Patient education: How to care for a port (The Basics)

What is a port? — A port is a type of central line, which is a special kind of IV. Sample brand names for ports include Port-a-Cath, BardPort, PowerPort, Infuse-a-Port, and Mediport. The medical term for a port is a "totally implanted venous access device."

Ports have a small, hollow "reservoir" that is attached to a thin, flexible tube called a "catheter" (figure 1). Both the reservoir and the catheter are under the skin. The catheter goes into a large blood vessel that leads to the heart. The reservoir is a round disc that is covered with a special silicone. The silicone allows the port to be used over and over.

The medical staff can "access" the port using a special type of needle. The needle goes through your skin and into the reservoir (figure 2). The needle can stay in for a week at a time and will be covered with a clear bandage and taped in place. When the port is not being accessed, all you will see is a small bump under your skin.

A port can stay in place for months or years until your treatment is no longer needed.

How do I care for myself at home? — Ask the doctor or nurse what you should do when you go home. Make sure that you understand exactly what you need to do to care for yourself. Ask questions if there is anything you do not understand.

You should also:

●Know what kind of port you have and how to care for it. Before you go home, your doctor or nurse will talk to you about this. They will teach you how to change the dressing, flush the port, "access" the port (put a needle in), and "de-access" the port (take a needle out). They will also make sure that you have the supplies you need. Having a port increases your risk of infection. This is why it's so important to take care of it.

●Ask a family member or friend to help you care for the port, if needed. Some people have a home health nurse come to their home to help with this.

Will the port always be accessed? — When you are at home, there might be times when the port is still accessed. This means that it still has a needle in place, for example, to give medicine.

When the port is accessed:

●Do not get the port wet while the needle is in place. Take a sponge bath or keep the dressing covered when showering.

●Keep the dressing clean and dry. This helps keep the needle secure and in place.

When the port is not accessed:

●You can shower, take a bath, or swim in a pool.

●You do not need to have a dressing over the port. It will look like a small bump under your skin.

●Wear clothes that do not rub on the port.

●You can do many of your normal activities. Talk to your doctor about what activities are safe for you.

●Flush the port before and after giving medicines and blood draws. Some doctors want you to flush the port at least 1 time each month. Other doctors might want you to flush the port at least every 3 to 4 months. Talk to your doctor about how often you need to do this.

How do I change the dressing on the port? — When the port is accessed, it will have a clear dressing to hold the needle in place. Always change the dressing right away if it is wet, loose, or dirty. This is to help prevent infections.

To change the dressing:

●Gather the supplies, and place them on a clean workspace. Your supplies might come in a kit. You need clean gloves, sterile gloves, masks, chlorhexidine swab sticks or wipes, tape, and sterile dressings. Your doctor might also give you skin preparation wipes.

●Always wash your hands well with soap and water before touching the needle and tubing. This will help avoid spreading germs. Everyone should wear a mask during the dressing change, including the person with the port. Another option is to have the person with the port keep their head turned away while the dressing is being changed. Wear clean gloves when taking off the old dressing.

●Take off the old dressing. Do not use scissors or sharp tools. They could cut the extension tubing that is connected to the needle. Do not pull on the tubing when taking off the dressing.

●Check the skin where the needle enters for swelling, drainage, or redness.

●Wash your hands again. Put on sterile gloves.

●Clean the skin with a chlorhexidine swab or wipe using a back-and-forth scrubbing motion for 30 seconds. Start where the needle enters the skin, and clean away from this point. Clean the outside of the tubing and the entire area where the new dressing will go, about a 4-inch (10 cm) square. Let the cleaned area air dry for at least 30 seconds or until completely dry. Do not fan, wave, or blow on the skin to help it dry faster.

●Your doctor might give you a small sponge to go around the needle where it goes into the port. Put this sponge on the skin so it circles the needle. Make sure that it is right-side up as marked on the sponge. In some cases, the sponge is a part of the dressing.

●You might have been given skin preparation wipes to use. If so, once the cleaned area is dry, use the wipe around the port where the new dressing will go. Let the skin dry completely before putting on the dressing. This protects the skin by helping prevent irritation from changing the dressing. It also helps the dressing stick.

●Lay the tubing on the skin in a loose circle if it is long, or in a straight line if it is short. It should not lie on top of where the port is under the skin or lie on itself. Put the dressing on all sides of the tubing. Make sure that you cover where the needle goes into the skin. The dressing should be snug but not stretched or it will pull on the skin. Most dressings are clear and will stick to the skin. If it is not sticking, put medical tape on the edges only to hold it in place. If you often have trouble with the dressing not sticking to your skin, talk to your doctor or nurse about the dressing you use or the way you are changing your dressing. They will help you get the dressing to stick better.

●Throw away the old dressing, mask, and used swabs and wipes.

●Remove the gloves.

●Wash your hands with soap and water.

How do I access and flush the port? — The port should be flushed before and after each use with a sterile fluid. Also, be sure to follow your doctor's instructions about flushing the port when it is not being used. This helps keep the port and catheter from getting blocked.

To flush the port, you need to access it. Your doctor will tell you how long you can have the port accessed before you need to change the needle. You might be able to leave an access needle in place for up to a week at a time.

To access and flush the port:

●Gather the supplies, and place them on a clean workspace. You will need:

•Clean gloves

•A mask for the person who is accessing the port, and a mask for the person with the port

•Chlorhexidine swab sticks

•Alcohol wipes

•A special needle to access the port connected to tubing – This needle is bent in the middle and connected to a short piece of clear tubing.

•10-mL syringes filled with the fluid to flush the catheter – Your doctor might order heparin, normal saline, or a special flush for you to use. Your doctor might have you use a smaller amount of fluid to flush the line if you are caring for a child with a port.

•Injection cap

•Numbing cream, if your doctor gave you this.

●Wash your hands with soap and water.

●Everyone should wear a mask when accessing the port. This includes the person with the port. Another option is to have the person with the port keep their head turned away.

●Put on clean gloves, and take off the old dressing if there is one. Throw it away.

●Wash your hands with soap and water.

●If your doctor gave you a numbing cream, patch, or spray, put it on the skin over the port. Follow the instructions for how long to wait for it to work. Then, remove the cream or patch, and wipe the skin with clean gauze.

●Put on sterile gloves. Clean the skin over the port with a chlorhexidine swab using a back-and-forth scrubbing motion for 30 seconds. Let the cleaned area air dry for at least 30 seconds or until completely dry. Do not fan, wave, or blow on the skin to help it dry faster.

●Connect the injection cap to the tubing. Fill the injection cap, tubing, and needle with flush solution. Clamp the tubing, and leave the syringe attached to the tubing.

●Hold the edges of the port in place with your thumb and index finger of the hand that you do not write with. Do not touch the skin where you will insert the needle, because it is clean.

●Insert the needle at a 90° angle from the skin in the center of the port (figure 2). Push the needle in firmly until it touches the back of the port. Do not push more once you reach the back of the port.

●Unclamp the tubing, and pull back on the syringe to check for a blood return. You do not need to fill the syringe with blood. Pull back just enough to check that the blood is there.

•If there is a blood return, flush slowly and steadily until the syringe is almost empty. Clamp the tubing before you get to the very end of the flush solution, when there is less than 1 mL in the syringe.

•If there is not a blood return, reinsert the needle and try again. If there is still no blood return, start over with a new needle. If you cannot get a blood return with a new needle, call your doctor.

●If you are leaving the needle in place, remove the syringe. Cover the needle and tubing with a clear dressing.

●If you are only flushing the port, remove the needle. Apply gentle pressure with a clean gauze to stop any bleeding.

●Throw away any used swabs, wipes, or other supplies. Throw away the needle and syringe in a hard plastic container (picture 1).

●Wash your hands with soap and water.

How do I flush the port and de-access it? — When you do not need to have any medicines or fluids going into the port, the needle can be removed. This is called "de-accessing" the port. Flush the port before you do this.

To flush and de-access the port:

●Gather the supplies, and place them on a clean workspace. You will need:

•A mask for the person who is accessing the port, and a mask for the person with the port

•Clean gloves

•Alcohol wipe

•10-mL syringes filled with the fluid to flush the catheter. Your doctor might order heparin, normal saline, or a special flush solution for you to use. Your doctor might have you use a smaller amount of fluid to flush the line if you are caring for a child with a port.

●Wash your hands with soap and water.

●Wearing clean gloves, scrub the injection cap with an alcohol wipe for 15 seconds, and let dry. Do not fan, wave, or blow on the cap to help it dry faster.

●Attach the flush syringe to the injection cap. Unclamp the tubing, and pull back on the syringe to check for a blood return.

•If there is a blood return, flush slowly and steadily until the syringe is almost empty. Clamp the tubing before you get to the very end of the flush solution, when there is less than 1 mL in the syringe. Remove the syringe.

•If there is not a blood return, reposition the needle and try again. If there is still no blood return, start over with a new needle. If you are not able to get a blood return with a new needle, call your doctor.

●After flushing the port, put on the mask. Also, have the person with the port wear a mask or keep their head turned away while the port is de-accessed.

●Remove the clear dressing.

●Hold the port steady with your thumb and index fingers of 1 hand. With your other hand, remove the port needle by pulling straight up. Be careful not to stick your fingers or skin with the needle. Most needles have a safety catch or cover. Your nurse will show you how to cover the needle when it is out.

●Throw away the needle and syringe in a hard plastic container (picture 1).

●Apply gentle pressure with a clean gauze to stop any bleeding.

●Throw away your mask, used swabs, wipes, and other materials.

●Wash your hands with soap and water.

What else should I know? — Some tips for while you have a port:

●Shoulder seatbelts can rub on the port site. Fold a washcloth, and place it between the seatbelt and the port.

●Avoid contact sports or rough play.

●If the port is accessed, keep the dressing covered when showering. Change the dressing if it gets wet or dirty, or becomes loose.

●Check the skin over the port each day for signs of infection.

When should I call the doctor? — Call for advice if:

●You have symptoms of infection. These include a fever of 100.4°F (38°C) or higher, chills, or redness, drainage, warmth, stinging, or pain where the port needle goes into your skin.

●You have problems with the port site:

•The site starts bleeding and does not stop with gentle pressure.

•The site becomes more red, or the skin over or around the port breaks open.

•You develop a rash, bumps, itching, or irritation where the dressing goes onto the skin.

•There is drainage or pus from the port site.

●You have problems with the port:

•The port seems to have moved under your skin.

•You are not able to get the needle into the port.

•You have pain, irritation, or swelling around the port site when you flush the port.

•Your arm is swollen.

•You are not able to get the medicines or flush solution through the port.

•You are not able to get a blood return from the port.

•You have any concerns about the port.

●You have sudden shortness of breath or chest pain.

●You hear a swishing sound in 1 of your ears when you flush the port.

●You notice changes in your face, jaw, neck, chest, or upper arm, like:

•Swelling

•Change in skin color

•Veins are swelling or sticking out more

More on this topic

Patient education: Port insertion (The Basics)
Patient education: Port removal (The Basics)
Patient education: Central line infections (The Basics)
Patient education: Lowering the risk of a central line infection (The Basics)