Drawing Blood Cultures From A Port

What is a port-a-cath?

A port-a-cath, also referred to as a port, is an implanted device which allows easy access to a patient's veins. A port-a-cath is surgically-inserted completely beneath the skin and consists of two parts – the portal and the catheter.

Depiction of an under the skin portacath

The portal is typically made from a silicone bubble and appears as a small bump under the skin. The portal, made of special self-sealing silicone, can be punctured by a needle repeatedly before the strength of the material is compromised. Its design contributes to a very low risk of infection. The slender, plastic catheter attached to the portal is threaded into a central vein (usually the jugular vein, subclavian vein, or the superior vena cava).

What is the indication for a port-a-cath?

Ports are indicated for patients requiring frequent and long-term intravenous therapy, such as the oncology population. Having a port allows healthcare professionals easy access to a major vein with low risk of infection.

This benefit is extremely important for the immunocompromised population of oncology patients. Additionally, it reduces the pain that would otherwise be experienced with countless needle pokes for IVs, since the skin over a port hub becomes thicker and desensitized.

Another consideration is that oncology patients may receive chemotherapy often, which can be toxic and erosive to tissues in the body. By infusing chemotherapy through a strong vein via port, the medication has a lower chance of leaking into tissues and causing extravasation or irritation.

The implantation of a port is considered a minor procedure performed under local or general anesthesia by an interventional radiologist or surgeon. With one or two small incisions, the catheter is threaded into the vein and attached to the portal chamber. The procedure is typically completed within one hour. A simple x-ray is used for post-operative imaging to confirm appropriate placement of the port. For a few days after the procedure, the patient may experience discomfort at the insertion site, which can be managed by NSAIDs.

Once a port is cleared for use, a patient may receive intravenous therapy through it for the course of his/her treatment. An adult portal chamber can take about 2,000 punctures on average, which may last a patient several years.

Are there different types of ports?

A port can be single or double lumen. Single lumen ports are most common and typically sufficient for patients requiring scheduled intravenous therapy.

However, having a double lumen port is advantageous for patients who often receive multiple intravenous therapies at once. If two intravenous agents aren't compatible in the same line, you can infuse both simultaneously in different port lumens without complication. The double lumen port also allows concurrent infusion of medication, chemotherapy, blood products, or parenteral nutrition. It is also beneficial for drawing labs without interruption of an infusion.

Ports can be referred to by brand name, like Port-a-cath or Mediport. Regardless of the terminology, all ports function the same way, with the exception of the PowerPort.

A PowerPort is a special type of port, available in single or double lumen, which can withstand higher injection pressures. This is an important consideration for receiving intravenous CT contrast dye. A PowerPort must be accessed with a particular type of needle, a PowerLoc needle, in order to inject contrast.

The portal chamber is always characterized by a triangular shape body, which can be palpated under the skin. In addition, a patient with a PowerPort will receive a wallet-sized identification, key ring card, and bracelet. It is helpful for patients to carry one or all of these identifiers to help healthcare professionals in the future appropriately access and utilize the PowerPort.

Triangular powerport portacath

(Image of a triangular PowerPort)

The surgeon determines the location of the port on the body based on a patient's internal anatomy or personal preference. It is most often placed under the subcutaneous tissue of the chest, upper arm, or lower rib cage.

What are some important things to know about caring for ports?

A port provides direct access to a major vein, so if the line becomes infected, it could be detrimental to a patient's wellbeing. In order to avoid line infections potentially leading to sepsis, healthcare professionals need to take great care when handling ports. Ports should be accessed using sterile procedure. When being handled for treatment, the end of the line outside of the body needs to be cleaned according to hospital policy with each use. Additionally, always wash hands before touching the catheter tip.

Some signs of port-related infection may include local swelling, warmth, redness, or pus formation. Systemic symptoms may include fever or chills. If infection is suspected, contact the MD immediately. Blood cultures will likely be drawn BEFORE administering antibiotics, and if the infection cannot be treated with medication, the line may be pulled completely.

If your patient is receiving intravenous therapy through a port, especially chemotherapy, check the site every hour for signs of infiltration or phlebitis. Assessing the port is especially important for patients receiving chemotherapy agents that are vesicants. For these particular chemotherapies, you will often check for blood return every couple hours during infusion to confirm appropriate placement.

Port catheters do have the potential to crack or rupture with excessive injection pressure. It is important to pay attention to syringe size to avoid creating too much intraluminal pressure. The smaller the syringe, the greater the force on injection. For this reason, many hospital policies do not allow you to use smaller than 10cc syringes to inject and aspirate from the port line.

The catheter tip in the vein may "swim" or float to another area in the body. The tip may also be pushing against the wall of the vein. If you are unable to flush or get return, DO NOT use force to flush the tubing. Have the patient try to change position, lift his/her arms above the head, or breathe deeply and cough.

If the port still does not function appropriately, the patient may need to get an x-ray to confirm placement of the catheter. If a thrombosis is suspected, gently pulse a flush of normal saline to dislodge the clot. If the clot does not flush, the MD may order tPA (tissue plasminogen activator) to help break up the clot. To prevent clotting, a port must be flushed with normal saline daily and locked with heparin when not in use.

What are the overall benefits for a patient with a port?

Easy and quick access with less pain than typical needle sticks
Longevity of device use
Reduction of infection risk
Low maintenance care at home
Body image (not noticeable under the skin)

How-To Access a Port:

You will need:

A Port Access Kit (sterile gloves, CHG cleanser, central line dressing kit, skin protectant)
A Biopatch (or disc impregnated with CHG)
Masks for yourself and the patient
Needless Connector
A 90 degree, Non-Coring Port needle (also called a Huber needle) or PowerLoc needle for PowerPort
Sterile Normal Saline flush syringe

Explain the procedure to the patient. If the patient has sensitive skin or for pediatric patients, you can use Emla Cream or Freeze Spray as a local anesthetic on the port site. Ask the patient if they use a particular needle size or if they have a PowerPort.
Perform hand hygiene and apply clean gloves
Locate and palpate the port.
Place a mask on the patient and nurse.
Perform hand hygiene again.
Open the sterile port access kit and create a sterile field. Add your non-coring needle, Biopatch, and sterile 10cc syringe to the field.
Apply sterile gloves.
Attach the flush to the non-coring needle and purge the air by priming the line until you see the saline drip from the needle tip.
Scrub the site clean with CHG from the kit using a back and forth/up and down motion for the amount of time indicated on the directions, typically 30 seconds to 1 minute in each direction.
Allow the antiseptic to dry on the skin.
Stabilize the port with the index finger and thumb of your non-dominant hand.
With the needle at a 90 degree angle from the skin, insert the needle into the center of the portal chamber until you feel the needle hit resistance at the back of the chamber.
Aspirate the syringe to assess for blood return and verify placement.
Once blood return is verified, flush the tubing and clamp. Connect the needless connector.
Apply the Biopatch around the needle with the blue side up.
Apply skin protectant around the site.
Cover the entire site with a transparent dressing. All sides should be occlusive. If patients have sensitivity to Tegaderm, Opsite may be used.
Label the site with date, time, and nurse's initials.
Re-access the site and change the dressing according to hospital policy.

This YouTube video shows the proper steps to access a port.

If you are caring for a patient with a port and have any further questions, please refer to hospital policy or contact your nurse educator.