Basic knowledge of types of intravenous ports can help nurses who manage these for patients.
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
POINTS FOR PATIENT EDUCATION
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.