Practice, practice, practice. Stabilization is key, especially for the deep ones. My patients have said the way their port sits can change over time, especially if they have lost a lot of weight. If it feels tilted to one side, make sure you push down the opposite side so you hit the circle straight on. You don't have to "stab," just pull skin taut and push with steady pressure. Have patients take a deep breath as distraction. Use lidocaine spray or EMLA cream if they really have a hard time with it (I'm outpatient oncology and I do this for <10% of people, most can handle accession just fine). If you don't get blood return, have them take deep breaths, lie flat, turn their heads and cough, raise the arm on that side, stand up and lean over, etc. Our facility has us instill high dose heparin first for fibrin sheaths which never works, but then alteplase always does.