Hygiene guidelines for using a port

Question

Dear experts,

I am asking on behalf of a patient:

My question: Are there any general hygiene guidelines for using a port?

I got my port two-and-a-half years ago. When I taught how to carry out my i.v. therapies at home 18 years ago, cleanliness was of utmost importance – closing the windows, washing hands, disinfecting, etc. When rinsing my port (I have had it for two-and-a-half years now) I have to fight for all that: sterile gloves, swab, I only get band-aids when I ask for them. I have never seen surgical masks, injections being drawn up sterilely, or even sterile drapes at my clinic. On the other hand, I witnessed an infusion being drawn up on the ward and, with the infusion set attached, being carried across the hospital to the CF clinic – unprotected. Or the nurse would disinfect her hands carelessly, then run them through her hair and afterwards change the infusion. It isn’t any better on the ward.

This uncertainty leads me to not have my port opened in the clinic anymore, let alone have the nursing staff on the ward administer infusions to me. Since my port is located in my upper arm, however, opening it myself is quite difficult. There are hospitals, though, that abide by specific hygiene rules even when they have got their hands full.

Your answer explaining how much hygiene is required when using a port is meant to ease my uncertainty, and I could also argue with the hospital staff and doctors differently than just with my anxiety.

Many thanks!

Answer

Dear patient,

You are absolutely right: a hygienic, i.e. a sterile course of action is indispensable when dealing with a port system.

The port catheter (“port” in short) is a long-term venous access located completely in the subcutaneous fatty tissue. The port chamber is located directly under the skin (in the chest area or the upper arm). Joined to it is a tube that opens out into a vein and whose end lies in a big vessel just before the right atrium; i.e., it is a so-called central venous catheter (CVC). By opening the chamber with a special needle through the skin, one can establish access to the blood stream.

The port puncture can be carried out by nursing or medical staff. Doing so, however, a hygienic course of action must be paid attention to, and the materials used need to be kept sterile. Otherwise, the port system might get infected. This can range from a local skin infection at the site of the port to a possible sepsis, i.e., a systemic infection. Since bacteria cling quite well to alien material, a port infection can only rarely be treated with antibiotics. In most cases, the port needs to be removed then.

In order to avoid the complication of an infection, a sterile course of action is necessary. Following is a brief summary of the standard protocol followed in our CF center (hygiene guideline of the Cologne CF Center):

Puncture process with assistance in passing the material and to guarantee an aseptic procedure:

Close windows; wash hands; disinfect work space with surface disinfectant; put on a sterile coat; staff and patient put on surgical masks; hand disinfection; put on sterile gloves; spread a sterile drape on the work space; have three sterile pads passed and put them on the drape; have a sterile fenestrated sheet passed and put it on the drape; unwrap port needle and put it on the sterile drape; unwrap two 10ml syringes; attach one syringe to a canula; insert canula sterilely into sodium chloride 0,9% solution and draw up; remove used canula from 10ml syringe and put it in a separate place on the drape; remove plug from port needle system and attach the 10ml syringe to port needle system; slowly inject the sodium chloride solution to vent the port needle system; afterwards, close the system’s clamp and put the port needle back on the drape; have the puncture spot be sprayed with skin disinfectant and leave it to take effect for 30 seconds; take sterile pad from drape and wipe clean in a spiral movement from the center of the port to the periphery; repeat the process with a second pad; spray puncture spot with skin disinfectant again and leave it to take effect for 30 seconds; cover puncture area with sterile fenestrated sheet; take syringe in fist and port needle between index finger, middle finger, and thumb; with other hand, fixate port chamber with two fingers and slightly stretch the skin on top; insert needle vertically until its end; open port system’s clamp and aspire and discard 6ml of blood from the port catheter; close clamp; attach syringe with the prepared sodium chloride solution to the port catheter; open clamp; rinse quickly but without pressure; close clamp, remove syringe, and attach plug; remove sterile fenestrated sheet; apply sterile pad over port membrane and port needle; fixation with stretch tape.

This is the standard procedure in our CF center. Deviations are possible at any time, of course, but should always happen from a hygienic point of view.

Apologies for the delayed response.

Best wishes,
Silke van Koningsbruggen

08.01.2009