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Order to access implanted chest ports


We are seeing an increased use in implanted  chest ports  through the ER and the Infusion center and I was wondering if  is it a requirement to have a physician order to access the port? I know this is something we have practiced, but it is  not in our policy  and I was wondering if this is still standard practice.  If a physician order is required who provides the order, the current ordering physician or the physician that ordered the port placement?

I appreciate everyone's input!



This should be addressed in

This should be addressed in your policy and procedure and you should seek guidance from risk management for your specific facility. There is no standard requiring a physician order to access an implanted port. Many times this is a political decision to keep some physician happy. The concern is many physicians want to control how a port is used thinjking that certain things increase risk of BSI. Like infusing TPN through a port is a greater risk for BSI, not true. If I have an implanted port, I would expect it to be used as soon as I walk in the door and I would never allow anyone to do a peripheral stick. 

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Gina Ward
Order for accessing Port

At our facility we have an order set titled " Line Access",  this order allows us to access and utilize the specific "line" the pt came in with;  PICC line, Midline, Infusaport, Groshong etc...   it then also includes the  order to change dressing weekly/re access port, flush the line with heparin upon completion ( if a port) , and ability to draw labs from the line.

This order can be given by any physician that is involved in the care of the patient.

We also are working on improving utilization of a patients port when they arrive to the ER.   Instead of waiting until they get to a room and have been stuck  5 times and have a 24 in their thumb.    Its getting alot better with my communicating the patient complaints, and educating the patients to speak up and say they want the port utilized.


Hope that helps, 

Gina Ward


Gina Ward R.N., VA-BC

Order for Accessing Port

What I have encountered through the years ,via personal and patient feedback, is that when they go to the ER or have a direct admit outside the Oncology unit, the nurses lack the knowledge for accessing ports.  Patients are quite disturbed by this.  As Gina mentioned, they end up with a multitude of venous sticks, incredible bruising and a digital line.

It would be to the advantage of nurses and well being of patients for every clinical nurse to be Port-a-Cath certified. Taking into perspective, the fact, that Paramedics are  educated on Port-a-cath access.  MD's do not have the ability to access Ports. The simple "Line Access" order is all we need. 




We have a standing order for

We have a standing order for staff to establish vascular access, so if a patient has a port/PICC/midline/etc., our staff enters this standing order set and we are able to use the vascular access device or start PIVs without a provider entering an order for us every time.

Lee Her Lee, RN


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