Written: 10/87 Nursing Policy: P-81

Reviewed: 1/88; LSUHSC-Shreveport, LA

Revised: 1/89; 2/90; 1/91; 5/92; 8/93; 7/95; 8/97; 11/99;
Revised: 7/04; 10/06; 8/09; 11/09
______________________________________________________________________________

IMPLANTABLE PORTAL ACCESS DEVICE

PURPOSE:
To permit repeated access for short or long-term infusions of medications, blood products,
nutritional and other fluids, such as bolus injections, and venous blood sampling.

DEFINITIONS:
1. Implantable Portal Access Device: Totally implantable venous portal systems which allow
intravenous access for blood sampling and delivery of medications and fluids.

2. Bolus: usually refers to a technique for rapid intravenous injection of a

concentration or amount of drug.

3. Normal Saline Flush: Sterile 0.9% Sodium Chloride Injection

4. Heparinized Saline Flush: (Heparin 100 units/ml)

POLICY:
1. Physician’s Orders
A. Adult Patients
An order shall be written by the physician for the use of the device for blood
sampling, bolus injections, long or short-term infusions of drugs, fluids, nutritional
fluids, and blood products.

B. Pediatric Patients
All pediatric patients shall have separate, individualized physician orders that specify
the fluid amounts, (saline flush, heparin flush, medications) which will be
administered.

2. Patient/Family Education
Prior to insertion of the device, the patient/family/significant other shall be educated
regarding (education shall be documented in the medical record):
A. What the device is and how it works.
B. The purpose of the device in the patient’s plan of care.
C. Activity restrictions.
D. How to care for the site.
E. And given a copy of the Central Line Infection Prevention Education Sheet.

3. Patient Home Care Instructions

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If the patient is to be discharged with an implantable portal access device in place, the
patient shall be given instructions on home care prior to discharge. These instructions shall
include at least:

A. Unless the device is accessed (needle or tubing attached), no special care is needed.

B. If the patient is to be discharged with an accessed portal device (needle and tubing
attached), the physician must be aware that the port is accessed on discharge and
why, and this information must be documented in the medical record. The site shall
be covered with a bio-occlusive (transparent impermeable) dressing and the patient
and significant other /family instructed to keep the dressing clean and dry and not to
attempt to cut, remove and/or otherwise alter the dressing or access in any way.

C. The site shall be regularly inspected for signs and symptoms of infection such as
redness, leakage, purulent drainage, bruising, or tenderness and the patient
instructed to watch for fever and generalized tiredness. Should any of these occur,
the physician/clinic should be notified immediately.

D. The physician should be consulted for instruction on any limitations of activity which
may cause problems with the port.

E. Patient Instruction Handout (Appendix A).

4. Competent RNs Performance

Only registered nurses who have competency validated may perform the following
procedures with Implantable Access Devices:
A. flush the system.
B. infuse medications, IV solutions, and blood products.
C. blood sampling.
D. deaccess needle from port

Note: Competency validation includes assessment by a qualified observer of the

necessary knowledge, skills, and ability to perform said procedure, as well as
appropriate documentation in the file of the registered nurse who performs
the procedure.

See Nursing Policy: N-38, Competency Assessment, for additional information.

5. Hand Hygiene
Hands shall be washed with an antimicrobial soap before palpating, inserting, changing or
dressing any intravascular device.

6. Administering IV fluids and Medications

IV fluids and medications shall be administered via a controlled infusion device.

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Never exceed 40 psi pressure when delivering agents through the system.

7. IV Tubing and Insertion Site

a. IV tubing, non-coring needles, and dressings shall be changed at least every
96 hours utilizing aseptic technique.
b. Tubing and dressings shall be dated and timed when changed with appropriate
documentation in the medical record.
c. The insertion site shall be cleansed with chlorhexidine gluconate or ChloraPrep as the
first choice and povidone iodine as a second choice, and a light dressing applied if
desired.
(See IC 22.0, Skin Preparation for Invasive Procedures Guideline in the Infection
Control Manual online for additional information).

Exception: Outpatient Clinic patients discharged on extended therapy or unless

otherwise ordered by a physician.

8. Needle Usage
Only 20 - 22 gauge non coring needles shall be used to access the system utilizing the
following guidelines (Note: PowerLoc Safety Winged Infusion Needles shall be used
with the Power Port Implantable Port):
a. Ninety-degree needles shall be used for bolus or continuous infusions.
b. The needle shall be inserted perpendicular to the portal septum.
c. The needle shall never be tilted or rocked once the port has been entered.
d. Positive pressure shall be maintained while clamping the tubing prior to withdrawing
needle from the port to prevent reflux.

9. Inspection of Insertion Site

The insertion site shall be palpated for tenderness through the intact dressing at least every
eight hours. If tenderness develops, if there is fever with no obvious source, or symptoms
of local and/or blood stream infection occur, the site shall be visually inspected and
symptoms reported promptly to the physician.

10. Checking Patency Prior to Administration

The system shall be checked for patency (blood return) prior to administration of any
fluids, medications, or blood. The needle shall be inside the portal chamber and against the
needle stop before starting the injection for infusion.

11. Blockage
Unusually high resistance encountered while administering any agent through the system
may indicate blockage. The physician shall be notified immediately when this occurs, and

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the administration of the fluid stopped. Blockage may be caused by:

a. kinking of the catheter due to movement.
b. lodging of the distal end against the wall of a vessel.
c. occlusion by an intraluminal thrombus.
d. growth of a fibrin sheath around the catheter end.

12. Flushing the System

a. The system shall be flushed using sterile technique with 3 - 6 ccs normal saline
(using a 10 cc syringe) before and after medications are given.

b. The system shall be flushed with Heparinized Saline (100 units/ml) after each
use. When there are extended periods between injections, infusions, or blood
samplings the system shall be flushed using sterile technique with
5 cc Heparinized saline (using a 10 cc syringe) at least once every four weeks.

13. Nursing Documentation

The registered nurse shall be responsible for appropriate documentation in the medical
record to include patient education, the amount and type of any flush solution given
through the port, as well as fluids administered.

EQUIPMENT AND SUPPLIES NEEDED FOR INFUSION OR INJECTION:

1. Sterile gloves
2. Chlorhexidine or Chloraprep prep stick
3. Sterile non-coring needles or PowerLoc Safety Winged Infusion Needles
4. IV administration set
5. Chemotherapy extension tubing with Luer lock
6. Normal saline flush solution
7. 5 cc (l00 units per cc) of heparinized saline solution (See 1B for pediatric patients).
8. Sterile dressing, either sterile gauze and tape, or a transparent impermeable dressing
9. 10 cc syringes

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I. ACCESSING THE PORT – IMPLANTABLE ACCESS DEVICE

RESPONSIBLE ACTION RATIONALE

PARTY
MD, RN, RN 1. Explains the procedure to the patient.
Applicant
2. Washes hands with approved antiseptic.

3. Opens and prepares supplies.

4. Dons sterile gloves.

5. Cleanses skin with chlorhexidine gluconate,

chloraprep or povidone iodine if allergic to
chlorhexidine, starting from center of septum
and continuing outward to a diameter of 3
inches using a side to side motion .

6. Attaches non-coring needle to 10 cc

syringe filled with at least 5 cc of normal
saline (attaches a luer lock tip if needed).

7. Clears air from tubing and needle, and

clamps tubing.

8. Removes gloves.

9. Dons sterile gloves.

10. Palpates/locates portal septum using

nondominant hand.

11. Stabilizes portal septum by using thumb and

index finger.

12. Utilizing aseptic technique, accesses the

system by inserting needle at a 90 degree
angle to the septum, penetrating the skin
and septum until contact is made with
the bottom of the portal chamber.

13. Unclamps tubing.

MD, RN, RN 14. Confirms correct needle placement

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Applicant utilizing three factors:

a. Blood returns on aspiration
b. Priming solution infuses easily.
c. No signs of infiltration.

15. Injects saline into system.

II. ACCESSING THE PORT – POWER PORT IMPLANTABLE PORT

RESPONSIBLE ACTION RATIONALE
PARTY
MD, RN, RN 1. Verifies the port by the steps listed below. If
Applicant unable to confidently verify the power port or if
the radiologists requires additional verification a
scout image may be taken when the patient is on
the CT scanner prior to injection of the contrast.
A. Checks the patient’s chart for a
Power Port device patient record
sticker.
B. Palpates top of port to identify
three palpation points (bumps) on
the septum, arranged in a triangle.
Palpation points may be difficult
to palpate for 24-48 hours post-
insertion due to swelling of tissue
in the port pocket area.
C. Palpates the sides of the port to
identify triangular port housing.
D. Asks the patient if they have an
identification card, ID bracelet or
key ring to help remind them they
have a Power Port device.

2. Explains the procedure to the patient.

3. Washes hands with approved antiseptic.

4. Positions patient in comfortable reclining

position; palpate PowerPort device site to locate
septum.

5. Palpates outer perimeter of PowerPort device

(note unique triangular shape and three palpation
points)
MD, RN, RN 5. Assesses skin over and around the PowerPort
Applicant device.

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6. Nurse reports and documents signs of

complications such as redness, swelling, or
induration.

7. Opens and prepares supplies.

8. Dons sterile gloves, mask and other PPE. Places

a mask on the patient.

9. Cleanses skin with chlorhexidine gluconate,

chloraprep or povidone iodine if allergic to
chlorhexidine, starting from center of septum
and continuing outward to a diameter of 2 – 4
inches using a side to side motion . Do not
palpate the insertion site after the skin has been
cleansed.

10. Attaches PowerLoc Safety Wing infusion needle

to 10 cc syringe filled with at least 5 – 10 cc of
normal saline (attaches a luer lock tip if needed).

11. Clears air from tubing and needle, and

clamps tubing.

12. Removes gloves.

13. Dons sterile gloves.

14. Palpates/locates portal septum using

nondominant hand.

15. Stabilizes portal septum by using thumb and

index finger.

16. Utilizing aseptic technique, accesses the

system by inserting needle at a 90 degree
angle to the septum, penetrating the skin
and septum until contact is made with
the bottom of the portal chamber.

MD, RN, RN 17. Attach PowerPort compatible callout tag to

Applicant PowerLoc Safety Wing Needle.

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18. Unclamps tubing.

19. Confirms correct needle placement

utilizing three factors:
a. Blood returns on aspiration
b. Priming solution infuses easily.
c. No signs of infiltration.

20. Injects saline into system.

21. Applies sterile dressing including Biopatch or

Primapore per hospital/unit policy.

22. Instructs the patient to assume the position they

will be in during the power injection procedure,
before checking for patency. If possible, the
patient should receive power injection with his
or her arm vertically above the shoulder with the
palm of the hand on the face of the gurney
during injection. This allows for uninterrupted
passage of injected contrast media through the
axillary and subclavian veins at the thoracic
outlet.

III. HEPARINIZING THE PORT:

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RESPONSIBLE ACTION RATIONALE

PARTY
MD, RN, 1. Explains the procedure to the
RN Applicant patient. Washes hands.

2. Follows the procedure for

accessing the port using
sterile technique.

3. Confirms the correct needle

placement (See #14 above).

4. Attaches to a 10 cc syringe 4. Use of a 10 cc syringe helps to

with 5 cc of heparinized saline reduce PSI to the system. The
(100 units/ml) and instills all smaller the syringe, the higher
but 0.5 cc. the pressure that can be
generated.

5. Clamps the tubing prior to 5. Helps to create positive pressure

withdrawing needle from the thus minimizing retrograde
port. blood flow into the catheter tip.

6. Cleanses site with

chlorhexidine gluconate,
chloraprep or povidone iodine
if allergic to chlorhexidine
and applies light dressing, if
desired.

7. Removes gloves and washes

hands.

8. Records procedure on MAR

and./or in the 24 Hour Nurses
Record as appropriate.

IV. CONTINUOUS INFUSIONS

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RESPONSIBLE ACTION RATIONALE

PARTY
MD, RN, 1. Explains the procedure to the patient.
RN Applicant

2. Follows procedure for accessing the

port using aseptic technique.

3. Flushes IV extension tubing with

saline and clamps.

4. Accesses port with right angled non-

coring needle attached to the IV
extension tubing with clamp and Luer
Lock feature.

5. Opens clamp and flushes with 5cc

normal saline to confirm placement.

6. Clamps tubing and applies a

transparent impermeable dressing.

7. Secures needle hub and proximal part

of tubing with sterile steri-strips.

8. Connects IV administration set up and

opens clamp to infuse solution.

9. Clamps tubing when infusion is

completed.

10. Disconnects IV administrations set. 10. To maintain aseptically

between usages.
11. Flushes port with 5cc saline to clear
line, then heparinizes the port.

12. Changes tubing, needle, and dressing

at least every 96 hours.

13. Removes gloves and washes hands.

RN, RN 14. Records procedure on MAR and/or in

Applicant 24-Hour Nurses Record as
appropriate.

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V. BLOOD SAMPLING
RESPONSIBLE ACTION RATIONALE
PARTY
MD, RN, RN 1. Explains procedure to patient.
Applicant
2. Follows procedure for accessing port using
sterile technique.

3. Closes clamp on extension tubing.

4. Disconnects IV tubing (if during a

continuous infusion) and attaches a 10 cc
syringe, unclamps tubing.

5. Withdraws at least 5cc of blood, clamps

tubing and discards syringe and blood (if
ordered by the physician, the blood may be
returned to the patient using aseptic
technique).

6. Attaches a new 10 cc syringe, unclamps

tubing and withdraws required blood.

7. Clamps the tubing, attaches syringe with

20 cc normal saline, releases clamp and
flushes the system, clamps tubing.

8. Reestablishes IV infusion or heparinizes

the line with 5cc Heparin flush if the
infusion is completed.

9. Clamps the tubing prior to withdrawing

needle from the port.

10. Applies light dressing, if desired.

11. Removes gloves and washes hands.

RN, RN Applicant 12. Records procedure on MAR and/or in the

24-Hour Nurses Record as appropriate.
APPENDIX A
Patient Instruction
Implantable Portal Access Device

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For Oncology Clinic Patients

1. A Port-A-Cath, P.A.S. Port or Life Port is a tube that lets us draw blood and give you
medicine or fluids right into your bloodstream.

2. No special care to the site is needed unless an access (needle and tubing) is in place.
A bandage is not usually needed.

3. The site should be watched for signs of infection such as redness, leakage, purulent
drainage, bruising, and tenderness, and watch for fever, and generalized tiredness.
If any of these occur, call the unit/clinic telephone number provided at discharge.

4. If the site has a needle or tube in place at discharge, it should be covered with a special
bandage. The bandage and the access (needle and tubing) should be kept clean and dry and
no attempt should be made to cut, remove, and/or otherwise change the dressing, needle, or
tubing.

5. Should be flushed every 4-6 weeks; no appointment needed. Please come before 4:00 pm.

For Patient Care Services - Oncology Patients

1. A Port-A-Cath, P.A.S. Port or Life Port is a tube that lets us draw blood and
give you medicine or fluids right into your blood.

2. No special care to the site is needed unless an access (needle and tubing) is in place.
A bandage is not usually needed.

3. The site should be watched for signs of infection such as redness, leakage, purulent
drainage, bruising, and tenderness, and watch for fever, and generalized tiredness.
If any of these occur, call the unit telephone number provided at discharge.

4. If the site has a needle or tube in place at discharge, it should be covered with a special
bandage. The bandage and the access (needle and tubing) should be kept clean and dry and
no attempt should be made to cut, remove, and/or otherwise change the dressing, needle, or
tubing.

References:

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Handbook of Nursing Procedures (2001) Springhouse, Pennsylvania. ( added)

Infection Control Policy, IC 16.0: Methods to Prevent Healthcare Associated Intravascular

Device-Related Infections.

Clinician Information Port-A-Cath and P.A.S. Port Implantable Access System - Pharmacia
Deltec.

Hospital Policy, 4.8: Skin Preparation.

Infection Control Policy 22, Skin Preparation for Invasive Procedures

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________________________________________ _________________
Jamie Jett, MBA, RN Date
Administrative Nursing Director
Psychiatry, Coordinated Care and Professional Practice

________________________________________ _________________
Jean DiGrazia, MBA, RN Date
Assistant Hospital Administrator and CNO
Patient Care Services

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