What is an implanted port?

An implanted port is a device placed under the skin, usually on the upper chest, for accessing a vein. The port makes it easier to give IV medicines or fluids and take blood samples. Depending on the type of port the child has inserted, a separate IV may be needed if the doctor orders radiographic studies with contrast.

The implanted port has 2 parts: the catheter and the reservoir. The catheter is a long, hollow tube inserted into a large vein that goes to the heart. The reservoir is the part that is accessed (a needle is put into it) for treatments.

How should the child be prepared?

Use simple words to explain why the port is needed and what to expect. How much detail you give will depend on the age of the child, and the degree of anxiety about the procedure. If you need help, ask a social worker or consultant.

Explain procedures before they are done, especially what the child will see, hear, and feel. Tell the child what is expected ahead of time, such as, “Your job is to hold still while I flush the port.” This will help make care easier for both of you.

How is the port put in?

During surgery, the surgeon inserts the tip of the catheter under the chest skin and tunnels it into the superior vena cava, a large vein that goes to the heart. The reservoir is placed under the skin.

There will be two small incisions on the chest after surgery, one at the base of the neck where the catheter was inserted into the vein, and one where the reservoir was placed under the skin.
There will be a coin-sized bump under the skin where the implanted port is. Your child may have soreness or discomfort at the incision sites. Pain medicine will be given by mouth as needed.

How is the port used?

Caring for a child with an implanted port may be a little scary at first. Nurses and medical officers will take care of the port and give the medicines while your child is in the hospital. They will flush the port to help prevent blood from clotting and blocking it. If it becomes blocked, it may have to be removed.

How often the port needs to be flushed depends on whether a constant infusion is being given. The child needs the port flushed at least once a month but also after any infusions. At time of discharge the port will be flushed and the needle removed while in clinic/hospital.

Only non-coring needles are used with the implanted port. These are special needles that do not leave a hole in the reservoir of the port (see picture below). This allows the port to be accessed many times without damage.
Always use 10-ml or larger syringes. A smaller syringe may push too much pressure into the catheter and cause it to burst. Also make sure syringes do not have an air bubble in them. Every time the port is flushed with normal saline or heparin, 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.

Applying anesthetic cream

If using anesthetic cream (such as EMLA® or Prilox®) to reduce the discomfort of the needle, this needs to be applied at least 1 to 2 hours before accessing the port to numb the skin. It should not be rubbed in and after placing a blob on the area of the port it should be covered with a non-absorbent dressing. To find the area to apply it, feel for the edges of the port with your fingers.

Preventing infection

Implanted ports are helpful for taking care of children requiring chemotherapy; 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. Fortunately there are steps we can take to prevent CLABSIs. The most important step is hand washing.

At the hospital
Cleanliness is a must! Each time the port is flushed, these steps should be followed:

  1. Prepare a clean work area by cleaning a surface and lay a clean towel on it.
  2. Wash hands well, using an alcohol hand sanitizer according to directions. If hands are dirty, wash with soap for at least 15 seconds, use a paper towel or clean hand towel to dry.
  3. Before each time you flush or put any medicine into the IV tubing, scrub the injection cap for 30 seconds with a chlorhexidine wipe, using friction and let the cap dry. Do not blow on it.

Parents and patients also have a role to play in preventing CLABSIs:

  • Wash hands with soap and water, or use alcohol-based hand rub found in each room. Hand hygiene is required:
    • When you enter and leave your child’s room;
    • Before and after you prepare food, eat, or feed your child;
    • Before and after you use the bathroom or change a diaper.
  • Ask your child’s visitors to wash their hands when they enter and exit your child’s room.
  • Do not allow visitors to touch the IV tubing.
  • Watch your nurses and doctors to make sure they wash their hands before and after handling IV tubing. Do not be afraid to remind them to wash their hands!
  • Keep any IV tubing out of the diaper area when changing the diaper, and do not allow your child to suck on tubing.

Cleaning up

Put the needle and the tubing into the sharps container. Put used syringes into the hazardous waste container, especially if they are soiled with blood.

When should I call for help?

Call the consultant if:

  • temperature higher than 101° F (38.4° C)
  • redness, swelling, drainage, or pain at the incision site or port site
  • port not flushing or drawing back easily

Accessing the port

  1. Prepare the work surface.
  2. Wash your hands.
  3. Gather supplies:
    • chlorhexidine swabs & wipes
    • pre-filled heparin syringe 10u/mL (1)
    • injection cap (bionector)
    • IV solution or medicine
    • non-coring port needle with tubing, size
    • normal saline syringes (2)
    • transparent dressing, if you will leave the port needle in place
    • medicated wafer disc (“Biopatch”) if port will be in use greater than 24 hours
  4. Check the normal saline and heparin syringes, and any other medicines or fluids before giving them. Make sure they are the right medicines and the heparin is the right strength.
    • A medicine is good until the expiration date. Throw it away sooner if you see sediment in it or if you question its cleanliness.

Prepare the port needle and tubing

  1. Wash your hands.
  2. Put supplies in order of use on the work surface. Open packages without touching anything inside.
  3. Pick up the injection cap, keeping the threaded end sterile – do not let it touch anything. Screw the cap into the end of the port needle tubing.
  4. Scrub the injection cap with a chlorhexidine wipe and let it dry.
  5. Remove the tip cover from a normal saline syringe.
  6. Twist the syringe tip into the injection cap.
  7. Flush the solution through the tubing to the end of the port needle until a drop appears
  8. Leave the syringe in the injection cap.
  9. Clamp the tubing.

Clean the port site

  1. Wipe off the anesthetic cream, if used, with a clean cloth.
  2. Wash your hands, and wear sterile gloves.
  3. Scrub the site with one chlorhexidine or povidone-iodine applicator for 30 seconds, using friction in a back and forth pattern: up and down, sideways, and diagonally.
  4. Allow skin to completely dry (approximately 60 to 90 seconds). Do not blow on or fan the area.

Place the needle into the port

  1. Wearing sterile gloves hold the port needle by both “wings” in one hand. Remove the needle cover.
  2. Put the fingers of your other hand around the outer edges of the port to hold it steady. 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 bottom of the port chamber.
  4. Unclamp the tubing.
  5. Pull back on the syringe plunger to check for a blood return before injecting any medicines or fluids.
  • If there is a blood return, flush with the saline. Continue with your planned procedure.
  • If there is no blood return, and you think you are in the right place, gently flush with 2-3 ml of saline. If you are able to flush easily, pull back on the syringe plunger but if still no blood return then stop and call the consultant.

Leaving the needle in place

  1. After accessing the port and flushing with saline, remove the syringe and connect to IV.
  2. If the needle is to be in place less than 24 hours: Cover the needle and tubing with a transparent dressing.
  3. If the needle is to be in place longer than 24 hours: Apply a medicated wafer disc (such as a Biopatch) around needle insertion site if available. Cover needle and tubing with transparent dressing.
  4. Change the port needle every 7 days.

Giving medicines and flushing the implanted port

  1. Wash your hands.
  2. Scrub the injection cap with a chlorhexidine wipe and let it dry.
  3. If you are giving medicines, connect and give as instructed.
  4. After giving the medicine or infusion, disconnect the syringe from the injection cap on the port needle.
  5. Flush the port with normal saline, using the push-and-pause method. Remove the syringe. Avoid touching injection cap.
  6. Immediately attach syringe filled with 3-5 mL 100 Units/ml Heparin (prepared with 1 ml of 5000 units/5ml diluted with 9ml N-saline) and flush port using push-pause.
  7. While still under positive pressure clamp the IV tubing.

Removing the port needle

  1. Hold the port steady with the fingers of one hand.
  2. With your other hand, hold the port needle by both “wings” of the butterfly and pull straight out.
  3. If bleeding occurs, apply pressure with sterile gauze until it stops, and apply a bandaid if needed.