Recall that externalization of the Port-A-Cath for intermittent access refers to insertion of a non-coring needle luer-locked to extension tubing with a cap or saline lock.

Steps:

1. Assess catheter site and surrounding skin. Observe for redness, swelling, tenderness or discharge at the portal site.
2. Palpate dome. Cleanse portal site with chlorhexidine. Allow 60 seconds to dry.
3. Cleanse portal site with normal saline to remove antiseptic.
4. Dry area with 2x2 gauze.
5. Prime capped access needle and extension tubing set with normal saline solution, then apply clamp on the extension device.
6. Stabilize the dome between thumb and two fingers of one hand, in a tripod fashion.
   
7. At a 90-degree angle to the dome, push the access needle firmly through the skin and septum into the centre of the Port-A-Cath until the needle lightly touches the base of the port.
8. Use a 10mL syringe to withdraw 2.5mL of blood to confirm patency. Discard (note- if using the Port-A-Cath for blood sampling, withdraw 10mL prior to obtaining sample to avoid contamination)
9. If catheter patency is not established:

• Assess catheter for kinking
• Have patient inhale or cough
• Have patient raise arms above head, or
  • Attempt pull-push technique with 20-30mL normal and attempt to confirm patency again

10. Connect IV tubing to the extension tubing and initiate infusion.
11. Apply a small amount of chlorhexidine ointment at needle entry site. Remove the access needle “wing” by pinching and lifting while immobilizing the needle

12. If there is a space between the patient’s skin and the bottom of the access needle platform, place a folded gauze underneath the platform to minimize needle movement.

13. Stabilize the needle by applying a transparent or gauze dressing.

Important Points to Remember:

• Secure all IV connections with luer lock and tape
• Never connect a syringe with a volume less than 10mL to a Port-A-Cath
• The average life of the septum is 1000-2000 penetrations with an access needle, however this depends on the gauge of the access needle, the size of the septum and the brand of the Port-A-Cath
• When administering multiple IV medications flush the line, extension tubing and access needle with a compatible solution. This reduces the risk of incompatible medication interactions