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Venous Access Ports - Accessing and De-Accessing (102.009)

Venous Access Ports - Accessing and De-Accessing (102.009) - Policies, Clinical, UWMF Clinical, UWMF-wide, Clinical Policies and Procedures, Central Lines

102.009

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UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE

TITLE: VENOUS ACCESS PORTS
Accessing and De-accessing

Effective Date: April, 2004 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education
Reviewed March, 2005 Nov.,2007 May, 2009 June 2012


PURPOSE: To provide guidelines for accessing and de-accessing implanted venous access ports 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 use 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)
Band-Aid
Gloves (sterile), mask
Alcohol wipes
2 – packages Sterile 2x2 gauze
2% Chlorohexidine/(ChloroPrep)
Anesthetic agent/cream (optional)

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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. Open the Non-coring needle package by peeling off the paper portion. DO NOT TOUCH anything inside
the package. Dump the contents of the package onto the sterile field.

9. Open the package of sterile gauze and gently drop the materials onto the sterile field near, but not on, the
other items.

10. Remove the saline (and Heparin, if indicated) syringes from their plastic packaging.

11. Set the heparin syringe near, but not on, the sterile field.

12. 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.

13. Put on sterile gloves.

14. Pick up the end of the tubing attached to the Non-coring Needle and remove the cap.

15. 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 Non-coring Needle.

16. Pick up the other gauze and use it to push the plunger of the saline until the fluid comes out of the needle.

17. 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.

18. Open the ChloraPrep® swabstick package from the dressing kit. Using ALL 3 swabssticks (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 using the friction scrub
technique.


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

20. 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.

21. 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.

22. 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.

23. 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. Remove the empty
syringe

24. Attach the second syringe of saline to the tubing. Open the clamp and flush the Port with the entire contents
of the syringe using a push/pause method. Close clamp on tubing, and remove saline syringe.

25. 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.

26. Remove the Non-coring needle: 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.

27. Dispose of the Non-coring needle and tubing in Sharps® container.

28. Dispose of other supplies in appropriate trash receptacle.

29. Documentation in Progress Notes section of HealthLink in the patient’s record:
Patient education
Procedure performed, date & time completed
How the patient tolerated the procedure
Discharge instructions
Follow-up appointment (if any)

WRITTEN BY: Ronnie Peterson, R.N., M.S., Manager of Clinical Support

REVISED 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

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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.

UWHC Departmental Policy 1.25. (September 1, 2010). Use of vascular implanted ports and peripheral access system (PAS) ports. U-
connect, faculty and staff Intranet for UW Health. Available at:
https://uconnect.wisc.edu/servlet/Satellite?cid=1121776146935&pagename=B_EXTRANET_UWHC_POLICIES%2FFlexGroup%2F
Show_Policy_Category&c=FlexGroup&root=uwhc.


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


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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.