Please refer to Table 1.below for recommended flushing instructions for particular procedures. Ports can be placed in either the arm or the chest.

Table 1: Recommended flushing volumes for ports.

Prescribed surface anaesthesia (ie Emla cream) may be used to anaesthetise the surface area of the skin. If required patients are usually advised to apply this 20-60minutes prior to having the procedure performed.

• sterile gloves
• sterile dressing pack
• chlorhexidine 2% in 70% alcohol sponge applicator
• port needle
• sterile 10ml Luer-Lok syringes N.B. no syringe smaller than a 10ml Luer-lok should be used
• blunt needles
• 20ml 0.9% sodium chloride for injection (2x 10ml Luer-Lok syringes) or use two 10ml PosiFlush XS 0.9% sodium chloride syringes – ensure the packaging stipulates XS as only these syringes are externally sterile
• 5ml heparinised 0.9% sodium chloride (100iu/ml)
• Vygon TKO needle free device - Do not use needle free devices with extension sets
• disposal bag and sharps bin
• sterile transparent semi-permeable dressing (If port needle is staying insitu)

Please note: if your hands are not socially clean and you need to wash your hands with soap and water (rather than alcohol gel), this must be carried out a minimum of 2 meters away from the working surface/dressing trolley and any CVAD equipment.

1. Clean working surface/dressing trolley with detergent wipe and allow to fully dry for at least 30 seconds. Clean hands with alcohol gel as per the WHO 5 moments for hand hygiene. Put on a plastic apron.
2. Open dressing pack onto clean area and open the necessary equipment onto the dressing pack aseptically.
3. Wipe away surface anaesthesia at needle insertion site prior to the procedure and dispose (if applicable).
4. Clean hands with alcohol gel as per the WHO 5 moments for hand hygiene and apply sterile gloves.
5. Using aseptic technique draw up 20ml 0.9% sodium chloride for flushing into 2 10ml Luer-Lok syringes or use two 10ml PosiFlush XS 0.9% sodium chloride syringes – ensure the packaging stipulates XS as only these syringes are externally sterile. Draw up heparin as per instructions in Table 1 (see Procedure for maintenance of a port section).
6. Prime the port and infusion set with approximately 2mls of the 20ml sterile 0.9% sodium chloride and close the clamp on the set. Leave on the sterile area.
7. Cleanse the patient’s skin (at least 10-13cm in diameter) around and across port site using chlorhexidine 2% in 70% alcohol sponge applicator for 30 seconds. Allow to dry completely for 30 seconds.
8. Feel the site of the port to identify its centre and stretch the patient’s skin between first two fingers of non dominant hand.
9. Insert port needle into the centre of the port septum. Advance needle through the skin and septum until reaching bottom of the reservoir (see figure 4). If the needle has to remain in place a sterile transparent semi-permeable dressing should be applied. Attach Vygon TKO needle free device to the end of the lumen - Do not use needle free devices with extension sets.

   

10. Confirm correct position of the needle within the port reservoir by aspiration of blood. Attach a sterile 10 Luer-Lok syringe. Open the clamp and withdraw 5-10mls stagnant blood from port. Close clamp. Discard syringe containing this blood into the sharps container.
11. If laboratory blood specimens are required then these can be taken next with a 10ml sterile Luer-Lok syringe.
12. Attach the syringe containing the sterile 0.9% sodium chloride for flushing to the end of the infusion set. Open the clamp. Flush the port with 2 x10mls of sterile 0.9% sodium chloride using a push/pause technique until the last 1ml and close the clamp on the last push.
13. Attach the syringe containing the sterile heparinised 0.9% sodium chloride for locking the port to the end of the infusion set. Open the clamp. Flush the port using a push/pause technique and close the clamp as the remaining heparinised 0.9% sodium chloride is pushed in, then remove port needle.
14. Once port care has been completed if a blood sample has been taken the syringe with the blood should gently agitated prior to transferring into the  appropriate laboratory blood bottles over the sterile field at waist level. If blood is left to sit in the syringe for a few minutes the blood sediments therefore red cells drift down and plasma/platelets are left at the top. If the syringe is not gently agitated prior to transferring into the blood bottles there is a risk of either concentrated red cells (elevated haemoglobin and Haematocrit) or dilute plasma (reduced haemoglobin and Haematocrit) – so the full blood count result could be inaccurate. If obtaining blood cultures follow the procedure for blood culture sampling
15. Remove PPE and clean hands with alcohol gel as per the WHO 5 moments for hand hygiene.
16. Dispose of all waste appropriately as per waste management guidelines:
    1. NHS Ayrshire & Arran segregation of waste policy
    2. NHS Ayrshire & Arran waste disposal policy.
17. Document procedure any problems, action taken and review date in the care bundle DRS 6104 (Appendix 5) and appropriate notes.

Please note: If a port is accessed for more than 48hrs an antimicrobial chlorhexidine sponge disc dressing should be placed around the port needle (once the port needle is in situ)

Port needles need to be replaced every 7 days. The new port needle should be inserted after the site has rested for as long as clinically possible (e.g. between antibiotics or duration of TPN rest period)

Patient group directions (PGDs) for CVADs:

HBN 23051: 0.9% sodium chloride (CVADs)

HBN 21224: heparin sodium chloride (CVADs)