A chest port, or Port-a-Cath, is a small medical reservoir placed completely beneath the skin, typically in the upper chest. It connects to a large central vein near the heart via a thin catheter. This device provides reliable, long-term access to the bloodstream for treatments like chemotherapy, intravenous fluids, blood transfusions, or blood draws. It eliminates the need for repeated peripheral needle sticks, benefiting patients requiring frequent therapy.
Essential Preparation and Supplies
Accessing a chest port requires strict adherence to sterile technique to prevent bloodstream infection. Only trained medical personnel, such as a nurse or physician, who understand aseptic protocols should perform the procedure. Before starting, the professional must perform thorough hand hygiene, often involving a 30-second hand wash, and don appropriate personal protective equipment, including a mask and sterile gloves.
Supplies are usually gathered in a specialized port access kit to maintain a sterile field. This kit contains items like sterile gloves, a transparent dressing, and a skin cleaning solution, most commonly chlorhexidine gluconate (CHG). A non-coring Huber needle is specialized and angled, designed to penetrate the port’s silicone septum without cutting out material that would damage the port.
Before skin preparation, the patient is positioned comfortably, often lying down, to allow the practitioner easy access and port stabilization. The practitioner must carefully palpate the skin over the port to locate the center of the septum, which is the self-sealing access point. Topical anesthetic cream may be applied beforehand to numb the area for sensitive patients, though this is not always required.
Step-by-Step Access Procedure
Once the sterile field is established, the skin over the port must be prepared meticulously with an antiseptic solution. Chlorhexidine is applied using a scrubbing motion over the entire area where the dressing will adhere, typically for a minimum of 30 seconds. It is important to allow the antiseptic to fully air-dry according to the manufacturer’s directions, usually for 30 seconds to one minute, to ensure maximum antimicrobial effect.
The non-coring Huber needle is prepared by attaching a needleless connector and priming it with sterile saline solution to expel air. The practitioner stabilizes the port between two fingers of their non-dominant hand, gently stretching the skin to hold the port firmly. With the dominant hand, the needle is inserted straight down at a 90-degree angle, perpendicular to the skin.
The needle is pushed firmly through the skin and septum until the tip hits the back of the port chamber, indicating secure placement. Correct placement is verified by gently aspirating with an attached saline syringe to ensure a blood return, confirming the catheter is positioned within the vein. Following confirmation, the practitioner flushes the port with 3 to 10 milliliters of sterile saline using a gentle push-pause technique to clear the line and check patency.
After successful flushing, a sterile, transparent dressing is applied over the inserted needle and the entire port site. This occlusive dressing stabilizes the Huber needle and maintains the sterile barrier against external contamination. In some cases, a medicated disc containing CHG may be placed around the insertion site before the transparent dressing is applied for infection prevention.
Maintaining the Accessed Port
Once a port is accessed, ongoing management ensures its safety and functionality until the needle is removed. The sterile transparent dressing must remain occlusive and should be changed at least every seven days, or immediately if it becomes loose, damp, or soiled. This regular change maintains the sterile field around the puncture site, reducing infection risk.
The Huber needle and attached extension set can remain in place for up to seven days before requiring replacement with a new, sterile needle set. Between treatments, the accessed port requires routine flushing with sterile saline solution to prevent blood from clotting within the catheter lumen. Depending on policy, a small volume of a blood thinner, such as heparin solution, may be administered after the saline flush to “lock” the port and prevent thrombotic occlusion.
Patients and caregivers must monitor the accessed site closely for signs of complications. These signs include new or increased pain, swelling, redness, warmth around the port site, or fluid leakage from beneath the dressing. Difficulty flushing the port, or inability to draw blood back, can signal a mechanical issue like catheter occlusion or “pinch-off” syndrome, requiring immediate medical evaluation.
When the port is no longer needed, the procedure is reversed through de-accessing. The practitioner removes the sterile dressing and, while stabilizing the port, quickly withdraws the Huber needle at the same 90-degree angle it was inserted. Gentle pressure is then applied to the site before a small sterile bandage is placed over the puncture mark.