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Clinical Procedure Nursing Practice Manual John Dempsey Hospital ­ Department of Nursing The University of Connecticut Health Center PROCEDURE FOR: POLICY: Central Lines: Implanted Port: 1.

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Accessing Port with Huber Needle

Registered Nurses or LPNs are responsible for accessing, initiating and discontinuing infusions, and drawing blood through implanted ports. RNs are responsible for assessing the port and site for infiltration, clotting, and other complications. Appropriate hand hygiene (washing hands immediately before accessing central lines) must be used for all aspects of port care. Aseptic technique must be utilized for all aspects of port care. Dressings will be changed as for all other central catheters: a. Every 7 days for transparent dressings (more frequently if the dressing is no longer occlusive) b. Every 48 hours for gauze dressings A Huber needle may remain in place for 7 days if there are no complications.

2. 3. 4. 5.

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EQUIPMENT:

Safety Huber needle Injection site; Y-Type Catheter Extension site 2 ­ 10 or 12 ml syringes Sterile normal saline Central line dressing kit Small transparent dressing Solution to be infused 10 ml NS drawn up in 10 or 12 ml syringe Heparin solution (100 units/ml) Tape Chlorhexidine swabs or pads Gloves

PROCEDURE: ACTION Accessing Port: 1. Wash hands. 1. Aseptic technique is essential as the implanted port serves as direct access to a major blood vessel. 10 ml or larger syringe is needed to avoid excessive pressure. POINTS OF EMPHASIS

2. 3.

Draw up 10 ml sterile NS in syringe. Set on clean surface. Open central line dressing kit and use the inner wrap as a sterile field. Apply the mask. Open and place the Huber needle, and injection site on the sterile field.

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Choose the length of the needle that is appropriate to the patient so that the needle is flush with the skin. Three lengths are available, 3/4, 1 and 1½ inch in length. The tubing is attached to the safety needle.

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Prime the needle and tubing while maintaining sterility.

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Clinical Procedure Nursing Practice Manual John Dempsey Hospital ­ Department of Nursing The University of Connecticut Health Center PROCEDURE FOR: Central Lines: Implanted Port: ACTION 6. 7. Remove the existing needle from the port (if present). Palpate the implanted port for the "depressible" or "spongy" area at the center of the port. This is the insertion site. Don sterile gloves. Cleanse the implanted port insertion site with chlorhexidine gluconate swab or pad with vigorous friction for at least 15-30 seconds. 6.

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Accessing Port with Huber Needle POINTS OF EMPHASIS Don gloves for removal of the existing needle (if present).

8. 9.

10. Allow to dry thoroughly. 11. Palpate the center of the port septum with one hand; with the other hand, grasp the flexible wings with the thumb and middle finger, placing the index finger on top of the safety hinge. (Figure A of appendix) 12. Remove the needle guard. 13. Insert the needle at a 90° angle to the port. Advance the needle through the skin and the port septum until it contacts the bottom of the port reservoir. 14. Confirm needle placement by aspirating 3 to 5 ml of blood. SECURING THE NEEDLE: 1. 2. 3. Secure the needle with tape. Apply the transparent dressing. Check the site frequently for swelling, leakage, etc. 2. 3. Leave the cap exposed for access. If site shows no signs of complications, assess every eight hours/PRN. 11. It maybe helpful to use two fingers on either side of port and place Huber needle midway between these two points.

INITIATING INFUSION: 1. Luer lock the 10 or 12ml syringe with 10ml NS into the Injection site. 1. Prior to accessing the central line, the hub must be scrubbed for 15-30 seconds with CHG and allowed to air dry. This will insure patency of the port. If no blood returns, reposition needle. Call MD if unable to get blood return.

2.

Pull back on the syringe to obtain blood return.

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Clinical Procedure Nursing Practice Manual John Dempsey Hospital ­ Department of Nursing The University of Connecticut Health Center PROCEDURE FOR: Central Lines: Implanted Port: ACTION 3. Slowly flush with 10ml NS through the tubing and port. Use a pulsatile pushstop-push-stop motion. Attach the IV solution or medication and begin the infusion. 3.

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Accessing Port with Huber Needle POINTS OF EMPHASIS The pulsatile motion is used to create a turbulent flow and reduce the buildup of residue on the inner surface of the device.

4.

DISCONNECTING THE INFUSION: 1. 2. 3. Wash hands. Disconnect the IV solution tubing. Luer lock a 10 or 12 ml syringe to the injection site and flush the port with 5ml of Heparin solution as per Heparin/NS flush procedure. 3. Use a pulsatile push-stop-push-stop motion.

REMOVAL OF HUBER NEEDLE: 1. 2. Wash hands. Don gloves. 2. Use care to remove needle slowly and straight upward to prevent trauma to port or skin.

Remove dressing and tape.

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Flip the needle trap up to a 90° angle. (See Figure B) Using your non-dominant hand, grasp the safety hinge with your thumb and middle finger. Gently push the safety hinge down against the patient's port.

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Using your non-dominant hand, securely hold the safety hinge in place. Using your dominant hand, grasp the flexible wings and pull upward until the needle is completely encapsulated in the needle trap. (See figure C.) You will hear the needle lock into the safe position. Flip the safety hinge towards the needle trap. (See Figure D). Place the needle in a Sharps Container. If any leakage or bleeding noted, apply small bandage or Band-Aid. APPROVAL: Nursing Standards Committee Infection Control 7/87

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The needle trap allows for visual confirmation to ensure that the needle is fully encapsulated and safe.

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EFFECTIVE DATE:

Clinical Procedure Nursing Practice Manual John Dempsey Hospital ­ Department of Nursing The University of Connecticut Health Center PROCEDURE FOR: Central Lines: Implanted Port:

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Accessing Port with Huber Needle

REVISION DATES: APPENDIX A:

12/88, 11/90, 7/93, 2/94, 9/96, 10/97, 8/00, 10/02, 4/03, 6/05, 10/05, 4/09, 2/10, 4/10

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