Ports and needles

Indications for use

The main treatments indicated for port access are the following:

• Intra-venous chemotherapy
• Intra-venous antibiotic therapy
• Long term Total Parenteral Nutrition (TPN)
• Loco regional chemotherapy
• Drainage of malignant ascites (peritoneal and pleural effusions)
• Long term pain treatment
• High pressure injection of contrast media when CT scan is performed
• Blood transfusion and blood sampling

Implantation of the vascular access port

The implantation site is chosen according to the indication, clinical condition of the patient, the patient’s lifestyle and the treatment to be administered. The operation is simple and takes only around 30 minutes under local anesthesia (general anesthesia for children). The vascular access port may be placed in the upper or lower thoracic position or even in a brachial position with a dedicated brachial port. 

The vein is punctured to introduce the catheter and the skin is incised to make a pocket to place the vascular access port under the skin. The port pocket is made as small as possible (about 2.5 cm). After implantation a dressing is placed to protect the incision. If treatment is required right after the port placement, it is possible for the physician to place immediately a needle into the port to administer the treatment.

If the treatment requires a few days infusion, a special needle will be put in place and covered with a sterile dressing. This needle does not need to be changed every day, but the maximum duration of needle placement should not exceed 7 days. When the patient is not receiving regular treatment through the access port, it is recommended to be flushed every 4 weeks. This is to make sure that the catheter and port are still functional. In most cases, there are no complications.

The insertion of the needle into the port is generally painless. However local anaesthetic cream can be applied over the injection site to numb the area. The access, use and maintenance of the vascular access port must be done according to strict aseptic rules and following approved local protocols.

Potential access routes 

There are many potential access routes for a central venous vascular access port catheter. The most used are the internal or external jugular veins, the subclavian vein, the cephalic vein and the axillary vein.

The advantages of an access port are numerous:

• Decrease in number of punctures in peripheral veins which could be damaged by chemotherapy and are then less accessible
• Easier and less painful venous access, which is more comfortable
• Home care treatment facilitated
• Possibility to go on with everyday activities

Usage 

It is of primary importance that the nursing staff takes care for hygiene precautions and follows the port usage process according to local protocols.

It is a complex process and consists of 9 individual steps to follow:

1. Preparation of the medical staff (hygiene measures)
2. Preparation of the access site (inspection, disinfection and preparing needles and dressing component)
3. Preparation of the port needle (rinsing and heparinization)
4. Puncturing the port (careful needle insertion)
5. Confirm the patency (aspiration of blood followed by injection of saline)
6. Needle fixation (fixation with transparent / non-transparent dressing)
7. Start the infusion (careful observation is required)
8. End of treatment (rinsing of port with saline)
9. Removal of the needle (end of process)

Hygiene precautions

Rigorous aseptic rules must be followed, according to the given protocol of the hospital based on national and/or international guidelines to prevent infection of the access port. To avoid any contamination of the injection site, it is important to ensure that the patient’s head remains turned away from the site during the procedure and refection of the dressing.

Maintenance

Rinsing and heparinisation

Always verify that the access port and catheter are functional by aspirating blood into the syringe and injecting 10 mL (or 5 mL for children) of saline solution (NaCl) 0,9 % into the access port/catheter before starting the infusion.

As part of port maintenance, rinsing is required before starting a treatment, after each treatment, before changing the infusion solution and every four weeks when the system is not in use. This applies regardless of whether it is a venous catheter, an arterial catheter, an epidural/intrathecal catheter or a pleural catheter. 

Flushing with heparinised saline solution (NaCI) 0.9 % can follow if required by local protocol. When heparinised saline solution (NaCI) 0.9 % is used, the system should be rinsed with 10 mL of saline solution (NaCI) 0.9 % alone before rinsing with heparinised saline (NaCl) 0.9 %. Some drugs react with heparin and may result in blockage of the access port/catheter due to formation of precipitates.

Removal of the needle

To avoid blood inside in the catheter, the port is flushed with normal saline solution (NaCI) 0.9 %. There is no specific recommendation regarding the removal technique of the needle.

The use of positive pressure or not, upon withdrawal of the needle, does not prevent blood diffusion into the lumen of the catheter over time. More important is to rinse the port and catheter as recommended in the Celsite® IFU’s, before, in between and after each infusion.