Subcutaneous Port Insertion Procedure Guide PDF

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SUBCUTANEOUS PORT INSERTION PROCEDURE MATERIALS REQUIRED: 24 – 27 GAUGE iv OVER-THE NEEDLE/WINGED CATHETER (BD SAF-T-INTIMA®) – WITHOUT Y CONNECTOR ALCOHOL SWAB TO CLEANSE THE NEEDLELESS INJECTION CAP 2% CHLORHEXIDINE WITH ALCOHOL 70% SWAB FOR SITE PREPARATION SMALL BREATHABLE TRANSPARENT FILM DRESSING WITH LABEL (EG TEGADERM) APPROPRIATE NEEDLELESS INJECTION CAP (eg clearlink) CLEAN GLOVES - OPTIONAL PREPARE REQUIRED MEDICATION THE PORT IS NOT PRIMED WITH MEDICATION PRIOR TO INSERTION

MEDICATION PREPARATION:    

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SELECT APPROPRIATE MEDICATION IF NARCOTICS, FOLLOW PROCEDURE FOR SIGNING OUT NARCOTIC MEDICATION 24 – 27 GAUGE iv OVER-THE NEEDLE/WINGED CATHETER (BD SAF-T-INTIMA®) HAS A DEAD SPACE VOLUME OF 0.4mls INCLUDING NEEDLELESS INJECTION CAP PREPARE PRESCRIBED PARENTERAL DOSE OF THE MEDICATION TO BE ADMINISTERED PLUS AN ADDITIONAL 0.4 mls OF THE MEDICATION. THIS WILL ALLOW FOR PRIMING OF THE PORT FOLLOWING INSERTION AND ADMINISTRATION OF THE PRESCRIBED DOSE OF MEDICATION (ONLY FIRST DOSE REQUIRES ADDITIONAL VOLUME) LABEL SYRINGE WITH COMPLETED MEDICATION LABEL

PREPARE EQUIPMENT:   

PERFORM HAND HYGIENE OPEN 2% CHLORHEXIDINE WITH ALCOHOL 70% SWAB OPEN 24 – 27 GAUGE iv OVER-THE NEEDLE/WINGED CATHETER (BD SAF-T-INTIMA®)

PREPARE THE PATIENT:   

INFORM THE PATIENT AND FAMILY AS TO WHAT YOU ARE DOING WITH RATIONALE AND OBTAIN VERBAL CONSENT PLACE PATIENT IN THE POSITION MOST COMFORTABLE FOR THEM SELECT APPROPRIATE SITE

ADAPTED FROM FRASER HEALTH AUTHORITY POLICY – HYPODERMOCLYSIS (2010) Subcutaneous port insertion guidelines. (2015).

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PERFORM HAND HYGIENE EXPOSE THE SITE CLEANSE THE AREA WITH CHLORHEXIDINE 2% WITH ALCOHOL 70% FOR 60 SECONDS THEN ALLOW TO DRY

INITIATION: 

TURN THE STYLET (WHITE CAP) 360 DEGREES TO UNSEAT GUIDE WIRE. This allows for easier guide wire removal.

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REMOVE PLASTIC SHEATH COVERING THE NEEDLE GRASP THE WINGS AND HOLD THEM TOGETHER ENSURING THE BEVEL OF THE NEEDLE IS FACING UPWARD

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GRASP A GENEROUS SUBCUTANEOUS FOLD OF AT LEAST 1 INCH (2.5CM) BETWEEN THE THUMB AND FOREFINGER.

ADAPTED FROM FRASER HEALTH AUTHORITY POLICY – HYPODERMOCLYSIS (2010) Subcutaneous port insertion guidelines. (2015).

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INSERT THE NEEDLE AT AN ANGLE OF 30 - 45 DEGREES INTO THE SUBCUTANEOUS FOLD WITH THE BEVEL UP AND PEBBLED SIDE OF THE WINGS DOWN, FOR THE FULL LENGTH OF THE NEEDLE COVER THE INJECTION SITE AND WINGS WITH A SMALL BREATHABLE TRANSPARENT DRESSING STABILISE THE CATHETER AND REMOVE THE STYLET WITH A STRAIGHT CONTINUOUS MOTION BY PULLING FIRMLY ON THE WHITE CAP (the yellow cap will follow) CHANGE THE INJECTION CAP TO THE APPROPRIATE NEEDLELESS INJECTION CAP (eg clearlink) APPLY INTEGRAL CLAMP TO TUBING LABEL THE SITE CLEARLY WITH DATE AND TIME OF INSERTION, YOUR INITIALS AND MEDICATION NAME AND DILUTION (eg morphine 10:1) DISPOSE OF REMOVED STYLET IN AN APPROPRIATE CONTAINER DOCUMENT INSERTION SITE, PATIENT TOLERANCE AND TEACHING, DATE AND TIME OF INSERTION, AND MEDICATION AND DILUTION ON THE NURSING FLOW SHEET

MEDICATION ADMINISTRATION          

PERFORM HAND HYGIENE PREPARE PRESCRIBED MEDICATION IN APPROPRIATE SIZED SYRINGE AS ABOVE PERFORM HAND HYGIENE CLEANSE NEEDLELESS INJECTION CAP WITH 70% ALCOHOL SWAB FOR 30 SECONDS INSERT LUER LOCK TIP OF SYRINGE INTO NEEDLELESS INJECTION CAP MAINTAINING ASPESIS UNCLAMP TUBING SLOWLY ADMINISTER MEDICATION ASSESSING THE PATIENT FOR PAIN/DISCOMFORT AND ANY CHANGES AT THE SAF-T INTIMA INSERTION SITE WHEN PRESCRIBED DOSE HAS BEEN ADMINISTERED CLAMP TUBING REMOVE SYRINGE FROM NEEDLELESS INJECTION CAP AND DISPOSE OF SYRINGE IN APPROPRIATE CONTAINER ONLY FIRST DOSE REQUIRES ADDITIONAL VOLUME TO PRIME THE PORT.

ADAPTED FROM FRASER HEALTH AUTHORITY POLICY – HYPODERMOCLYSIS (2010) Subcutaneous port insertion guidelines. (2015)....