Portacath protocols

[msb0811]

Hi, I am preparing an educational presentation for nurses and was wondering what some of the current practices are in your organization/office: Can you please answere the follow if you use Ports for infusions.

1. Do you work in an outpatient setting or inpatient?

2. If a port is not used how often is it flushed? (exp 4-6 weeks)

3. If the port was not in use for several months and not flushed what is the longest since last flush you would flush? (exp 12-16 weeks since last flush).

4. When you access the port do you aspirate and then flush or do you flush then check blood return?

Thanks for your assistance with my questions.

[iluvivt, BSN, RN]

I work on a hospital IV/PICC team since 1986. I also provide IV care as needed in or Outpatient infusion suite. My per diem job is for a very large home infusion company. INS currently recommends a q 30 day access and of course flush for VAPS when not in use. The policy is the same at both employers. If I have a patient that has a port that has not been accessed for several mos..this is what I do. I always get a hx on the port....how long has it been in place..when was it last accessed.....have you had any problems with it....were they able to get a blood return with the last access. I usually track down the most recent CXR and verify tip placement. Then I perform my assessment..access the port and see if I can flush and get a brisk blood return. If I do not get a brisk blood return after remedial actions and I see no s/sx of any other complications that would not allow me to use Tpa,such as a drug leakage pathway, then I would get a Tpa order. You should not leave a port with a PWO (persistent withdrawal occlusion) untreated. It is not the best practice to leave a port for mos and mos without monthly flushing...it should be removed if the patient no longer needs it. The patient will be at an increased risk for infection not to mention other complications without proper maintenance. There are many more lower profile ports on the market now with better designs that tend not to build up sludge. I usually access then flush then aspirate....I always find it much easier to get the brisk blood return if I do it that way. I personally prefer a 20 gauge huber since the 22 will often not give me that brisk return I always want to see.

[CRNI(R)]

@ ins1.org

The Infusion Nurse Society sets the global standards for excellence in infusion nursing. All infusion policy and procedures should be according to the INS and you can't go wrong!

[iluvivt, BSN, RN]

Thats what they say a q 30 day flush ...yes they even have flushing recommendation cards that you can purchase..INS does charge for everything and the current standards are 25 bucks

[Southernkitten]

1. Do you work in an outpatient setting or inpatient? Outpatient doctor's office/clinic

2. If a port is not used how often is it flushed? (exp 4-6 weeks) We currently do not have a policy concerning this - I believe the ONS says monthly

3. If the port was not in use for several months and not flushed what is the longest since last flush you would flush? (exp 12-16 weeks since last flush). I don't think there is an evidence based practice to pertain to this

4. When you access the port do you aspirate and then flush or do you flush then check blood return? I access, flush hard and draw back for blood return.

I'm currently working on a policy for my workplace (small, independent practice) and my search terms brought me to this page. Thanks!

[S.G.]

Hi, I am preparing an educational presentation for nurses and was wondering what some of the current practices are in your organization/office: Can you please answere the follow if you use Ports for infusions.

1. Do you work in an outpatient setting or inpatient?

2. If a port is not used how often is it flushed? (exp 4-6 weeks)

3. If the port was not in use for several months and not flushed what is the longest since last flush you would flush? (exp 12-16 weeks since last flush).

4. When you access the port do you aspirate and then flush or do you flush then check blood return?

Thanks for your assistance with my questions.

I accessed ports while working in Radiology. It was in a hospital but most patients were outpatient, although we did work with some inpatients regarding ports. Our department placed, removed, accessed, and would "troubleshoot" ports.

We taught to flush monthly with 5mL of 100unit/mL Heparin and provided written instructions to the patients.

We had seen patients whose ports hadn't been accessed for, literally, years. We would access with a 19ga huber needle and flush briskly with 10mL normal saline then draw back for blood return. We would do the normal things to attempt to obtain a return. If no return or unable to flush, we brought the pt into the angio suite and attempted to flush with contrast under fluoroscopy to see what was going on. From that point, the radiologist would either order tpa (via infusion on a pump or to sit in the line as used on the floor) or would call the oncologist and recommend removal and replacement.

I was always taught that for a chest port you do not aspirated before flushing but I cannot recall the rationale I was given.