According to a 2009 study, approximately 5 million central venous catheters are placed each year. Implantable ports provide reliable venous, arterial, epidural and peritoneal access and can be used to administer IV fluids, medications and to obtain blood samples. However complications including occlusion, infection, catheter migration and catheter separation from portal body can frequently occur.
A recent study conducted in a rural hematology-oncology clinic focused on infection. A port infection can present as local tenderness, pain, erythema, induration or edema at the insertion or exit site or over the port pocket. Patients may also have purulent or serous drainage, fever and chills. To prevent infection, aseptic technique should be utilized for dressing changes. In addition, clinicians should follow accessing and deaccessing procedures and keep the exit clear of potential sources of infection. The 62 patients included in the study were receiving a minimum of two complete cycles of chemotherapy after port insertion. Ports were accessed and deaccessed following outlined protocol.
*Steps for Accessing Ports:
- Wash hands. Assess the port site for erythema, warmth or drainage.
- Palpate the outline of the portal body.
- Wash hands.
- Apply nonsterile gloves. Cleanse port site with chlorohexidine swab in a circular motion for 30 seconds. Allow to dry for 30 seconds.
- Spray ethyl chloride.
- Stabilize portal body with one hand. Insert Huber needle (link to EZ Huber product page) into septum with other hand. Ensure patency by blood return. If no blood return, use interventions to assess port's patency.
- Stabilize port with gauze and tape or apply transparent dressing.
*Steps for Deaccessing Ports:
- Wash hands. Apply nonsterile gloves.
- Inspect exit site.
- Flush device with 20 ml normal saline followed by 5 ml heparin flush (100 units/ml). During final flush, clamp tubing to port.
- Stabilize port and remove needle.
- Apply bandage.
Six of the 62 patients in the study experienced a port infection, with four of the six ports requiring removal. The total number of catheter days for the implanted ports was 7,277. Patient catheter days ranged from 32-288. The study concluded that consistent, routine care is the best preventative measure against port complications. The entire study can be found in the October 2009 issue of the Clinical Journal of Oncology Nursing.
*The port access and de-access protocols are those that were used by the authors for this study. Please follow institutional policies and procedures regarding port access and de-access.