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Portacath Access Procedure

Procedure for accessing implanted devices using a non-coring needle:

  • Anaesthetic cream may be used over the access site if necessary.
  • Frequency of needle change- as directed by the referring hospital, normally once a week.
  • The needle should be removed earlier if any signs of inflammation/infection are observed.

Equipment:

  • Tray or clean surface.
  • Apron
  • Sterile dressing pack or sterile dressing towels.
  • Detergent wipes/70% alcohol wipes to clean the tray or the surface.
  • chlorhexidine wipes
  • A 90-degree, Non-Coring Port needle (also called a Huber needle) or PowerLoc needle for PowerPort.
  • Needle free access device e.g., Codan Swanlock.
  • Sterile transparent dressing with high moisture/vapour transmission rate e.g., IV3000.
  • 10ml 0.9% Sodium Chloride.
  • 6ml heparinised saline (100u/ml)- if prescribed by the trust.
  • Blunt needle and/or filter needles for drawing up.
  • 10ml Syringe x 2.
  • 3ml 2% Chlorhexidine sponge applicator (e.g., Chloraprep) x1

Technique:

  • Social handwash with liquid soap.
  • Collect the equipment needed and clean the assigned surface or tray with a detergent wipe and dry with a paper towel or allow to dry naturally. Wipe the surface again with a sanicloth wipe and allow to dry.
  • Perform a 6 stage handwash with liquid soap.
  • Open the sterile towel and unfold touching the edges only and place on the surface to create a sterile field.
  • Check the contents of the sodium chloride/ heparinised saline and clean the vile with an alcohol wipe before placing on the sterile field. Open the syringe, needle, gripper needle and place on the surface.
  • Open the sterile gloves and place on the surface away from the sodium chloride.
  • Open the second dressing towel and place on the client’s chest.
  • Apply alcohol gel to hands and allow to dry before then put on sterile gloves.
  • Using 2% Chlorhexidine sponge applicator (chloraprep) disinfect the area around the access site in a circular motion moving outwards to a diameter of 10cm (4 inches). Ensure contact time of at least 30 seconds over the site.
  • Allow area to air dry naturally.
  • Connect the non-coring needle with extension set to a 10ml syringe with 0.9% sodium chloride. Prime the line. Leave 0.9% sodium chloride syringe attached.
  • Immobilise the “port” by placing a finger each side, avoiding the access site.
  • With the needle at a 90-degree angle from the skin, insert the needle into the centre of the portal chamber until you feel the needle hit resistance at the back of the chamber.
  • Confirm placement by withdrawing blood and flushing with sodium chloride using the push/ pause technique, checking that it does not infiltrate the surrounding tissue. Occasionally it is not possible to draw blood back. This does not necessarily mean that the port is not working. If it flushes easily and does not cause any discomfort to continue with the flushing procedure.
  • Clamp the line.
  • Remove the sodium chloride syringe.
  • If prescribed -Attach the heparin 100units per ml syringe, unclamp the line and flush the line using the push/pause technique until 1 ml is left in the syringe. – Start to push in the last ml of heparin and clamp the line whilst continuing to do this (clamping the line under pressure).
  • Apply the transparent dressing over the site ensuring that the needle is secured.
  • Attach green curos cap if available until the next time the portacath is accessed.
  • Label the site with date, time, and nurse’s initials.

Additional Information

Portacath should be accessed by an appropriately trained person with appropriate size non – coring (e.g. Gripper) needle using ANTT and following trust protocol.

Ensure site completely covered with large Semi permeable, transparent dressing. E.g. Opsite I.V.3000 and ensure entry site visible at all times; needle free bung is attached and changed weekly under ANTT.

Ensure only 10ml syringes and use a “push/pause” technique when flushing to ensure turbulence in the line.

Change Semi-permeable dressing weekly and assess site. If site perfectly clean and dry then non-coring needle can be left for a fortnight (as per trust instruction), just re place dressing. If site not satisfactory then de-access and ask appropriately trained person to re-access following Trust protocol and using ANTT.

Inspect site at each use for signs of leaking, moisture, inflammation, redness, tenderness or swelling. Inform medical staff if site unsatisfactory or of any pain or discomfort during administration.

If any moisture noted under dressing, then change dressing, maintaining asepsis. Keep site dry whilst bathing.

If taking blood from the line, ensure line is flushed with at least 20ml normal saline immediately afterwards using a “push/pause” technique then flush with heparinised saline as above.

 

 

Revised:  January 2024

Version: 2 (Review)

Source:  Expert Care Manager