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Cindy Kahnk
In out-patient setting-use of strict sterile technique accessing Ports

I am curious as to what evidence there is for the use of strict sterile technique in accessing a Port-a-cath in the out-patient setting?  Currently, our process is the nurses don non-sterile gloves, clean port with chloraprep and access with our non-coring right angle needle. They do not wear a mask.  After accessing the port, a piece of tape is put across the Huber needle to secure it.  They do not apply an occlusive dressing.  I would appreciate your thoughts.

Cindy Kahnk MS-APRN

My thought is that this is

My thought is that this is below the national standard of practice written by the Infusion Nurses society, page S45-46. This is a sterile procedure because you are accessing a central venous catheter intended for long term dwell and these patients are immunocompromised. A piece of tape is far below the standard for proper stabilization and an occlusive dressing must be applied. How long are these ports left in this substandard condition? Is this what is written in your policies and procedures? Extravasation injuries from implanted ports pose a great risk, so stabilization and dressing are required. You will also need to check the ONS guidelines. 


Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Cindy Kahnk
Hi Lynn--Thank you for your

Hi Lynn--Thank you for your reply,

These ports, that are only secured with tape, are accessed in the out-patient infusion center for a blood draw. The patient may go up to their physician's office for a follow up visit. At their visit, the pt. may need blood products, chemo, or fluids, etc.. They may stay in the Infusion Center for blood, chemo, fluids well.

Sometimes these patients get admited to the acute hospital setting--the nurses on the inpt. units will redress the ports following our sterile technique policy.  However, these ports, by that time, have been exposed (with only tape) for 12 to 24 hours. 

 I totally disagree with this established procedure and am in the process of changing this poor technique. Thank you for your expert advice and I will move forward in changing our out-patient process.


Cindy Kahnk

In our AIC's and out patient

In our AIC's and out patient chemo clinics we use masks and sterile technique when accessing ports according to the INS standards (I am assuming ONS has similar standards).  Our kits come with a mask, sterile gloves, extension tubing and cap, transparent occlusive dressing as well as the alcohol and chlorprep.  It does not take any more time to place an occulsive dressing then tape and guaze.  I would not want to transport patients without proper securement.  There is a great potential for dislodgement and infection compromising the patient and your license with your current practice.

Ann Marie

 Ann Marie Parry RN CRNI

[email protected]

Ann Marie Parry, RN, CRNI, VA-BC

[email protected]

The only study I'm aware of
The only study I'm aware of was one done in an out pt setting using "clean" technique to access ports, similar to what you describe, except that, if memory serves me correctly, they did dress it.  (Sorry, my files are in boxes.  Maybe I can post this reference when I get my filing cabinet.)  These were accessed/deaccessed on the same day.  Showed no increase in infection, but small sample size of about 20 pts.  I certainly would not generalize this study to inpt or home care patients who have their port accessed for several days.  Sterile should be the standard and I would like to see this study duplicated as it was more than 10 yrs ago.
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