Accessing a port by Pamela Dockx.
Introduction.
Hi, I'm Pam Dockx.
And I'm a nurse on the oncology unit at Boston Children's Hospital.
Today, I will be talking about port-a-caths, which are a type of central venous access
device.
I will review the equipment needed to access the port, give a demonstration of how to access
the port, and review post-procedure care.
A venous access device, or port-a-cath, is designed to permit repeat access to the central
venous system without the presence of an external catheter.
The port-a-cath is implanted subcutaneously, usually on the anterior chest wall, although,
other sites may be used.
It is sutured to the muscle fascia.
Catheter Confirmation and Use.
The initial placement of the venous access device catheter tip is confirmed by radiographic
exam.
Catheter tip location is verified prior to use for patients with a previously placed
venous access device.
The patient's history and assessment should include current catheter function, a thorough
assessment of catheter dysfunction.
and if your medical record confirmation of the catheter tip placement is not available,
a radiographic confirmation will be obtained prior to using the device.
Equipment.
In order to access a port-a-cath you will need the following things.
A central venous catheter dressing tray, which includes sterile latex free gloves, a mask,
chlorhexidine sponge, a four by four gauze, an occlusive dressing, and tape.
Other items you will need are a right angle non-coring needle, topical anesthetic, such
as EMLA or Ela-Max, a needleless connector, and a 10cc sterile normal saline syringe.
Procedure.
Whenever possible, use topical anesthetic prior to access.
Explain the procedure to the patient and/or their parent to promote understanding and
cooperation.
Clean off the bedside surface you'll be working on to prevent the spread of infection.
You may want to ask your patient to lie down during the access as this makes it easier
to stabilize the port.
However, some patients may choose to sit up during the access.
Open the central venous access dressing tray and don a mask.
Perform hand hygiene, including a 30 second hand wash.
Open your sterile field.
Open your sterile, non-coring needle set, 10 mL sterile normal saline syringe, and needless
connector onto the sterile field.
Don sterile gloves.
Attach the needleless connector to the needle set and prime with several normal saline.
Close the clamp and return it to your sterile field.
Be sure to check your institution's policy in regards to which antiseptic agent should
be used to cleanse the skin prior to accessing the port.
Cleanse the skin with Chloraprep cleaning solution per your institution policy.
Utilize a 30 second scrub in a back and forth and up and down motion, including the entire
area where your dressing will adhere.
Palpate with the area of the implanted port with your non-dominant hand, locating the
center of the port's septum.
Rotate the site with each access.
Do not use the same hole for each access, as it will lead to skin breakdown.
With your dominant hand, firmly push the needle perpendicularly through the skin into the
device, until the needle meets the bottom of the device.
It is important that there be a small space between the needle and the skin line.
If flush with the skin, the needle length is too short, and there is an increased risk
of infiltration.
If necessary, support the space between the needle and the skin with a folded two by two
gauze to prevent rocking of the needle, which can cause damage to the septum and irritate
the skin.
Gently flush with 3 to 10 mLs of normal saline or aspirate for blood returned to verify proper
placement.
Apply an occlusive dressing.
If necessary, cover the wings of the extension set with a folded two by two gauze to prevent
inadvertent removal of the needle when taking off the occlusive dressing.
Of note, gauze placement is often used for short-term port-a-cath access to stabilize
the needle.
If needed in place for a longer period of time for continued needle stabilization, please
review your institution's infection control policy regarding how often to change the gauze
as it can be a medium for bacterial growth.
Apply tape around the tubing where it exits the dressing to ensure occlusivness.
Unclamp the extension tubing and gently flush with 3 to 10 mLs of normal saline and connect
to your administration set.
Date and initial your dressing.
If you're not connecting to an IV infusion, scrub the cap with alcohol for a minimum of
15 seconds and allow to completely dry.
Flush with 5 mLs of heparin, 10 units per mL, and disconnect the syringe, and clamp
the set.
Secure the port-a-cath to the patient at a second site by taping to the skin or pinning
to the clothing to prevent tension on the tubing and needle, which can cause an inadvertent
dislodgement.
Document the needle and dressing change in your patient's chart.
Post-Procedure Catheter Care.
Some other important information about port-a-caths.
Change the dressing when the non-coring needle is changed or if the dressing becomes loose
or soiled.
The dressing should remain occlusive at all times.
Use only non-coring needle sets, right angle.
These are available in various lengths, depending on the size of the patient.
Change the non-coring needle a minimum of every seven days.
The needle may need to be changed if you experience difficulty flushing or if you are unable to
obtain blood return.
This concludes our video on accessing a port.
Thank you for watching.
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