Implanted Vascular Access Ports Policy

1. Policy Statement

It is the policy of this organization that implanted vascular access ports shall be accessed exclusively with noncoring needles after pre-access assessment confirms absence of contraindications, that all access and maintenance procedures shall adhere to Aseptic Non Touch Technique principles, and that patients and caregivers shall receive comprehensive education regarding port care, complication recognition, and device management.

2. Purpose

This policy exists to:

• Establish pre-access assessment requirements to identify contraindications before port access
• Define noncoring needle selection, insertion, and replacement standards
• Standardize flushing and locking protocols to maintain port patency
• Establish dressing and securement requirements to protect the access site
• Define verification requirements before power injection through implanted ports
• Establish ongoing device surveillance standards
• Ensure comprehensive patient and caregiver education for port management

3. Scope

This policy applies to:

• All licensed clinical personnel who access, maintain, or provide education about implanted vascular access ports
• All care settings within this organization where implanted ports are accessed, including inpatient, ambulatory, infusion center, and home care
• All patients with implanted vascular access ports, including oncology, chronic infusion therapy, and other patients with long-term access needs
• Patients and caregivers managing implanted ports in the home setting

4. Policy Requirements

4.1 Core Standards

4.1.1 Skin antisepsis shall be performed prior to each access of an implanted vascular access port. The antiseptic agent shall be allowed to dry completely before needle insertion to ensure maximum antimicrobial efficacy.

4.1.2 Implanted vascular access ports shall be accessed exclusively with noncoring needles. When power injection is required for radiologic imaging procedures, only power-injectable noncoring needles shall be used, and all procedures shall adhere to the manufacturer’s directions for use.

4.2 Pre-Access Assessment

4.2.1 Before accessing any implanted port, the clinician shall conduct a thorough assessment of the port site and surrounding tissue to identify contraindications to access that would necessitate further clinical evaluation rather than proceeding with the access attempt.

4.2.2 The assessment shall include:

• Visual inspection and palpation for swelling, tenderness, erythema, or drainage at the port site
• Observation for venous collaterals on the chest wall, which may indicate underlying venous occlusion
• Evaluation of overlying skin integrity to identify any erosion of the portal body through tissue
• Assessment for signs consistent with catheter-associated deep vein thrombosis, including unilateral limb swelling, pain, or discoloration

4.2.3 When any of these findings are present, the port shall not be accessed. The clinician shall collaborate with the healthcare team to determine appropriate diagnostic evaluation and management.

4.2.4 When intravenous access is required, accessing a patient’s existing implanted port shall be preferred over inserting an additional vascular access device, provided no contraindications exist.

4.3 Pain Management Considerations

4.3.1 Prior to initiating the access procedure, clinicians shall assess patient needs and preferences related to pain management.

4.3.2 Pharmacologic and non-pharmacologic strategies shall be employed based on patient history, preferences, and institutional protocols.

4.3.3 Topical anesthetic agents, when used, shall be applied with adequate time to achieve effective anesthesia prior to needle insertion.

4.4 Aseptic Technique Requirements

4.4.1 Adherence to Aseptic Non Touch Technique (ANTT) principles is mandatory during all port access procedures to reduce catheter-associated bloodstream infection risk.¹² Clinicians shall employ either Standard-ANTT or Surgical-ANTT based on clinical circumstances and institutional protocols.

4.4.2 Following completion of skin antisepsis, sterile gloves shall be worn if the port site requires palpation to locate the port body prior to needle insertion. This maintains the sterility of the prepared field and prevents contamination of the access site.

4.5 Noncoring Needle Selection and Insertion

4.5.1 Gauge Selection

4.5.1.1 The smallest gauge noncoring needle capable of accommodating the prescribed therapy shall be selected. This approach minimizes trauma to the port septum while ensuring adequate flow rates for the intended infusion.

4.5.1.2 Safety-engineered noncoring needles shall be used and may be required by jurisdictional regulations.

4.5.2 Needle Length Determination

4.5.2.1 The selected needle shall be long enough that the tip contacts the bottom of the port reservoir upon full insertion. The external components of the needle — including wings or stabilization disc — shall rest level with the skin surface to ensure secure seating within the port hub throughout the duration of access.

4.5.3 Bevel Orientation

4.5.3.1 During insertion, the bevel of the noncoring needle shall be oriented in the direction opposite to the outflow channel where the catheter attaches to the port body. In vitro studies demonstrate that this bevel orientation results in more effective removal of protein deposits during flushing procedures.

4.5.4 Replacement Frequency

4.5.4.1 The frequency of noncoring needle replacement shall follow manufacturer recommendations or institutional protocols. Current evidence is insufficient to establish definitive recommendations for replacement intervals during continuous infusion therapy.

4.5.5 Insertion Assistive Devices

4.5.5.1 Needle insertion assistive devices may be considered, as some evidence suggests they may improve first-attempt success rates during port access.

4.5.6 Apheresis Port Considerations

4.5.6.1 When accessing implanted ports with funnel designs intended for apheresis procedures, clinicians shall use the catheter type specifically recommended by the port manufacturer.

4.6 Flushing and Locking Protocols

4.6.1 Assessment of port function through flushing shall be performed both at the time of access and prior to each infusion administration.

4.6.2 Blood Return Verification

4.6.2.1 Presence of blood return shall be confirmed upon insertion of the noncoring needle and before initiating any infusion. This verification ensures catheter patency and appropriate tip position.

4.6.3 Maintenance Flushing for Non-Accessed Ports

4.6.3.1 For adult patients, a minimum of 10 mL of 0.9% sodium chloride shall be used for flushing procedures. Research indicates that 0.9% sodium chloride alone may be equally effective as heparin-containing solutions for maintaining port patency.

4.6.3.2 Extending maintenance flushing intervals to every three months, using 10 mL of 0.9% sodium chloride followed by 3 to 5 mL of heparin at a concentration of 100 units per milliliter, has demonstrated safety and efficacy for maintaining adequate patency while reducing patient burden.

4.6.3.3 For ports that are accessed but not actively infusing, daily flushing shall be performed to maintain catheter patency.

4.7 Dressing and Securement

4.7.1 Dressing Type and Application

4.7.1.1 A transparent semipermeable membrane (TSM) dressing shall cover the noncoring needle and access site whenever a port remains accessed. This dressing type allows continuous visualization of the site while providing a barrier against contamination.

4.7.2 Dressing Change Intervals

4.7.2.1 TSM dressings shall be changed at minimum intervals of every seven days.

4.7.2.2 If gauze is used over the noncoring needle and access site instead of or in combination with a TSM dressing, more frequent changes are required — specifically every two days.

4.7.2.3 An exception applies when gauze is used solely to support the wings of a noncoring needle without obscuring the access site. In these cases, provided the gauze remains intact, visibly clean, and free of moisture, drainage, or blood, the TSM dressing may be changed at the standard seven-day interval.

4.7.3 Chlorhexidine-Containing Dressings

4.7.3.1 Chlorhexidine-containing dressings shall be considered for adult patients and pediatric patients over two months of age.

4.7.3.2 For oncology populations, chlorhexidine-containing dressings shall be employed around the needle insertion site when infusion duration exceeds four to six hours.

4.7.4 Needle Securement

4.7.4.1 The noncoring needle shall be secured to prevent dislodgement and the consequent risk of infiltration or extravasation. Sterile tape strips or other appropriate securement methods shall be employed while ensuring protection of skin integrity around the insertion site.

4.8 Power Injection Protocols

4.8.1 Pre-Procedure Verification

4.8.1.1 Before using any implanted port for power injection, clinicians shall confirm that both the port and the noncoring needle are rated for power injection use.

4.8.2 Device Identification Methods

4.8.2.1 Clinicians shall confirm power-injection capability using one or more of the following methods:

• Unique alphanumeric device identifier documented in retrievable form within the patient’s health record
• Review of operative procedure documentation from the original implantation
• Manufacturer-provided identification cards
• Radiographic scout scans
• Palpation of the port body (palpation alone shall not serve as the sole identification method, as not all power-injection-capable ports possess unique characteristics identifiable through tactile examination)

4.8.3 Monitoring During and After Power Injection

4.8.3.1 Clinicians shall monitor for signs of catheter rupture during and following power injection procedures. Clinical indicators suggesting catheter rupture include localized swelling, erythema, and patient reports of pain at or near the port or along the catheter tract.

4.9 Ongoing Device Surveillance

4.9.1 Annual chest radiograph imaging shall be considered for assessment of port position and catheter integrity. This surveillance can identify complications including catheter migration, fracture, or other positional abnormalities before they become clinically significant.

4.10 Patient and Caregiver Education

4.10.1 Pre-Implantation Education

4.10.1.1 Prior to port implantation surgery, patients shall receive information addressing:

• The surgical procedure itself
• The specific type of port being implanted
• Routine care requirements including flushing frequency and aseptic technique during access
• Power injection capability if applicable
• Recognition of potential complications with appropriate response actions

4.10.1.2 Provision of written educational materials before insertion shall be the standard, as research demonstrates decreased patient anxiety and improved knowledge retention when education precedes insertion.

4.10.2 Home Infusion Education

4.10.2.1 Patients and caregivers managing ports in the home setting shall receive education specific to this environment, including:

• Daily dressing inspection
• Management of activities of daily living such as bathing, dressing, and seatbelt use to prevent needle dislodgement
• Recognition and reporting of complications
• Instructions to promptly report pain, burning, stinging, or soreness at the port site
• Appropriate follow-up actions for concerning symptoms

4.10.3 Post-Treatment Considerations

4.10.3.1 For patients whose treatment has concluded, education regarding device disposition shall be provided. This includes discussion of port removal versus continued maintenance and potential complications associated with prolonged dwell time, including infection, thrombosis, and catheter tip migration.

4.10.3.2 Patients shall be equipped to make informed decisions about device management in consultation with their healthcare team.

5. Compliance

5.1 Key Performance Indicators

• Rate of pre-access assessment documentation prior to port access (target: ≥95%)
• Rate of blood return verification prior to port use (target: 100%)
• Rate of noncoring needle use for all port access procedures (target: 100%)
• Rate of TSM dressing use when port is accessed (target: ≥95%)
• Rate of dressing change interval compliance (target: ≥95%)
• Rate of pre-implantation education documentation (target: ≥95%)
• Rate of power injection device verification documentation prior to contrast procedures (target: 100%)
• Rate of port-associated bloodstream infection per 1,000 port-access days

5.2 Enforcement

Non-compliance with this policy shall be addressed through the organization’s standard performance improvement and professional accountability processes, including documentation audits, peer feedback, targeted education, and escalation to unit leadership or the Vascular Access Governance Committee as appropriate.

6. Exceptions

Exceptions to this policy require documented clinical justification recorded in the patient’s health record. In emergent situations where standard access protocols cannot be fully observed, the deviation shall be documented with a plan for transitioning to compliant practice at the earliest safe opportunity. Exceptions shall not become routine practice without formal policy revision.

7. Related Documents

• Vascular Access Device Selection and Insertion Policy
• Vascular Access Site Preparation and Skin Antisepsis Policy
• Central Vascular Access Device Tip Location Policy
• Aseptic Non Touch Technique (ANTT) Policy
• Hand Hygiene Policy
• Informed Consent for Vascular Access Policy
• Adverse Event Management and Reporting Policy
• Vascular Access for Therapeutic Apheresis Policy
• Patient Education — Going Home with an Implanted Port

8. Revision History

References