Flushing the system is essential to prevent clot formation and catheter occlusion. Normal saline is used to flush fluids through, a heparinized saline solution is used to maintain patency while maintaining access or to discontinue access. Usually, a Port-A-Cath is flushed with 10mL of normal saline and locked with 2.5mL normal saline mixed with 2.5mL of heparin 100 units/mL for a 5m total volume. When not in use, the Port-A-Cath requires little maintenance. Flushing and heparinization of the device is required a minimum of every 4 weeks to ensure patency of the line.

Steps:

1. Palpate dome. Cleanse portal site with chlorhexadine swabs. Allow 60 seconds to dry.

2. Repeat step 1 with saline to remove antiseptic.

3. Prime access needle and capped extension tubing with normal saline solution. Clamp.

4. Stabilize the dome between your thumb and two fingers of one hand in a tripod fashion.

5. At a 90 degree angle to the dome, push the access needle firmly through the sin and septum into the centre of the Port-A-Cath until the needle lightly touches the base of the port.

6. Use a 10mL syringe to withdraw 2.5mL of blood to confirm patency. Clamp the extension tubing and discard the blood.

7. If catheter patency has not been established:

a. Assess catheter for kinking
b. Have patient inhale or cough
c. Have patient raise arms above head
d. Attempt pull-push method with 20-30mL normal saline and observe for blood return

8. Inject 10mL of sodium chloride 0.9%. Close the extension clamp

9. Attach a 10mL syringe with heparinized saline flush solution

a. Flush through to last 0.5mL of flush solution
b. To maintain access:

• Clamp extension tubing and use positive pressure technique to lock up the device
• Apply transparent or gauze dressing to stabilize the access needle

c. To discontinue access:

• Stabilize port, and using positive pressure technique, continue flushing remaining 0.5mL of flush solution while removing the access needle. Note: This step in the process requires 3 hands. The patient may be able to inject the last 0.5mL saline/heparin while you remove the needle.
• Dry area with gauze
• Apply dressing if necessary

Important Points to Remember:

• It is recommended that flushing of the Port-A-Cath with heparin solution be limited to no more than twice in a 24 hour period. If frequent infusions for short periods are required, use a continuous infusion of a compatible solution between treatments to maintain patency
• Never connect a syringe with a volume less than 10mL to a Port-A-Cath
• Clamp the extension device between each manipulation