venous port

Patient care

Venous access ports are useful for patients requiring intermittent intravenous (IV) therapy such as chemotherapy or antibiotics, parenteral nutrition, blood products, or IV fluids, and/or intermittent blood sampling. The port may be implanted for 3 months to several years. It consists of a self-sealing silicone rubber septum (resembling the head of a stethoscope and measuring 7 to 10 mm in diameter) covering a metal or plastic reservoir and a silicone catheter connecting the reservoir to a central vein. Ports may have one or two lumens. The dual-lumen port has two noncommunicating reservoirs with their own catheters in a single port body. The most common site for port implantation is in the anterior chest below the clavicle, although other sites such as the upper arm are options. Once the site heals (5 to 7 days), the skin covering the device protects the patient from infection. Ports also may be open-ended (requiring flushing with a heparinized saline solution to prevent clotting, or valved (with no flushing needed between uses). The patient should be aware of which type device has been implanted, or should carry a wallet card identifying the device. When a port is not in active use the patient can participate in normal activities.

Sterile technique should be used when accessing a port. A topical anesthetic spray or cream should be applied, if the port has been recently implanted, or if the patient requests analgesia to prevent or reduce discomfort. The patient is positioned, so the site is easily viewed. The septum is palpated (unless newly implanted), and assessed for signs and symptoms of infection, such as redness, swelling, pain, and local warmth. Any infection should be documented, the patient’s primary health care provider notified, and the site not accessed. For access, the port septum should be localized and stabilized using the nondominant hand, stretching the skin taut with the thumb and first two fingers. Patient anxiety about the procedure can be eased by speaking reassuringly to the patient throughout, explaining what is being done and the rationale for each action. The site is then prepared following agency procedure. The primed, noncoring needle (20 gauge is appropriate for most injections and infusions) is then held perpendicular to the septum with the dominant hand and inserted at a point between the thumb and fingers. Minimal resistance should be noted as the skin and port septum are punctured. The needle (which should be just long enough to reach the back of the port) is then advanced until the needle stop hits the back of the septum and the bottom of the reservoir is encountered, and blood is aspirated to verify correct needle placement. If resistance is encountered when inserting the needle, it may not be in the middle of the septum. If this occurs, the needle is carefully withdrawn and discarded, and a new, primed needle used. When accessing the port for an infusion, the wings of the noncoring needle are then secured with sterile wound closure strips or sterile tape. A skin protectant solution may be applied if this is part of local institutional protocol.

During continuous use, a needle can remain in place up to 7 days, although most agencies recommend change every 3 to 5 days. The venous access port is flushed per the institution's protocol, prior to being deaccessed. Following administration of prescribed therapy, the port is deaccessed. Hands are washed and nonsterile gloves are donned. Any dressing and tape are removed, and the skin held taut over the port using thumb and first two fingers. Maintaining light pressure on the port body, the needle is pulled straight out in a smooth movement, avoiding side-to-side movements that could damage the septum. A small amount of capillary bleeding may occur at the needle site, which is then covered with an adhesive bandage as desired. Documentation should include needle size, prescribed infusions or bolus dosings, needle and dressing changes and dates, patient tolerance of therapy(ies), complications, blood draws, and any changes in the patient’s physical assessment.