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Medication Administration Via Venous Access Ports (102.006)

Medication Administration Via Venous Access Ports (102.006) - Policies, Clinical, UWMF Clinical, UWMF-wide, Clinical Policies and Procedures, Central Lines

102.006

UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE

TITLE: MEDICATION ADMINISTRATION VIA VENOUS ACCESS PORTS

Effective Date: DRAFT Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education
Reviewed


PURPOSE: To provide guidelines for administration of medications via an implanted venous access port at
UWMF & DFM Clinics.

DEFINITION:
Central venous catheters are used to give long-term medicine treatment for pain, infection, or cancer, or to supply
nutrition. A central venous catheter can be left in place far longer than a peripheral intravenous catheter (PIV), which
gives medication into a vein near the skin surface. The tip of all central venous catheters is in the superior vena cava
(SVC). There are several types of central venous catheters.
Implanted port: (Groshong, Open-ended, Power) This type is similar to a tunneled catheter but the exit site is left
entirely under the skin. Medications are injected through the skin into the catheter via a non-coring needle.


Venous Access Port

POLICY: Nurses will utilize the following guidelines to properly administer medication via venous access
ports.

SUPPLIES:
Provider’s order
Patient record
Dressing Change Kit (may be provided by patient)
Non-coring needle with tubing and clamp
2 10ml syringes with needles attached (if needed to draw up Normal Saline) OR
2-10ml prefilled Normal Saline syringes
1-10ml prefilled Heparin (100unit/ml) syringe (if indicated by Line or Valve type – see attached chart)
1-needle-less valve (SafSite®, MaxPlus®, MicroClave®, etc.)
1-Bio-Patch® (if port will remain accessed for 72 hours/3 days or longer)
3-packages of sterile 2x2 gauze (each package contains 2 gauze pieces)
Gloves




PROCEDURE:
1. Check provider’s order and clarify any inconsistencies.

2. Wash hands and gather supplies.

3. Introduce yourself, verify patient’s full name and DOB. Provide privacy.

4. Review medications allergies and explain procedure to the patient.

5. For patient who prefer anesthesia at site of port access:
Contact provider to obtain order
Apply non-sterile gloves and locate port by palpation
Apply ordered anesthetic agent over and around site.

6. Begin set-up of sterile field by opening dressing kit. Touch only the very edges of the drape.

7. Apply mask from kit. Remove sterile gloves in packaging and set aside.

8. Add supplies to the sterile field:
a) Open the Non-coring needle/tubing package by peeling off the paper portion. DO NOT TOUCH
anything inside the package. Gently drop the contents of the package onto the sterile field
b) Open all packages of sterile gauze and dump the content onto the sterile field near the other items
c) Open the package containing the needle-less valve (without touching the valve) and dump the valve onto
the sterile field
d) If a BioPatch® will be used, open the package containing the patch and dump it onto the sterile field

9. Remove the Saline (and Heparin, if indicated) syringes from their plastic packaging.

10. Set the Heparin syringe near, but not on, the sterile field.

11. Remove the caps from both Saline syringes. Set these syringes just onto the sterile field so that ½ of the
syringe is on the field and the other ½ rests off of the field.

12. Put on sterile gloves.

13. Pick up the end of the tubing attached to the Non-coring Needle and remove the cap. Attach the needle-less
valve.

14. Separate the gauze pieces. Pick up one piece and wrap it around the Saline syringe – maintaining sterility of
this hand as the outside of the syringe is not sterile. Pick up the syringe, touching only the gauze, and attach
it to the end of the valve at the end of the tubing. (If the valve has a cap, it will need to be removed before
attaching the saline syringe). DO NOT set down the syringe.

15. Pick up another gauze and use it to push the plunger of the saline until the fluid comes out of the Non-coring
needle. Leave the saline syringe attached to the tubing.

16. Place the filled Non-coring needle, tubing, and syringe onto the sterile field so that the saline syringe is ½ on
and ½ off the sterile field. DO NOT allow any gauze to rest on the sterile field. Discard all gauze that has
been used up to this point.


17. Open the ChloraPrep® swabstick package from the dressing kit. Using ALL 3 swabsticks (one at a time),
perform a “friction scrub” (back & forth motion, with pressure) for 1 full minute (20 seconds per
swabstick). Clean the port site area AND 2-3 inches of skin around the area.

18. Allow to dry for 30 seconds. DO NOT blot, wave at, or blow on the area.

19. Maintain sterility of needle and tubing by holding the colored wings in your dominant hand (the saline
syringe should hang freely below). Remove the protective cover over the needle.

20. Using your non-dominant hand, find the landmarks of the Port. When you have located the center area of
the Port (septum), use your dominant hand to insert the needle at a 90 degree angle into the Port septum.
Press firmly until the needle touches the back wall of the port.

21. Take a gauze pad from the sterile field and wrap it around the saline syringe to pick it up. Use another gauze
and wrap it around the plunger of the syringe.

22. Slowly pull back plunger on the syringe of saline to check for blood return in the tubing.
a) If you do not get a blood return, flush a small amount (1ml) of saline into the Port and re-try. If you still
cannot get a blood return, STOP, and notify provider. You may leave needle in place while you do this.
b) If you do get a blood return, push down on the plunger and vigorously flush the Port with the entire
contents of the syringe using a push/pause method (creates turbulence and ensures any residual
medication or matter is removed from tubing). Close the clamp on the tubing. Leave the empty syringe
on the end of the tubing for now.

23. Dress the site:
a) Place a BioPatch® under the Non-coring needle if the site will stay accessed for longer than 72
hours/3 days
b) Fold two of the sterile 2x2 gauze pads in half and place underneath one of the ‘wings.’ Repeat this
for the other “wing.”
c) Cover the entire site with transparent adhesive dressing included in the dressing kit.

24. Remove the empty saline syringe and administer medication
a) IV Infusion: attach primed IV tubing to Port tubing. Unclamp tubing on both Port and IV. Regulate
flow
b) IV Push: administer medication through Port tubing at recommended rate from provider or
pharmacy

25. When medication administration is complete, clamp all tubing and remove medication administration device
(IV tubing or syringe).

26. Attach the second syringe of saline. Open the clamp and flush the port with the entire contents of the syringe
using the push/pause method. Close the clamp.

27. If Heparin is indicated (see attached chart), attach syringe of Heparin. Flush entire contents of the syringe
into the Port using the push/pause method. WHILE HOLDING PRESURE on the plunger of the syringe,
close the clamp on the tubing (this helps to prevent blood from backing up into the IV system). Remove the
empty syringe.

28. Remove the empty Heparin syringe. If the valve requires a cap, put that on now. If the valve does not
require a cap, you may go to the next step.


29. If the patient does not require further treatment or medication administration, the Port may be de-accessed at
this point. Stabilize the Port by applying pressure on either side of needle insertion site, and remove needle.
Apply Band-Aid (if needed) and make the patient comfortable.

30. Dispose of the Non-coring needle and tubing in sharp container.

31. Dispose of other supplies in appropriate trash receptacle.

32. Allow patient to remain in waiting room to observe for any adverse reactions (amount of time per policy or
as designated by provider).

33. Documentation (Progress Notes in HealthLink utilizing SmartPhrase: .medinclinic)
Manufacture, Lot #, Expiration date (as indicated)
NDC#
Name, dosage, route of medication, and time given
Assessment and laboratory results relevant to purpose of the medication
Effects of the medication on patient, i.e., pain relief
Patient education/teaching about the drug or administration technique
How patient tolerated procedure, i.e., desired effect, adverse reactions
Discharge instructions
Follow-up appointment (if any)


WRITTEN BY Carol Decker, RN, MSN, Clinical Staff Educator, 2012

REVIEWED BY: LaVay Morrison, RN, BSN, Clinical Staff Educator, 2012
Shar Ballentine, RN, BSN, Clinical Program Coordinator, Chartwell Midwest Wisconsin
Susan Antonie, RN, Hematology/Oncolocgy Clinic, UWMF
Julie Nampel, RN, Clinic Mgr, Hematology/Oncology, UWMF & GYN/Med/Oncology, UWHC
Rebecca Harrison, RN, Urgent Care, Team Lead
Brian Tish, RN, Urgent Care, Team Lead


REFERENCES:
Infusion Nurses Society. (2006). Policies and procedures for infusion nursing. (3rd ed.). Infusion Nurses
Society.

UWHC Departmental Policy 1.21. (April 2, 2012). Central venous catheters, adult and pediatric. U-connect, faculty and staff intranet
for UW Health. Available at:
https://uconnect.wisc.edu/servlet/Satellite?cid=1095721213003&pagename=B_EXTRANET_UWHC_POLICIES%2FFlexMember%
2FShow_Policy&c=FlexMember.


AUTHORIZED BY: Richard Welnick, MD, Medical Director, UWMF Ambulatory Clinic Operations
Sandra A. Kamnetz M.D., Vice Chair, Department of Family Medicine


_______________________________________________________________________________
Medical Director, UWMF

________________________________________________________________________________

Vice Chair, Department of Family Medicine

Recommended Line Maintenance per Type of Line and Valve
SAS = Saline, Administer/Procedure, Saline
SASH = Saline, Administer/Procedure, Saline, Heparin
NS = Normal Saline
Type of CVC Valve Type Flush Flush when
Not in Use
Other
Implanted
Port
Groshong

SAFSITE

SAS with 20 ml NS

Monthly with 20 ml NS
Clamp line, then remove
syringe.
Change cap after each
use.
MaxPlus SAS with 20 ml NS Monthly with 20 ml NS Remove syringe, then
clamp line.
Scrub the hub with
alcohol for 20 sec prior to
each use.
SmartSite SAS with 20 ml NS Monthly with 20 ml NS Clamp line, then remove
syringe.
Scrub the hub with
alcohol for 20 sec prior to
each use.
Open-ended SAFSITE SASH with 10 ml NS and
5ml heparin 10 U/ml
Monthly with 5 ml heparin
100 U/ml
Clamp line, then remove
syringe.
Change cap after each
use.
MaxPlus SAS with 20 ml NS Monthly with 20 ml NS Remove syringe, then
clamp line.
Scrub the hub with
alcohol for 20 sec prior to
each use.
SmartSite SASH with 10 ml NS and
5ml heparin 10 U/ml
(while accessed)
Monthly with 5ml heparin
100 U/ml
Clamp line, then remove
syringe.
Scrub the hub with
alcohol for 20 sec prior to
each use.