Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [356], C).
2. 2.Show
   If required, apply topical local anaesthetic cream to the area and leave for 30–60 minutes.
   To reduce the feeling of pain on insertion of the needle. E
3. 3.Show
   Assist the patient into a comfortable position.
   To aid patient comfort and gain access to the port. E
4. 4.Show
   Wash hands with soap and water, or an alcohol‐based handrub, and dry.
   To minimize the risk of contamination (DH [117], C).
5. 5.Show
   Locate the port and identify the septum; assess the depth of the port and thickness of the skin.
   In order to select the correct length of needle (Dougherty [123], E).
6. 6.Show
   Check the duration and type of therapy required.
   In order to select the correct gauge and configuration of the needle (Camp‐Sorrell et al. [60], C; Dougherty [123], E).

Procedure

1. 7.Show
   Wash hands with soap and water, or an alcohol‐based handrub, and dry. Open the pack and empty the equipment out onto the sterile field. Keep in mind the principles of aseptic non‐touch technique and protect key parts at all times.
   To minimize the risk of contamination (DH [117], C; Fraise and Bradley [156], E; Rowley and Clare [388], E).
2. 8.Show
   Put on apron and sterile gloves.
   To minimize the risk of contamination (DH [117], C).
3. 9.Show
   Flush the port needle and extension set with 0.9% sodium chloride.
   To check the patency of the needle and set (Dougherty [123], E).
4. 10.Show
   Clean the skin over the port with 2% chlorhexidine in 70% alcohol using back‐and‐forth strokes. Allow to dry.
   To minimize the risk of contamination and destroy skin flora (DH [117], C; Loveday et al. [278], C).

   To ensure disinfection (DH [117], C; Loveday et al. [278], C).
5. 11.Show
   Holding the needle in the dominant hand, stabilize the port between the thumb and index finger of the non‐dominant hand (Action figure 10).
   To ensure the port is stabilized and will not move on insertion of the needle (Dougherty [123], E).
6. 12.Show
   Inform the patient that you are about to insert the needle.
   To prepare the patient for a pushing sensation. P, E
7. 13.Show
   Push the needle through the skin at a perpendicular angle until it hits the back plate.
   To ensure the needle is well inserted into the portal septum. E
8. 14.Show
   Draw back on the syringe and check for blood return.
   To check the needle is correctly placed and the port is patent (Camp‐Sorrell et al. [60], C; Dougherty [123], E).
9. 15.Show
   Flush with 0.9% sodium chloride and observe the site for any swelling or pain.
   To check for patency and correct positioning (Camp‐Sorrell et al. [60], C; Dougherty [123], E).
10. 16.Show
    Administer the drug as required.
    To carry out instructions as per the prescription. E
11. 17.Show
    Flush with 10 mL 0.9% sodium chloride.
    To ensure all of the drug is administered (RCN [381], C).
12. 18.Show
    If the needle is to remain in situ, attach a needle‐free connector and flush with an appropriate flushing solution (e.g. 0.9% sodium chloride or heparinized saline as per local policy) using a pulsatile flush and ending with positive pressure.
    To maintain patency (Camp‐Sorrell et al. [60], C; Dougherty [123], E; Goossens [177], E).
13. 19.Show
    Secure the needle by placing gauze under the needle (if necessary) and cover with a semi‐permeable transparent IV film dressing.
    To ensure the needle is well supported and will not become dislodged (Camp‐Sorrell et al. [60], C; Dougherty [123], E).
14. 20.Show
    If the needle is to be removed, lock with appropriate solution (5 mL 0.9% sodium chloride or 500 IU heparin in 5 mL 0.9% sodium chloride as per local policy).
    To maintain patency over a longer period of time (Camp‐Sorrell et al. [60], C; Dougherty [123], E; Goossens [177], E).
15. 21.Show
    Maintain pressure on the plunger as the syringe is disconnected from the injection cap.
    To prevent backflow of blood and possible clot formation (Camp‐Sorrell et al. [60], C; Dougherty [123], E).
16. 22.Show
    Press down on either side of the portal of the implanted port with two fingers.
    To support the port while removing the needle (Camp‐Sorrell et al. [60], C; Dougherty [123], E).
17. 23.Show
    Withdraw the needle using steady traction and activate the safety device where appropriate. Discard the needle in an appropriate sharps container.
    To prevent trauma to the skin and reduce the risk of needle stick injury (HSE [217], C).

Post‐procedure

1. 24.Show
   No dressing is usually required, but a small plaster may be applied.
   To prevent oozing at the site. E
2. 25.Show
   Remove gloves and dispose of waste in the appropriate containers.
   To reduce the risk of environmental contamination (DH [117], C).
3. 26.Show
   Document the date of access, size and length of needle, number of attempts and any problems encountered in the patient's notes or care plan.
   To ensure adequate records are maintained and to enable continued care of the patient and device (NMC [356], C).