Regular assessment of the port when it is accessed is essential to check for signs of erythema, swelling or discomfort, which could indicate infection, infiltration or extravasation (Gorski et al. [181]). Most manufacturers recommend that only syringes of 10 mL or larger should be used for drug administration or when flushing; this prevents excessive pressure, which can result in separation of the catheter from the reservoir or rupture if the catheter is occluded (Conn [83]). When the port is accessed, the needle can remain in situ for 7 days (Dougherty [123], Gorski et al. [182]), although Karamanoglu et al. ([237]) found that leaving the needle in place for up to 28 days led to no increase in rates of infection or irritation. When not in use, the port only requires flushing once a month (Blackburn and van Boxtel [41], Gorski et al. [182], Vescia et al. [453], Weinstein and Hagle [465]). Some local policies continue to recommend heparinized saline, usually 500 international units heparin in 5 mL 0.9% sodium chloride (Berreth [29], Perucca [369]) for intermittent or infrequent use of implanted ports (Kefeli et al. [240], Palese et al. [366]). However, most guidelines favour the use of 0.9% sodium chloride for flush and lock purposes (Gorski et al. [181], Loveday et al. [278], RCN [381], Sousa et al. [423]).

Patients can be taught to access their own ports. See ‘Discharging patients home with a VAD in situ’ above.