An implanted port is a central venous access device placed entirely beneath the skin for long-term, repeated access to the bloodstream. It consists of a small reservoir, typically located in the upper chest wall, connected to a catheter. This catheter is threaded into a large central vein, usually terminating near the heart, making it an effective route for administering medications, chemotherapy, blood transfusions, or drawing blood samples. The port’s self-sealing septum allows for multiple needle punctures without compromising the device’s integrity. Accessing this device is a sterile medical procedure that must be performed only by trained healthcare professionals (HCPs) to prevent serious complications like infection.
Preparing for the Access Procedure
Proper preparation is the first line of defense against infection and procedural failure when accessing an implanted port. The HCP reviews the medical order and gathers all necessary sterile supplies. Supplies include a dedicated port access kit, antiseptic swabs (often chlorhexidine-based), sterile gloves, masks for both the patient and the HCP, saline flushes, and a specialized non-coring needle.
Hand hygiene is performed before creating the sterile field, and both the patient and the HCP wear masks to minimize airborne contamination. The patient is positioned comfortably to ensure the port site is easily accessible and stable during needle insertion. The port site is inspected for signs of irritation, redness, or swelling, and the port is palpated to identify the exact location of the central septum for needle insertion.
Detailed Steps for Port Access
Access begins with cleansing the port site using the prescribed antiseptic solution, such as a chlorhexidine preparation. The antiseptic is scrubbed onto the skin and allowed to air dry completely. Once the skin is dry, the port is stabilized to prevent it from shifting during needle insertion.
The specialized non-coring Huber needle, connected to extension tubing and a saline-filled syringe, is inserted perpendicular to the skin, aiming for the center of the port septum. The needle is advanced with steady pressure until the tip contacts the hard back wall of the port reservoir, often felt as a “click” or resistance. The HCP then aspirates the syringe to check for blood return, confirming the needle is correctly positioned and the catheter is patent. Saline is flushed using a push-pause technique to clear any aspirated blood and verify that the fluid flows easily without causing pain or swelling.
Maintenance and De-accessing the Port
Once the port is accessed and placement is confirmed, the Huber needle is secured with a sterile, transparent dressing that covers the site and the needle base. This dressing must be changed regularly or immediately if it becomes damp, soiled, or loose, to maintain the sterile barrier. When the port is not actively infusing medication, patency is maintained through routine flushing with normal saline, often followed by a final lock solution like heparin or a saline lock. This flushing ensures the catheter remains clear of blood clots and drug precipitates.
When treatment is complete, the port is de-accessed to remove the needle. The line is flushed with a final solution, such as a heparin lock, while maintaining positive pressure on the syringe plunger during the final moments of withdrawal. This positive pressure technique helps prevent a backflow of blood into the catheter tip as the needle is removed. The needle is then quickly withdrawn straight out while the port is stabilized, and a sterile gauze is placed over the puncture site to manage any minor bleeding.
Recognizing and Managing Issues
Several complications can arise with an implanted port, and recognizing them quickly is necessary for patient safety. Any signs of trouble should prompt immediate notification of a healthcare provider, and the port should not be used for infusion until assessed.
Common Complications
Complications include:
- Local infection: Characterized by warmth, redness, swelling, pain at the site, or purulent drainage around the needle.
- Port occlusion: Manifests as an inability to aspirate blood return or resistance when attempting to flush the line, indicating clot formation. Attempting to forcefully flush a blocked line must be avoided, as it could dislodge a clot into the bloodstream.
- Extravasation or infiltration: Occurs if fluid leaks out of the port system into the surrounding subcutaneous tissue, causing swelling or discomfort during an infusion.
- Systemic complications: Such as fever or chills without an obvious source, which may signal a bloodstream infection related to the port, requiring immediate medical attention and blood cultures.