Implanted ports (Port-a-Cath®)

• PPE (minimal consideration of gloves and aprons)
• Clean tray or trolley
• Sterile gloves
• Sterile dressing pack
• 2% chlorhexidine in 70% isopropyl alcohol wipe/wand (0.5% chlorhexidine in 70% isopropyl alcohol is recommended as an alternative for babies less than 3 months old)
• Medical adhesive remover (if required)
• NFAD (x1 per lumen)
• 10ml luer lock syringes (x1 per lumen)
• IV 0.9% Sodium Chloride (NaCl) (appropriate volume for patient and VAD)
• Sterile semi permeable transparent dressing 
• X2 21g safety hypodermic needle and 18G blunt filter needle
• Appropriate size ‘GRIPPER®’/’Huber’ needle, depending on type of Port-a-Cath®
• Topical anaesthetic cream
• Catheter lock (if required)
• Curos cap (disinfection cap) (x1 per lumen)
• Clinical waste bag
• Sharps bin.

The Port-a-Cath® device requires to be flushed before, in between and after medicine administration, or IV Fluids, after collecting blood samples and monthly when the port is not in use.  

• Explain the process to the child and parent and gain consent.
• Ascertain that the patient has had no pain or discomfort with the Port-a-Cath® before palpating the position of the portal. If pain or swelling present seek expert advice.
• Prior to accessing the port, topical anaesthetic may be applied over the site, covered with an adhesive semi-permeable dressing. Leave for recommended duration for maximum anaesthetic effect.
• Perform hand hygiene.
• Clean trolley or tray with disinfectant wipes.
• Perform hand hygiene.
• Decontaminate neck of ampoule with 2% chlorhexidine and 70% alcohol wipe and allow to dry.  Using ANTT, draw up flush using 10ml syringe and hypodermic needle. Dispose of needle into sharps bin protect tip of syringe by placing onto sterile field or by placing in Micro Critical Field (sterile syringe packet) and place to the side.
• Open dressing pack. Using ANTT, assemble sterile field and open all equipment onto sterile field.
• Perform hand hygiene.
• Apply PPE.
• Prime “GRIPPER®” needle with 0.9% sodium chloride (approximately 2mL if has extension tubing) clamp lumen closed and remove syringe.
• Connect the primed needle free access device to the port needle hub.
• Remove dressing and topical anaesthetic cream (if applicable). Medical adhesive remover can be used here to aid in the removal of the dressing.
• Discard gloves and apply sterile gloves.
• Place drape below Port-a-Cath® site.
• Cleanse area at port site and surrounding skin with the 2% chlorhexidine in 70% isopropyl alcohol wipe/wand starting at the exit site, in a ‘circular’ pattern for 30 seconds before working outward to the periphery (an area slightly larger than the new dressing). Allow to dry for at least 30 seconds.
• Using ANTT, palpate and stabilize the portal septum.
• Insert “GRIPPER®” needle at a 90° angle until base of portal septum felt with needle.
• Attach empty syringe, unclamp catheter and withdraw 2-5mL of blood-stained fluid.
• If no blood flashback is observed try check patient position/correct needle placement. Medical referral may need to be considered.
• Secure Port-a-Cath® needle with a sterile semi permeable dressing, if to be left in situ.
• ‘Scrub the hub,’ clamp and needle free device using 2% chlorhexidine and 70% isopropyl alcohol wipe for 30 seconds and allow to dry.
• Attach syringe with 0.9% sodium chloride. Unclamp lumen, slowly inject 5-10ml 0.9% sodium chloride using push/pause technique.
• Keep positive pressure on plunger, apply clamp and disconnect syringe.
• If medicines are to be administered, repeat to previous two steps remembering to flush with 0.9% sodium chloride between medicines.
• If catheter lock required, administer using a push/pause technique. On completion, keep positive pressure on plunger, apply clamp and disconnect syringe.
• ‘Scrub the hub’ with 2% chlorhexidine and 70% isopropyl alcohol solution for minimum of 30 seconds and allow to dry.
• Apply curos caps to lumen after use.
• Discard all disposable equipment.
• Remove PPE and discard as healthcare waste.
• Perform hand hygiene.

Record procedure and complete CVAD bundle.

• PPE (minimal consideration disposable apron and gloves)
• Clean tray
• Sterile gauze swabs
• Sterile adhesive dressing (check allergies)
• Medical adhesive remover (if required)
• Clinical waste bag.

Every 7 days unless medical staff indicated a longer period.

• Explain the process to the child and parent and gain consent.
• Perform hand hygiene.
• Apply PPE.
• Loosen and carefully remove the old dressing in an upward direction towards the exit site, taking care not to pull or dislodge the gripper needle. Medical adhesive remover can be used here to aid in the removal of the dressing.
• Stabilise the port with two gloved fingers of one hand and withdraw needle with other hand.
• Apply pressure if bleeding with sterile swabs until bleeding stops.
• Apply sterile adhesive dressing if required.
• Discard all disposable equipment.
• Remove PPE and discard as healthcare waste.
• Perform hand hygiene.

Record procedure and complete CVAD bundle.