Policy # 2.13.5
UNIVERSITY OF IOWA COMMUNITY HOMECARE
SUBJECT:
Pediatric Implanted Port
PURPOSE:
To access and care for an implanted port.
EQUIPMENT:
Chloraprep swab stick
Vascular access needle (90 non-coring)
10ml luerlock syringes and needles
Tape
5-10ml normal saline
Heparin (if needed)
Valve
Skin prep
Adhesive remover
Transparent dressing
Sterile gloves
POLICY:
A.
A non-coring needle must be used to access the port. The point of the non-coring needle
slices the septum rather than cores it, so the septum reseals after needle removal. Do not
turn the needle once it is in the septum as this will damage the septum.
B.
Non-coring needles are changed every 7 days. For continued IV access, a dressing can be
applied over the needle. Dressings must be changed every 7 days when implanted port
needs reaccessing.
C.
If the port is being used more than once every 24 hours, flush with 5 ml of 10 u/ml
heparin after each use. To maintain patency of the implanted port, flush monthly with
5cc of 100 u/cc heparin.
D.
Do not use syringes less than l0cc in size. Smaller syringes create more the 25psi and can
damage the port.
Implanted Port, Care of Pediatric- 1
Policy # 2.13.5
PROCEDURE:
1. Explain procedure to patient.
2. Position patient in supine position. Wash hands and assemble equipment.
3. Flush non-coring needle and valve with 10ml normal saline keeping needle sterile.
4. Palpate port.
5. Cleanse skin over port using good friction with Chloraprep swabstick for 30 seconds. Allow
to dry for 30 seconds.
6. Wash hands and put on sterile gloves.
7. Locate port septum by placing thumb and forefinger of non-dominant hand on outer edges of
port. The septum is located between these outer edges.
8. Using dominant hand, hold non-coring needle and puncture skin and septum by inserting
needle perpendicular to port.
9. Push non-coring needle firmly through skin and septum until back of port is felt.
10. Open clamp. Aspirate blood to verify patency, then flush with 5cc to l0cc of normal saline.
While flushing, if resistance, pain or swelling is observed at the needle insertion site, the
needle may not be completely inserted in port. Readjust needle and reattempt to flush.
11. Skin protective agent may be applied.
12. Apply transparent dressing leaving distal end of tubing outside of dressings for easy access.
Secure tubing with tape to decrease tension on needle.
15.
16.
17.
Close clamp and:
a.
Remove saline syringe
b.
Attach IV tubing, or
c.
Attach heparin syringe and flush 5ml of heparin, close clamp, remove syringe
Remove gloves. Wash hands.
Document accessing of implanted port and/or application of dressing.
Implanted Port, Care of Pediatric- 2
Policy # 2.13.5
REMOVAL OF PORT NEEDLE:
1.
Wash hands thoroughly.
2.
Put on gloves.
3.
Check that port has been flushed with heparin. If not, flush port with heparin per above
procedure. When heplocking the port use 5cc of 100U/ml.
4.
Remove old dressing. Observe for redness, drainage, signs of infection or infiltration.
5.
Firmly grasp port with non-dominant hand. Remove needle using dominant hand by
grasping safety wings and pinching them together.
6.
Place Band-Aid or 2 x 2 gauze over site. Inform patient site dressing may be removed
within a few hours.
7.
Remove gloves. Wash hands.
8.
Document appropriately.
PRECAUTIONS, CONSIDERATIONS, AND OBSERVATIONS:
1.
Medical aseptic technique must be maintained when accessing port to prevent systemic
catheter sepsis.
2.
Only non-coring needles should be used to access ports. These needles are changed once
per week.
3.
Do not turn the needle once it is in the septum as this will damage the septum.
4.
Needle insertion site should be regularly assessed for signs of infiltration, infection or
irritation.
5.
If the patient is allergic to Chloraprep, Iodine swab sticks should be used. If the patient is
allergic to transparent dressing, use an adhesive wound dressing (e.g., Primapore or gauze
and tape).
6.
Dressings must be changed once every 7 days when implanted port needs reaccessing.
7.
Port must be flushed with heparin prior to deaccessing (unless unable to flush due to
malfunction of port).
RESEARCH REFERENCES:
Implanted Port, Care of Pediatric- 3
Policy # 2.13.5
Long Charlene M. et al. A Comparative Study of Nursing Protocols for Venous Access Ports.
Cancer Nursing, 15 (1), 1992, 18-21.
LITERATURE REFERENCES:
Baranowski, Leslie. Central Venous Access Devices. Journal of Intravenous Nursing, 16 (3),
May/June, 1993, 167-194.
Gullo, Shirley M. Implanted Ports: Technologic Advances and Nursing Care Issues. Nursing
Clinics of North America, Volume 28 #4, 859-871.
Intravenous Nursing Standards of Practice, 2011.
Rostad, Marcia. Intravenous Access Central Lines: Part III. Urologic Nursing-, 12 (4),
December 1992, 130-135.
Speer, E., et al. Central Venous Catheterization: Issues Associated with the Use of Single and
Multiple Lumen Catheters. Journal of Intravenous Nursing, 13 (1), 30-39.
Written: 1/97
Reviewed: 1/00, 6/01, 2/10, 9/15
Revised: 1/00, 6/01, 5/04, 2/06, 3/07, 6/12, 6/13
Approved By:
Nursing Staff UICH
Implanted Port, Care of Pediatric- 4