Accessing an implanted port and administering factor

This leaflet is for parents and patients who are learning to access an implanted port and administer factor using a sterile technique.

Equipment required

Plastic tray

Sharps bin

Dressing pack

1 pair of sterile gloves

2 x sterile clinell wipe

1 x chloraprep stick

Port needle: size - _________

Needleless bung

2 x 10ml syringes

3 x needles (including one filter needle for glass ampoules)

2 x 0.9% saline 10mls

Heparinised saline (Hepsal) __ x _______

Equipment to make up factor concentrate including syringe

Dressing if leaving the port accessed

Procedure

1. Collect together equipment required, including the sharps bin. Check that all the vials are in date and not damaged. Ensure that you will be undisturbed.
2. Wash hands with liquid soap and dry with a paper towel.
3. Wash plastic tray with washing up liquid or liquid soap and dampened paper towel. Dry with a clean paper towel.
4. Clean the tops of the saline and heparinised saline and factor vials with a clinell wipe and leave to dry for 30 seconds.
5. Open the dressing pack onto the tray being careful to only touch the underside of the paper. If required, place hand into the waste bag and use the sterile surface to allow you to organise the contents of the dressing pack and to remove sterile gloves and place them on the side.
6. Peel open 2x 10ml syringes, syringe for factor, filter needle, 2x needles, port needle, needleless bung, chloraprep and place them onto the sterile paper without touching them.
7. Break off the tops of the saline and hepsal vials. Place them beside the tray, not on it. Make up factor as previously shown.
8. Wash hands again as above and put on the sterile gloves, included in the pack, being careful to only touch the inside of the gloves with your bare hands.
9. Join together the syringes and needles, being careful not to touch the head of either item.
10. Draw up 2x 10mls of saline and ___ mls of heparinised saline without touching the vials. Remove the needles from the syringes and place straight into the sharps bin being careful not to touch the tip of the syringe or the sharps bin. Remember to use a filter needle for the heparinised saline as it is in a glass vial.
11. Organise your syringes on your sterile field in the order you will use them. i.e 1x saline, 1x factor, 1x saline, 1x hepsal
12. Draw up factor as previously taught; place it on the tray turning that syringe upside down so that it is easily identifiable.
13. Attach the needleless bung to the port needle set and using the saline, attach the syringe and flush through until the set is primed. Remove the syringe.
14. Activate the Chloraprep stick and clean the area over and around the port once working from the centre of the port outwards in a spiral. Ensure skin is cleaned with an ‘agitated’ movement NOT ‘wipe over action’. Allow the skin to dry for at least 30 seconds. Make sure the area of clean skin is wider than the actual indwelling port site.
15. Using the dominant hand hold the port as previously shown ensuring that the needleless bung and clamp are curled up in your hand.
16. Using the non-dominant hand to locate the sides of the port, insert the needle straight into the site using the dominant hand.
17. Once the port needle is in continue to hold the needleless bung in the non- dominant hand. Attach the saline syringe back onto the needleless bung, being careful not to contaminate the part of the needleless bung where the syringe is attached. Pull back until you see a flashback of blood in the giving set.
18. Administer the factor.
19. Flush the set with the saline using a pulsing motion to clear the port.

20. Use the ___ml of heparinised saline to lock the port. Administer with a pulsing motion and clamp the line while giving the last 1ml.

21. Holding onto the port, pull out the port needle and dispose of safely in the sharps bin.

22. Dispose of all other glass and sharps in the sharps bin.

23. Remove gloves and wash hands.

24. Wash tray with soap and water.

25. Enter treatment on Haemtrack.

For further information please contact

Your Haemophilia Nurse specialist: 01223 257039