on the required flow rate and the depth of the port beneath the skin.
Patient identification and consent are confirmed, and the patient is positioned comfortably to allow easy access to the port site. The nurse must carefully inspect the skin overlying the port for any potential issues before proceeding. This assessment includes checking for signs of infection, such as redness, swelling, or drainage, and confirming the skin’s integrity and the absence of unusual tenderness or pain. If the site appears compromised, the procedure is halted, and the healthcare provider is notified immediately.
The Aseptic Technique for Port Access
Maintaining a strict aseptic technique is essential to prevent introducing pathogens into the bloodstream. After thorough hand hygiene, the nurse and the patient must wear face masks to minimize airborne contamination during the sterile procedure. A sterile field is established, and all necessary sterile supplies are placed within this field. The selected Huber needle is primed with normal saline to remove all air from the tubing before insertion, preventing an air embolism upon connection to the patient.
The skin over the port is prepared using a specified antiseptic agent, most commonly 2% chlorhexidine gluconate and 70% isopropyl alcohol (CHG/IPA). The solution is applied vigorously using a back-and-forth or scrubbing motion over the site for a recommended time, often 30 seconds. The nurse must then allow the antiseptic solution to air dry completely, which is crucial for its germ-killing effect before the needle is inserted. Palpating the port chamber is necessary to locate the center of the septum, which feels like a spongy, raised area beneath the skin.
The port is stabilized firmly between the thumb and forefinger of the non-dominant hand. The non-coring needle is grasped and inserted perpendicular to the skin, at a 90-degree angle, directly into the center of the septum. A confident, firm push is required to penetrate the skin and the septum until the tip of the needle makes firm contact with the rigid backplate of the port chamber.
Once the needle is fully seated, placement is confirmed by gently aspirating with a 10 mL syringe or larger. The withdrawal of a brisk blood return confirms the needle is correctly positioned within the port reservoir and the catheter is patent. The port is then flushed with a volume of normal saline, typically 10 to 20 mL, using a turbulent or push-pause flushing technique. This technique involves intermittent, short bursts of fluid injection, which creates turbulence within the catheter lumen to dislodge any potential buildup of blood or fibrin.
Post-Access Care and Ongoing Maintenance
After successful access and confirmation of patency, the needle hub is secured to the skin to prevent accidental movement or dislodgement. A sterile transparent dressing is applied over the site and the needle, ensuring the insertion point is completely covered and the dressing edges are occlusive. The dressing should be labeled with the date and time of insertion, along with the nurse’s initials.
For continuous access, the needle and dressing are typically changed every seven days, though this frequency may vary based on the specific type of dressing used and facility policy. Ongoing patency of the catheter is maintained through routine flushing, which is performed after every use and at regular intervals when the port is not in active use. This involves flushing with normal saline followed by a small volume of a heparinized or saline lock solution, depending on the facility’s protocol.
The final step of the flushing procedure incorporates a positive pressure technique to prevent blood reflux into the catheter tip. This involves clamping the extension tubing while simultaneously maintaining pressure on the syringe plunger as the last portion of the lock solution is administered. This positive pressure within the line helps ensure the catheter tip is filled with the lock solution, reducing the risk of clot formation and subsequent occlusion.
Troubleshooting Common Issues and De-Accessing
Nurses may encounter several issues during port use, the most common being an inability to obtain a blood return or sluggish flow. If blood return is not immediately achieved, the nurse should first check the tubing for kinks or clamps and then ask the patient to change position, such as coughing or raising their arms, as this can sometimes reposition the catheter tip. If the port flushes easily without resistance but blood return remains absent, the port may still be used for non-vesicant infusions, but the absence of blood return must be thoroughly documented.
Difficulties with flushing, indicated by resistance or pain, require the nurse to stop immediately, as forcing a flush can damage the port or rupture the catheter. When the port is no longer needed for infusion therapy, it must be safely de-accessed, which involves a final flush and the use of the positive pressure technique.
De-Accessing Procedure
The nurse first flushes the port with normal saline, followed by the final lock solution, utilizing the push-pause method and the positive pressure clamping action. The port is stabilized with one hand while the non-coring needle is removed with a smooth, swift motion.
The needle is pulled straight out at a 90-degree angle, maintaining the positive pressure technique until the needle is completely clear of the septum. This action helps prevent blood from being drawn back into the catheter lumen as the needle is withdrawn, which is a common cause of port occlusion. Once the needle is removed, light pressure is applied to the site for a brief period to ensure hemostasis before a small, simple dressing is applied. The used needle is immediately discarded into a sharps container.