These instructions are for Children’s Hospital of Philadelphia (CHOP) patients going home with an implantable venous port that is accessed (needle is in the port).

Important information about the accessed port:

• When your child’s port stays accessed but does not have fluid going through it, blood can back up and cause the port to clot.
• To prevent clotting, the port is flushed with heparin.

Instructions for flushing an accessed port:

• You will flush the port with heparin once a day if it is not being used.  
• If your child is getting IV antibiotics or Parenteral Nutrition (PN), you will flush the catheter with normal saline (0.9% sodium chloride) before hooking up to the antibiotics or PN. This will show you if the catheter is working properly.  
• After the antibiotic or PN is finished, you will flush with saline again, then heparin.

1. Select a clean surface to work on. Avoid the bathroom or kitchen as these areas may have more germs. If you must use the kitchen, avoid areas where you prepare food. Clean the work surface with an antibacterial cleaning solution every time.
2. Gather supplies and place them on a clean paper towel.
   • Alcohol pad (or provided scrubbing device with alcohol product)
   • Heparin flush  
   • Saline flush
3. Clean hands with soap and water or use hand sanitizer.
4. Remove the air from the flush syringe:
   • Gently tap the side of the syringe to make any air bubbles rise to the top.
   • Remove the top from the syringe and hold it, making sure that nothing touches the inside of the top or the end of the syringe.
   • Place the syringe in your hand and gently push up on the plunger with your thumb. You may feel resistance.
   • Continue to push up until a small amount of solution comes out of the top of the syringe and there are no more air bubbles in the syringe.  
   • Replace the top on the syringe without touching the inside of the syringe. Place it down until you are ready to use it.  
5. Scrub the needleless catheter cap with an alcohol pad for 15 seconds. Allow the cap to dry for 15 seconds. Do not blow on or fan over the cap.
6. Remove the top from the syringe and screw the end of the syringe onto the catheter cap. Turn to the right until it is securely connected.  
7. Unclamp the catheter.  
8. Push the heparin or saline from the syringe into the catheter, using push-pause technique. Clamp the catheter.
   • Keep pressure on the syringe plunger while you clamp the catheter. If the catheter is hard to flush, stop pushing in the heparin. Check to make sure the catheter is not clamped and that there are no kinks in the catheter tubing.  
   • If you are still having trouble flushing the catheter: clamp the catheter, remove the flush syringe from the catheter cap and Call your CHOP healthcare team.  
9. Once flushing is complete, unscrew the syringe from the catheter cap and throw it away. Check to make sure that the catheter cap is on tight.
10. If instructed to use a protective alcohol cap, follow these instructions.

Instructions for troubleshooting an accessed port:

Blood backing up into line:

1. Check that the line is clamped.  
2. Ensure that the needleless catheter cap is present and tight at the end of the line.
3. Flush again using push-pause technique to clear the blood from the line.  

Port needle comes out:

1. Remove dressing by gently lifting and peeling from the skin.  
2. Dispose of needle in safe manner by placing it in an empty plastic container (examples: milk carton or laundry detergent bottle) and contact your county to schedule a hazardous waste pick-up.  
3. If the site is bleeding, place an adhesive bandage over the site.  
4. Call your CHOP healthcare team.  

Needleless catheter cap comes off:

1. Check that the line is clamped.  
2. Call your CHOP healthcare team.

Signs of infection: port site that is puffy, red, painful, and/or oozing or fever (your healthcare team will tell you what they consider to be a fever for your child)

1. Call your CHOP healthcare team.

Leakage or breakage:

1. Never use anything sharp including scissors near the line.  
2. Check that the needleless catheter cap is on the end of the line.
3. Check that the line is clamped.  
4. Call your CHOP healthcare team.  

Dangling lines:

1. If necessary, secure line with tape to skin.  
2. Do not let your child’s line dangle into any water (bathtubs, pools, etc.).  
3. Your child may not swim while the port is accessed.

Shower/bath (if necessary):

1. Cover the port dressing with a water-resistant dressing, such as Aquaguard^®. Follow these instructions for bathing with an Aquaguard. Your nurse can give you the Aquaguard and show you how to use it.  

Instructions for troubleshooting an accessed port with an infusion:

Clogged catheter: increased pressure when flushing or unable to flush line, or medicine will not infuse,  pump is alarming.  

1. Do not forcefully flush-catheter damage may result!  
2. Check that clamp is open and there are no kinks in the tubing or catheter.  
3. If still unable to flush, clamp the central line and call your home care nurse. They may be able to open the catheter with medication.  

Signs of infiltration: swelling of neck or chest, or chest pain or difficulty breathing.  

1. Stop any fluids running through the central line.  
2. Call your CHOP healthcare team for swelling of neck or chest. Call 911 immediately for chest pain or difficulty breathing.  

Signs of central vein thrombosis (blood clot in the vein where the catheter is): swelling and or pain at the port site.  

1. Call your CHOP healthcare team immediately.

Air embolism (air enters the bloodstream): Pale, gray or bluish skin color, trouble breathing, coughing, chest pain, fainting

1. Clamp catheter immediately.  
2. Place child on left side with head down to trap air in the right side of the heart.  
3. Call 911 or emergency medical services.

Call your CHOP healthcare team with any questions and as directed in these instructions:

Call the office of the healthcare provider or team who ordered the port to be placed: 

8:30am-5:00pm, Monday – Friday:
Call that office

Evenings, nights, weekends, and holidays:
215-590-1000 and ask to speak to the Fellow on call for that specialty.

If your child is an oncology patient, call the CHOP oncology team:

If you have any questions about your child’s health, please contact your child’s healthcare provider. This document is intended only to provide general educational information and is not intended as medical advice or treatment. Please consult with your healthcare provider prior to use, as some of this information may need to be adapted for your child’s specific needs. It is the responsibility of your healthcare provider to advise you on the appropriate use of this information. If you/your child are not already a CHOP patient, this document does not create a doctor-patient relationship between you/your child and CHOP. CHOP is not responsible for any outcomes you/your child might experience from your use of this document. This document is provided "AS IS", WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, express or implied. If this document refers to any drugs or medical devices, it is the responsibility of your healthcare provider to check the FDA status prior to use. If this document includes references to drug dosing, please do not rely on this document. Your healthcare provider should check the package insert for each drug before use. Hyperlinks used within this document may not be translated into other languages.

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