An implanted port is a small medical device, typically placed beneath the skin in the chest, providing long-term access to a vein for treatments like chemotherapy or blood draws. The port is accessed using a specialized port needle (Huber needle), which features a non-coring tip designed to penetrate the port’s silicone septum without damage. Removing this needle, known as de-accessing, requires a strict sterile technique to prevent infection and maintain device integrity. This procedure is generally carried out by a trained healthcare professional.
Essential Preparation and Required Supplies
A safe de-accessing procedure requires meticulous preparation to ensure sterility. Thorough hand washing or use of an alcohol-based sanitizer is essential to prevent introducing pathogens. The patient should be positioned comfortably, often lying down, to help stabilize the port during removal.
The necessary supplies must be gathered and organized on a clean surface. These items typically include non-sterile or sterile gloves, antiseptic wipes (such as CHG or alcohol), pre-filled syringes of normal saline and a heparin locking solution, sterile gauze pads, an adhesive bandage or small dressing, and a designated sharps container.
Step-by-Step De-Accessing Technique
Needle removal is preceded by a final flushing sequence to clear the catheter of residual medication or blood, preventing clot formation. The port is flushed with a minimum of 10 milliliters of normal saline, using a push-and-pause motion to create turbulence that cleans the catheter walls. A locking solution like heparin or a citrate solution is then administered based on protocol.
Maintaining positive pressure within the catheter prevents blood from flowing back into the catheter tip as the needle is withdrawn. This is achieved by injecting the last 0.5 milliliters of the flush solution while simultaneously clamping the tubing or withdrawing the needle. This action minimizes the risk of a blood clot forming, which is a common cause of port malfunction.
Once flushing is complete, carefully remove the dressing securing the needle. Anchor the port housing securely between two fingers of the non-dominant hand. With the port stabilized, pull the needle straight up and out of the septum in a single, controlled motion, maintaining a 90-degree angle to the skin. Many modern Huber needles incorporate a safety feature that shields the sharp tip immediately upon removal, preventing accidental needle sticks.
Immediate Post-Procedure Site Care
Immediately after needle removal, place a sterile gauze pad over the puncture site and apply gentle but firm pressure for several minutes. Applying pressure stems minor bleeding and reduces the likelihood of bruising or hematoma formation. Pressure application may take longer for patients on blood-thinning medications.
Once bleeding stops, inspect the site and apply a small adhesive bandage or sterile dressing to cover the puncture wound. This dressing protects the site from contamination while the skin heals. The bandage can typically be removed after a few hours, though some protocols suggest leaving it in place for up to 24 hours. The contaminated needle set must be disposed of immediately into a designated sharps container.
Recognizing and Addressing Adverse Events
Adverse events can occasionally occur during or after de-accessing. Signs of a localized infection include increasing redness, swelling, warmth, or pus-like drainage at the port site. A fever, chills, or general feeling of illness may indicate a more serious bloodstream infection.
Excessive or persistent bleeding that does not stop after several minutes of direct pressure warrants immediate attention. Catheter occlusion is another potential issue, typically recognized if the port is difficult or impossible to flush before removal. Forcing a flush against resistance should be avoided, as it can damage the port or catheter.
If a patient develops a fever, experiences uncontrolled bleeding, or notices severe pain or swelling, they should contact their healthcare provider immediately. Complications like catheter fracture or migration require urgent medical intervention.