Implanted Port: Care at Home

Article Translations: (Spanish) (Somali)

Going home with an implanted port

Your child will be going home with an implanted port. You will learn how to use and care for the port, which will include ways to prevent infection, accessing the port (putting in the needle), flushing, giving medicine (if ordered), deaccessing (removing the needle), and knowing when and who to call for help. The hospital staff will lead and supervise line cares any time your child is in the hospital.

Preventing Infection

Implanted ports are helpful for taking care of your child; however, they can increase the risk of infections when bacteria grow in the device and travel to the bloodstream. This is called a Central Line Associated Blood Stream Infection or CLABSI. A CLABSI can be serious and life threatening.  

It is very important to prevent infection, or the port may need to be removed. There are things you can do to prevent a port infection.

Cleanliness is a must! Each time you give a medicine or flush the port, follow these steps:

1. Clean your hands with an alcohol-based sanitizer or wash with soap and water before touching your child’s port. This means washing your hands before doing any of these:
   • Inserting the needle, flushing, giving medication, removing the needle and any time handling the port or the line.
2. Clean solid surface work areas with a disinfectant (such as Lysol® or another brand) when preparing to do port cares.
3. Look at the port site and look for signs of infection.

Can my child go swimming?

Yes, after the insertion site is healed and when the port is not accessed. Your child may swim in a chlorinated pool, lake or ocean. Please discuss details with your child's provider.

Applying Anesthetic Cream

If your child is using anesthetic cream (such as EMLA® or ELA-Max®) to reduce the discomfort of needle insertion, apply it 1 to 4 hours before accessing the port. Follow the instructions that come with the cream, or see the education sheet, "Anesthetic (numbing) cream."

To apply, feel for the edges of the port with your fingers. Put the correct amount of cream to the area. Cover the cream with Tegaderm® or adhesive plastic wrap.

Accessing the Port

1. Prepare and clean the work area
2. Wash your hands well
3. Gather supplies:
   • chlorhexidine gluconate (CHG) applicator
   • heparin syringe
   • sterile normal saline syringe
   • injection cap
   • sterile gloves
   • sterile drape
   • masks (3)
   • non-coring port needle with correct size and length
   • CHG port dressing
   • no sting skin prep
   • sharps container for needles
4. Check the labels of the normal saline and heparin syringes before giving them.
   • Sterile normal saline and heparin syringes are good until the expiration date. Throw it away sooner if you see sediment in it or if you question its cleanliness. If you throw one away be sure to call the home care pharmacy for a replacement.
5. If anesthetic cream (such as EMLA® or ELE-Max®) was used, wipe off with clean cloth or paper towel.

Preparing the port needle and tubing

1. Wash your hands.
2. Put on mask. Masks should be worn by you, your child, and helper, if present.
3. Open sterile drape. Only touch the outside edges to keep the middle section sterile.
4. Open supplies onto sterile drape without touching any of the items inside the packages or touching the packages to the sterile drape.
5. Wash your hands well.
6. Put on sterile gloves. After sterile gloves are on, only touch supplies on your sterile drape.
7. Attach the injection cap into the end of the port needle tubing.
8. Attach the sterile normal saline syringe to the injection cap.
9. Flush the sterile normal saline through the injection cap and tubing to the end of the port needle until a drop appears.
10. Leave the sterile normal saline syringe connected to the injection cap.
11. Clamp the tubing. Place on sterile area.

Cleaning the port site

1. Scrub the site with one CHG applicator for 15 seconds, using friction in a back and forth pattern, up and down, sideways, and diagonal pattern.
2. Allow to dry for 30 seconds and until completely dry. Do not blow on or fan the area.

Placing the needle into the port

1. Hold the port needle by the handle in one hand. Remove the needle cover.
2. Hold the port steady with other hand by holding the outer edges of the port. Be careful not to touch the area where the needle will go into the port.
3. Hold the needle at a 90-degree angle, aim for the center of the port, and push the needle firmly through the skin and the port until it touches the back of the port chamber.
   
4. Unclamp the tubing.
5. Pull back on the syringe plunger to check for a blood return before flushing with normal saline.
   
   • If there is a blood return, flush with the sterile normal saline using the push-and-pause method: push a little solution, then pause for 1 to 2 seconds, then push a little more, pause, and so on.
   • If there is no blood return, and you think you are in the right place, gently try to flush with 2 or 3 ml of sterile normal saline. If you are able to flush easily, pull back on the syringe plunger again to see if there is a blood return. If there is still no blood return, stop. Call the home care nurse.
6. Apply no sting skin barrier where the edges of the dressing will be. This protects the skin.
7. Put the CHG pad under the port needle.
8. Apply remaining dressing over port needle and tubing.

Giving medicines and Flushing the Port

Important notes about flushing

• Always use 10mL or larger syringes. A smaller syringe may push too much pressure into the line and cause it to break.
• Before each time you flush or put any medicine into the port, put on non-sterile gloves and scrub the injection cap for 15 seconds with a new CHG wipe, using friction. Allow to dry for 15 seconds and until completely dry. Do not blow on or fan the area.
• Every time you flush, use the "push-and-pause" method: push a little solution, then pause for 1 to 2 seconds, then push a little more, pause, and so on. This method cleans the inside of the catheter.
• If it is difficult to flush the port or give medicine through it, do not force it to flush. Call your doctor or home care nurse for help.

How often the port needs to be flushed depends on whether a constant infusion is being given. Your child needs the port flushed:

___ once a month                           ___ normal saline

___ every day                                   ___ heparin

___ after infusions

You may learn how to give medicines or fluids. Home care nurses will teach you and help you become comfortable with the steps before you do them yourself.

 

Quick Steps to Give Medicine/Flush 1. Scrub 2. Flush with normal saline 3. Give medicine or fluid 4. Scrub 5. Flush with normal saline 6. Flush with heparin, if ordered 7. Clamp port line.

Steps

1. If you have just accessed the port, go to step 12.
2. Prepare the work area.
3. Wash your hands.
4. Gather supplies:
   • non-sterile gloves
   • CHG wipes
   • heparin syringe
   • normal saline syringe (2)
   • non-sterile gloves
   • medicines you will be giving, if any
5. Check the labels of the normal saline and heparin syringes, and any other medicines or fluids before giving them. Make sure they are the right medicines. 
   • A medicine is good until the expiration date. Throw it away sooner if you see sediment in it or if you question its cleanliness. If you throw a medicine away, be sure to call the home care pharmacy for replacement.
6. Put on non-sterile gloves
7. Prepare pre-filled normal saline syringe(s) by removing the air bubble in them. Remove cap. Hold syringe with tip up. Pull back slightly on the plunger and then push plunger gently, squirting the air bubble out. Place cap back on the syringe.
8. Scrub the injection cap with a CHG wipe for 15 seconds and allow to dry for 15 seconds and until completely dry.
9. Attach the normal saline syringe tip into the injection cap.
10. Unclamp tubing.
11. Flush with normal saline using the push-and-pause method. When syringe is empty, remove it from the injection cap.
12. If you are giving medicine(s) continue to step 13. If you are not giving medicine(s) at this time, go to step 18.
13. Scrub injection cap with a new CHG wipe for 15 seconds and allow to dry for 15 seconds and until completely dry.
14. Connect the medicine and give as instructed by your home care nurse. If you are giving an infusion, go to "Leaving the needle in place for an infusion".
15. After giving the medicine, disconnect the medicine from the injection cap.
16. Scrub injection cap with a new CHG wipe for 15 seconds and allow to dry for 15 seconds and until completely dry.
17. Attach normal saline syringe and flush using the push-and-pause method. When syringe is empty, remove it from the injection cap.
18. Scrub the injection cap with a new CHG wipe for 15 seconds and allow to dry for 15 seconds and until completely dry.
19. Attach heparin syringe tip into the injection cap and flush using the push-and-pause method. When syringe is empty, remove it from the injection cap.
20. Clamp the IV tubing.

Leaving the needle in place for an infusion

1. After accessing the port and flushing with normal saline, remove the syringe.
2. Follow directions for IV infusion provided by your home care nurse.
3. After infusion, flush with normal saline and heparin as ordered.
4. If needle remains in place, attach an antimicrobial cap to the injection cap.

Deaccessing (removing) the port needle

Removing the port needle

1. Wash your hands.
2. Gather supplies:
   • non-sterile gloves
   • CHG wipes
   • Normal saline syringe
   • Heparin syringe
   • Sterile gauze (optional)
   • Adhesive bandage (optional)
3. Put on non-sterile gloves.
4. Scrub the injection cap with a new CHG wipe for 15 seconds and allow to dry for 15 seconds and until completely dry.
5. Attach normal saline syringe and flush using the push-and-pause method. When syringe is empty, remove it from the injection cap.
6. Scrub the injection cap with a new CHG wipe for 15 seconds and allow to dry for 15 seconds and until completely dry.
7. Attach heparin syringe tip into the injection cap and flush using the push-and-pause method. When syringe is empty, remove it from the injection cap
8. Hold the port steady with the fingers of one hand.
9. With your other hand, hold the port needle, and put one finger on the tip of the safety arm.
10. Lift the safety arm straight back until it clicks. This removes the needle from the port and covers the tip of the needle.
11. If bleeding occurs, apply pressure with sterile gauze until it stops.
12. Apply adhesive bandage if needed.
13. Put used syringes and supplies into your regular trash.
14. Put the needle and the tubing into a sharps container or use a special container, such as a hard-plastic bottle with a screw-on lid. Label it "Do Not Recycle - Household Sharps."
    • Do not overfill the sharps container. Disposal varies depending on the area you live in. Some communities have a household sharps collection program. To find out what you should do, check with your garbage collection company, pharmacy, or clinic.

How do I order supplies?

Your supplies will be ordered from a medical equipment supply company or home care pharmacy. The first order will be delivered to the hospital or your home. Check with your nurse to be sure you have everything you need. You will receive the number to call when you need to order supplies in the future.

Who and when should I call for help?

Call home care if the port:

• is difficult to flush or give medicine through
• has no blood return

Call the clinic if your child has:

• a temperature of 101.5° F (38.6° C) or higher
• redness, swelling, drainage, or pain at the incision site
• redness, swelling, drainage, or pain at the port site

Have questions?

If you have any questions, please call:

Home care nurse ____________________________

Supply company ____________________________

Home care pharmacy ____________________________

Doctor ____________________________

Last reviewed 4/2023 by Vascular Access and Home Care

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