Implantable ports are used to administer intravenous medications, fluids, blood products, and attempt blood sampling. These ports all have a self-sealing septum with an attached silicone catheter (see diagram).

General Principles:

A Huber needle MUST be used to access the port. The point of a Huber needle slices the septum rather than cores it, so the septum reseals after needle removal. Needles should not be rocked or rotated when in port or that will damage septum.

Needles need to be changed once a week with a new Tegaderm dressing placed over the needle to secure the needle in port. The dressing must be changed if it is loose, wet, or if drainage is present. Luerlock connections should be used and all connections taped.

Ports are flushed using 5cc of 100 u/cc heparin once a month and after each use. If port will be used within 24 hours, use 5cc of 10 u/cc hepadn.

All vials (Normal Saline, heparin, etc.) must be prepped before use by scrubbing with alcohol.

Avoid clothing or straps that cause pressure or rubbing on the port.

Carrying an identification card is recommended.

For questions or concerns, you may call:

1. Melanie Kenney, Pediatric Central Line nurse, (319) 356-1616, pager #4213.
2. Children's and Women's Services Supervisor, (319) 356-1616, pager # 3925.

Accessing the Implantable Port

EQUIPMENT:

• Alcohol swabs
• Huber needle and tubing
• 5cc luerlock syringes and needles
• Povidone-Iodine (PVP) swabsticks
• Hydrogen peroxide
• Topper4x4s
• Gauze 2x2s
• Tape
• Normal Saline
• 10 u/cc Heparin for up to 24 hours duration
• 100 u/cc Heparin for 24 hours up to one month duration
• Luerlock cap
• Skin prep
• Sterile cotton-tipped applicators
• Tegaderm dressings

  PROCEDURE:

1. Wash hands and assemble equipment.
2. Attach Huber needle tubing to syringe of Normal Saline, flush needle and tubing, keeping needle point sterile. Close clamp on tubing and set aside.
3. Palpate port and cleanse skin over port using three PVP swabsticks (three minutes) in a circular motion.
4. Wipe off PVP with hydrogen peroxide soaked 4x4s. Dry skin thoroughly with dry 4x4.
5. Locate port septum by placing thumb and forefinger of nondominate hand on outer edges of port. The septum is in the middle of these edges.
6. Using dominant hand, hold needle/tubing/syringe and puncture skin and septum by inserting needle perpendicular to port.
7. Push needle firmly through skin and septum until back of port is felt (back of port feels hard and immobile).
8. Open clamp. Draw back to check blood return, then flush with 5cc of Normal Saline. Observe for resistance when flushing, pain or swelling at port. If observed, needle is not completely into port. Adjust needle and attempt to flush.
9. Close clamp and
   1. attach IV tubing,

      OR

   2. Attach heparin syringe, open clamp, flush 5cc of appropriate strength of heparin, close clamp, attach luerlock cap and tape.
10. If leaving needle in port:
    1. Apply skin-prep to skin.
    2. Place one to four folded 2x2s under needle. Apply another folded W over hub of needle.
    3. Apply Tegaderm dressings and tape.

       OR

    4. Remove needle from port. Apply pressure with W at needle site if needed for small amount of serosanguineous drainage.

Signs and Symptoms of Implantable Port Infection

1. Observe port regularly for:
   1. Increased temperature.
   2. Fever associated with heparin flush or IV infusion through the port.
   3. Drainage from site.
   4. Increased redness at site and/or traveling along skin over the catheter or port.
   5. Swelling, pain or tenderness, discoloration or bruising at port site.
   6. Pain in shoulder, neck, or arm.
2. For implantable port questions or concerns, call:
   1. Melanie Kenney, Pediatric Central Line nurse, (319) 356-1616, pager #4213.
   2. Children's and Women's Services Supervisor, (319) 356-1616, pager #3925.