Ongoing Assessment and Care of an Implant Port

Anticipated outcome:

Patient will have an implanted port which is:

• Patent and when accessed that the needle is correctly secured
• Free from signs of infiltration, extravasation, thrombosis, and/or infection and where these complications do occur that they are managed effectively

Nursing Interventions:

Accessing Port:

• Apply tropical local anaesthetic cream 30-60 minutes (depending on type) prior to accessing port
• Use appropriate techniques to gain compliance whilst accessing port e.g. distraction, play therapy
• Ensure comfort and correct positioning of patient during accessing
• ONLY use non coring (Huber) safety needles and 10ml or larger syringes
• Check for blood return once needle is inserted and use appropriate methods to check position e.g. position, deep breathing, if blood return is sluggish or absent
• Flush with 0.9% sodium chloride to check there is no pain or swelling at site

Matching a patent device:

• Check for blood return on each admission – if no blood return follow algorithm where appropriate
• Flush all devices with at least 10ml 0.9% sodium chloride at start of drug administration, in between drugs and after drug administration (see policy)
• Flush all devices using turbulent flush and ending with positive pressure
• ONLY 10ml or larger syringes to be used for all drug administration
• When not in constant use – flush the implanted port with 500 units heparin in 5ml 0.9% sodium chloride every 8 weeks or as directed by hospital

Preventing infection:

• Use an aseptic technique whenever the device is manipulated
• Requires no dressing unless port is accessed the use gauze to support needle and cover with Opsite IV 3000 and change dressing at weekly needle change. Label dressing with date
• If allergic to transparent dressing the apply appropriate dressing
• Change port needle and extension set/clave connector every 7 days if in continuous use

Prevent movement or dislodgement of needle:

• Tape administration/extension set to prevent the tubing from pulling on device

Monitor site for signs of local complications:

• Observe site for erythema, oedema, blanching and ask the patient if any pain or discomfort experienced
• If extravasation occurs – follow extravasation policy
• If signs of infection, swab insertion site and send for M, C & S,, do not use port and inform doctor

Monitor patient for signs of systemic infection (rigors, pyrexia, tachycardia):

• Inform the doctor if temperature rises above 38°C or any of above signs
• Take blood for blood cultures from peripheral veins (where appropriate) and implanted port

Monitor patient for thrombosis – pain and/or swelling in neck, shoulder or arm:

• Inform doctor of any of the above symptoms
• Ensure appropriate anti-coagulant is prescribed and administered as required

Identify any complication and inform doctor of any complications during administration of treatment via implanted port

Liaise with the Nurse Consultant IV Therapy for advice as necessary

Discharge:

• Notify District Nurse and organise for flushing of device as appropriate

Removal of the needle:

• Ensure the port has been flushed with Heparin 600units in 6ml using a 10ml or larger syringe
• On removal of needle ensure safety mechanism is activated
• Apply a dressing to site

Inform and discuss with patient/carer/parent:

• The insertion procedures and the hazards, instructing the patient about the importance of positioning during insertion, and advise the patient to report if any of the following occurs after the insertion of implanted port: feelings of breathlessness and cough, chest pain, pain over shoulder
• The function, potential side effects and implications of the implanted port including potential thrombosis (swelling in neck or arm), potential infection (pain/redness at implanted port site), potential occlusion, and advise the patient how to mobilise and care for the implanted port in situ
• Advise the patient of the importance in reporting to the nurse/doctor if they have any symptoms, and that a record is kept for future therapy

Date:  January 2024

Version: 5 (Review)

Source:  Expert Care Manager