NHS Ayrshire & Arran guidelines
- sterile dressing pack
- one pair of sterile gloves
- plastic apron
- disposal bag and sharps bin
- port needle
- sterile transparent semi-permeable dressing (If port needle is staying insitu)
- antiseptic hand hygiene product
- chlorhexidine gluconate BP 2% & isopropyl alcohol 70% sponge applicator. Chlorhexidine gluconate BP 2% & isopropyl alcohol 70% wipe
- 2x 10mls 0.9% sodium chloride or 2x 10ml PosiFlush XS may be used – ensure the packaging stipulates XS as only these syringes are externally sterile
- 10ml leur-lok syringes
- blunt needle
- sterile infusion giving set
- sterile prescribed infusion product for administration
- infusion pump to deliver the product - Infusion devices must always be used when delivering treatment or fluids via a CVAD to reduce the risk of CVAD complications.
Procedure for commencing an infusion to a port that has not been accessed
An aseptic technique must be adhered to when commencing an infusion to a port. A trolley should be set up in the same way as to do the dressing change and flushing the line with the required equipment. The giving set must be primed using an aseptic technique and must not be run over a sink (This would significantly increase the risk of infection from sink organisms from splash back).
Do not prime giving sets prior to starting the procedure.
Please note that prior to commencing an infusion using a port steps 1 to 11 for accessing a port procedure must have been completed omitting drawing up the heparin in step 6.
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.
- 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.
- Open dressing pack onto clean area and open the necessary equipment onto the dressing pack aseptically.
- Wipe away surface anaesthesia at needle insertion site prior to the procedure and dispose (if applicable)
- Clean hands with alcohol gel as per the WHO 5 moments for hand hygiene and apply sterile gloves.
- Using aseptic technique draw up 2x 10ml 0.9% sodium chloride for flushing into Luer-Lok syringe or use 2x 10ml PosiFlush XS 0.9% sodium chloride syringes – ensure the packaging stipulates XS as only these syringes are externally sterile. Prime the gripper needle. Prime the sterile giving set with the sterile infusion fluid and keep on sterile field.
- 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.
- Feel the site of the port to identify its centre and stretch the patient’s skin between first two fingers of non dominant hand.
- 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). A sterile transparent semi- permeable dressing should be applied. Attach a Vygon TKO needle free device to the end of the lumen - Do not use needle free devices with extension sets.
- Attach a sterile 10ml 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.
- Flush the port with the 2x 10ml sterile 0.9% sodium chloride for flushing.
- Aseptically attach the primed sterile giving set to port aseptically. Open clamps. Use an infusion pump. Start the infusion.
- Apply sterile transparent semi-permeable dressing (If port needle is staying insitu)
- Remove PPE and clean hands with alcohol gel as per the WHO 5 moments for hand hygiene.
- Dispose of all waste appropriately as per waste management guidelines:
- Document procedure any problems, action taken and review date in the care bundle DRS 6104 (Appendix 5) and appropriate notes.