Inability to Flush or Draw Blood

• Examine the line for external mechanical obstruction; ensure that the clamps are open and that the noncoring needle extension tubing or IV tubing isn’t kinked.⁶⁴
• If the port is located in the patient’s upper anterior chest wall, move the patient’s arm, shoulder, and head and attempt to aspirate for blood. Notify the practitioner if aspiration only occurs in a certain position. The patient may need to be evaluated for "pinch-off" of the catheter.²
• Verify the correct needle length was used and is properly placed. Replace the needle as necessary.²
• Occlusion can occur as a result of external or internal mechanical obstruction, including nonthrombotic occlusions (such as drug precipitates) or thrombotic occlusions caused by fibrin deposits or blood clots (thrombosis).
• If you suspect occlusion from precipitation, attempt to aspirate to clear the port or tubing. If you’re successful, flush the port with sterile preservative-free normal saline solution between all medications. If you’re unsuccessful, obtain a practitioner’s order for an appropriate catheter clearance agent to dissolve the precipitate. Ensure that the instilled volume of the agent to clear precipitates doesn’t exceed the internal volume of the port system so that the catheter clearance agent stays in the port and doesn’t go into the patient’s bloodstream.⁶⁴
• If occlusion is due to thrombosis, instill low-dose alteplase as prescribed.^64,65
• If the patient reports pain or if complete resistance is met, discontinue the flush procedure. Consult with the practitioner about performing a dye study to further define the problem. Determine which staff member is qualified to perform declotting of central venous devices in your facility.

Infiltration or Extravasation

• Stop the infusion immediately.^66,67
• Assess for a dislodged catheter, a dislodged noncoring needle, or a rupture or leak from the external catheter.¹²
• Aspirate for blood; don’t attempt to flush to prevent moving additional medication into the surrounding tissue.⁶⁷
• Assess the extent of infiltration or extravasation using a standardized scale.⁶⁷
• Aspirate fluid from the catheter using a small syringe.⁶⁷
• Estimate the volume of fluid that has escaped into the tissue based on the rate of injection or infusion and the time of your last assessment.⁶⁷
• Remove the noncoring needle.⁶⁶ Don’t attempt reaccess the port until you can treat the problem appropriately and swelling resolves. Consult the practitioner as indicated.
• Consult the pharmacist or practitioner to determine whether to apply cold or warm compresses.^66,67
• If necessary, administer the appropriate antidote, as prescribed.⁶⁷

Local Infection

• Assess the skin surrounding the port and noncoring needle for erythema, inflammation, tenderness, drainage, and skin breakdown.
• Monitor the patient’s temperature and vital signs.
• Notify the practitioner of signs and symptoms of localized infection.
• Obtain culture specimens as ordered.¹¹

Systemic Infection

• Monitor the patient’s temperature and vital signs.
• Notify the practitioner of signs and symptoms of systemic infection.
• Obtain blood culture specimens as ordered.¹¹
• Administer antibiotics as prescribed (after obtaining culture specimens).⁶⁵

Extrusion

• Notify the practitioner that the port reservoir is extruding and is visible through the patient’s skin to determine whether port removal is required.