Know Your Ports

Throughout the course of treatment, many patients with cancer receive chemotherapy, intravenous fluids, antibiotics, and much more via central venous catheters such as Mediports. It is crucial that oncology nurses perform proper technique and site maintenance to prevent infection and avoid infiltration or extravasation. Providing comprehensive patient education can prevent foreseeable issues and improve patient outcomes.

Several types of intravenous ports are available, and knowing which one is being used can provide clues regarding how to access and dress it.

For example, there are both single and double lumen ports. To find out which type a patient has, checking the radiology report always helps, but it usually can be determined by feeling for the septum(s). This is especially important when accessing a double lumen port, because the orientation can differ and even move slightly (septums are situated either side by side or superior and inferior). Some ports—mainly, single lumen ones—have raised bumps along the septum’s edge that make it easier to identify an exact access point.

A patient might have a PowerPort, a device that allows rapid injection of the contrast agent or dye during radiological exams. Depending on the treatment plan and the last date of access, one or both ports may need to be accessed. Once the type of port is determined, the nurse can plan supplies and method of access. The same technique is used whether accessing 1 or both ports, and 1 dressing will adequately cover both sites.

LOCATING THE PORT

Feeling for the septum is not always straightforward. Depending on the patient’s anatomy and weight, the port can be difficult to locate, especially if mild swelling post-surgery is present.

A port is typically placed on the right side of the patient’s chest and about 3 to 5 fingerbreadths below the clavicle. The insertion scar provides a useful landmark, because the port is usually located 0.5 to 1 inch below the surgical incision.

Bringing a patient who has large amounts of breast tissue to a fully upright position, with the right shoulder rotated toward the patient’s backside, can aid in visualizing or feeling the port access site.

CHOOSING A NEEDLE

Understanding the available needle types can help the nurse execute the best possible access to the port. Consider these questions: What is the most comfortable way to hold and insert this particular needle? Are butterfly wings present? Do any pieces require removal before or after access?

Proper needle length is crucial for preventing infiltration and/ or extravasation. Although a ¾-inch needle is widely used, a particular patient may require anywhere from 1 to 2 inches.

Once inserted, the nurse should be able to feel the needle’s tip gently tap the plastic or metal backing of the port. Once accessed, the needle should lay relatively flat against the patient’s chest and blood return should be present, along with an easy, pain-free saline flush.

TIPS TO ENSURE SUCCESSFUL ACCESS

• Maintain a sterile field with all equipment needed for access, including any dressings, flushes, valves, etc. This is critical for infection prevention, as well as ease of access and time management.
• Allow proper dry time for any skin cleanser, such as ChloraPrep, to help prevent not only infection but also a rash. A dressing placed before the cleanser fully dries can cause a red raised rash that might be confused for a dressing allergy.
• Ensure that the needle is primed with saline. However, many hospital policies differ slightly in best practice for port access.
• Stabilize the port with the nondominant hand prior to access to improve Mediport access success rate.
• Although rare, it is possible for ports to flip.

POINTS FOR PATIENT EDUCATION

• Emphasize the benefits of an implanted port: It avoids many painful venipuncture attempts and provides a stable line if urgent medication is needed. This knowledge can help allay patients’ fears and solidify their decision when selecting a port.
• Explain what to expect regarding a new port site. Bruising and swelling should subside. If steri strips were used, ensure the patient is aware to let them fall off on their own. Removing them prematurely could reopen the incision and increase the risk of infection.
• Educate patients on monitoring for signs of infection, both systemic and at the port site. Be sure they know what symptoms require medical attention: fever and abnormal swelling, redness, warmth, or drainage, especially during healing.
• Be sure patients who have implanted ports understand that, once the site heals, they will have more freedom of activity, because the port is completely under the skin and protected (once healed). They can shower normally and even swim when the port is not accessed, although participating in contact sports is not advised as injury to the port site is possible.
• Remind patients remaining accessed for multiday infusions that the site must stay clean and dry. Many patients like to use AquaGuard dressings, which help protect the site from water.
• Instruct patients that, if not in use, a port should be accessed and flushed once a month to maintain patency.

Ashley Hay, BSN, RN is a freelance healthcare writer and owner of AHayWriting.com with over 10 years of nursing experience in several areas of pediatric and adult oncology.