MARSHALLTOWN MEDICAL & SURGICAL CENTER Marshalltown, Iowa

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1 MARSHALLTOWN MEDICAL & SURGICAL CENTER Marshalltown, Iowa CARE OF PATIENT POLICY & PROCEDURES Policy Number: 4.37 Subject: Implanted Venous Access Device (Infus-A-Port), Nursing Management Of (Indwelling Vascular Access Port) Purpose: 1. As a percutaneous drug delivery system for the patient requiring long-term vascular access. 2. For blood sampling, injection or infusion therapy. 3. For intraperitoneal chemotherapy. 4. Venous or arterial access. Policy: An RN may access a infusa-port for infusion and blood sampling after checking 2 patient identifiers. Supportive Data: 1. Consists of a self-sealing injection port with an attached catheter for the receiving and deliverance of parenteral fluids to selected body sites. (Depending on placement). 2. Port is totally implantable. 3. Only a non-coring infusaport needle should be used. 4. The bend of the infusaid needle should be angled for patient comfort and needle stability. Also can be secured better for long term use. 5. There are 19, 20 and 22 gauge needles. 6. Check for drug compatibility. Turn off solution, check for blood return, flush stopcock, then slowly inject secondary med. Flush again, then resume primary infusion. 7. Dressing changes are to be done weekly unless otherwise ordered. 8. The infusaid needle should be changed every seven days. 9. If Infuse-a-port is not in use, once a month Heparin lock flushes should be administered. 10. Heplock solution for flushes should be 5cc of the 100 units/ml. 11. When frequent access of port is occurring (example - daily, every 6, 8, 12 hr. meds), the heplock solution strength should be customized by the attending physician. 12. Infusion pump should be used. 13. Blood and blood products can be given through Infuse-a-port with use of appropriate size needle. 14. Infusaports may be accessed immediately after insertion for blood, chemotherapy, IV fluids, and antibiotics. 15. A topical anesthetic may be used for comfort before skin cleansing, for example when using large bore needles for blood transfusions. (Physician order needed.) 16. If fluid restriction is important for the patient flush fluid may be reduced to a minimum of 5cc. 17. When a heparin flush solution is used and the heparin is incompatible with administered medications/solutions the SASH (i.e., saline, administration, saline, heparin) procedure is utilized. SASH is a flushing procedure using saline prior to and after administration of medications/solutions incompatible with heparin and followed by a final flush of heparin solution.

2 Implanted Venous Access Device (Infus-a-Port), Nursing Management of Page 2 EQUIPMENT LIST: (Not all this equipment is used in every situation.) 1. Infuse-a-port continuous infusion kit from CSS contains the following: Chloraprep Swab sterile gloves sterile towels sterile stopcock Heparin lock injection cap 3cc syringe with 25 gauge needle with 1/2cc xylocaine 2 - sterile 20 or 22 ga bent rt angle non-coring needle with or without tubing 3-2X2 sterile sponges 1 package steri strips 1 - transparent 4X4 3/4" dressing 2-10cc syringe 4-20 gauge needles 1-30cc bottle Normal Saline 3 - alcohol sponges Sterile gloves vented IV set with micronfilter (do not use filter for chemotherapy) 3. plastic waste bag 4. Infusion Pump 5. IV solution as ordered 6. Heparin of 100u/mL Nursing Management Of Newly Established Infusaport Procedure Steps 1. Observe for redness, firmness, swelling or bleeding/hematoma, device rotation and skin erosion. 2. Inspect dressing for presence of a needle. If present, assure security of needle to site with tegaderm Key Points 1. Consider ice pack to decrease swelling and for comfort. Initiation Of Huber And/Or Needle Infusion Procedure Steps Key Points 1. Explain procedure to patient. Provide for privacy. 2. Prepare fluids in infusion pump. 3 Carefully remove the old dressings. 3. Be careful not to contaminate. 4. Open sterile towel and place sterile equipment on it. 5. Identify infuse-a-port septum by palpating the outer perimeter of the port. 6. If topical anesthetic used, (i.e. Xylocaine gel or Emla Cream) it must be applied at least minutes prior to accessing 7. Observing sterile technique, use chloraprep swabsticks to prep Infuse-a-Port in a side to side extending prepped area beyond periphery of the port. Let dry. 4. Maintain sterility. May use sterile glove wrapper as a sterile field. 6. Other topical anesthetics may be used. Follow manufacturer s advice for the time frames.

3 Implanted Venous Access Device (Infus-a-Port), Nursing Management of Page 3 8. Use sterile gloves. 9. Attach syringe with sterile stopcock to infusaid needle, connect to tubing and flush solution through to eliminate all air, close stopcock. 10. Anchor the port with non dominant hand, and aim the needle at the center of the device. Insert infusaid needle into infuse-a-port septum at a perpendicular angle. 11. Open stopcock or clamp. Check for blood 9. The stopcock is recommended for frequent accessing. a) Extention tubing and stopcock or needles with preattached tubing and a clamp may be used. b) Never leave open to air. Shut stopcock or clamp when changing or connecting syringes. 10. Insert completely until it stops. Infuse-a-port has needle stop. 11. Aspirated blood may be reinfused. return before starting infusion. 12. Flush with 10cc normal saline. 12. Use a 10 cc syringe. 13. Place rolled 2x2 under needle hub. Apply steri strips across needle and needle hub connection. Cover with transparent dressing. 14. Another med can be given via stopcock without disconnecting the primary IV. Check for drug compatibility. Turn off solution, check for blood return, flush stopcock, then slowly inject secondary med. Flush again, then resume primary infusion. 14. Checking for blood return before new med is infused will determine the needle has not dislodged. 15. Begin infusion or administer meds. 15. Examine infusion site closely. If the patient feels an abnormal sensation or pain at the injection site, it may indicate that the drug has extravasated. Discontinue infusion immediately and notify the physician. 16. Discard equipment in appropriate receptacles 16. Flush with 10cc of normal saline between each medication. 17. Wash hands. 18. Document. (IV flow chart in CPSI or OP documentation forms) Termination of Infusion: 1. Upon termination of infusion, close stopcock or clamp. Disconnect pump tubing from stopcock. 2. Attach 20 ml. syringe filled with saline to stopcock. Open stopcock and flush catheter. Close stopcock, or clamp. 3. Attach 10 ml. syringe filled with 5cc heparinized saline, open stopcock or clamp and flush catheter. Maintain positive pressure at the end of heparin injection and clamp. 4. Remove dressing, Gently withdraw needle from port septum and apply adhesive bandage. 5. Discard dressings, wash hands. 6. Document. (IV flowchart in CPSI) 3. This constitutes the "Heparin lock" and retards catheter tip occlusion by blood.

4 Implanted Venous Access Device (Infus-a-Port), Nursing Management of Page 4 Blood Sampling: 1. Prep site following initiation steps Insert 1. May not need stopcock. Using a 10 cc syringe. special infusaid needle into prepped port site and flush catheter with 5 ml saline. 2. Draw back 10 ml blood and discard. 2. The lab does not recommend reinfusing this blood. 3. Draw required volume of blood. 3. Lab personnel will direct nursing staff in how much blood to withdraw. 4. Immediately flush catheter with a minimum of 20 ml saline. 5. Continue with bolus injection, continuous infusion procedure or re-establish "Heparin Lock". 6. Discard equipment. 7. Document. Documentation: Originated by: Care Of Patient Effective date: July 1987 Authorized by: Prof. Prac. 11/06 Authorized by: VP Operations, Chief Nursing Officer Date Revised date: 12/91, 12/93, 6/95, 3/96, 1/98, 2/01, 4/02, 7/02, 4/04, 11/06 Review date: 12/94 Distribution: ICU, Med/Surg, SCC, ASC, ED If Heparin lock MAR, IV flow chart, otherwise on Nurse's Notes or the Outpatient Clinic/Chemotherapy Administration record. Reference: Nursing Procedures, 4 th Edition, Lippincott, Williams and Williams, 2004, pg Intravenous Nursing Society Guidelines. Tenenbaum, Linda. "Cancer Chemotherapy, a Reference Guide," W.B. Saunders, "Access Device Guidelines, Module 1, Recommendations for Nursing Education and Practice," Oncology Nursing Society, 1989.

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