Flushing Protocol for Implanted Venous Port Level III

Purpose The purpose of this procedure is to ensure that implanted venous ports are flushed to
maintain patency; to prevent mixing of incompatible medications and solutions; and to
ensure entire dose of solution or medication is administered into the venous system.

General Guidelines 1. Verify with State Nurse Practice Act for RN/LPN scope of practice and function.
2. The implanted venous port is a central line.
3. Always use a syringe barrel size of 10 ml or greater when flushing an infusion
catheter to avoid excessive pressure inside the catheter, to prevent potential rupture
of the catheter, and to prevent dislodgement of clots.
4. Always use push-pause technique for flushing.
5. If the port is accessed with non-coring needle:
a. Intermittent use – flush with SASH method (5 ml of saline [preservative-free
0.9% sodium chloride], administer medication, 5 ml of saline [preservative-free
0.9% sodium chloride], 5 ml of 100 unit/ml heparin).
b. Accessed, but not in use – flush once a day with 5 ml normal saline
[preservative-free 0.9% sodium chloride], 5 ml of 100 unit/ml heparin.
c. If the port is not accessed – flush monthly with 5 ml normal saline
[preservative-free 0.9% sodium chloride] and 5 ml 100 unit/ml heparin.
6. Only specially designed non-coring safety needles are to be used when accessing an
implanted port. These needles are to be changed every 7 days or upon suspicion of
contamination.
7. A non-coring needle does not need to stay in place if no medications/solutions are
being given.
8. When the non-coring needle is to stay in place, a sterile transparent semi-permeable
dressing should be used to cover the non-coring needle and port area.
9. If contamination of the dressing is suspected, the dressing and needle must be
changed.
10. Use sterile technique when accessing an implanted port.

Equipment and 1. For daily maintenance:

Supplies a. One prefilled 10 ml barrel size syringes of preservative-free 0.9% sodium
chloride (saline);
b. One prefilled 10 ml barrel size syringe of heparin (100 unit/ml);
c. Alcohol wipes; and
d. Non-sterile gloves.
2. For intermittent medications:
a. Two prefilled 10 ml barrel size syringes of preservative-free 0.9% sodium
chloride (saline);
b. One prefilled 10 ml barrel size syringe of heparin (100 unit/ml);
c. Alcohol wipes; and
d. Non-sterile gloves.
3. For monthly access flush:
a. One prefilled10 ml barrel size syringe with 5 ml preservative-free 0.9% sodium
chloride (saline);
b. One prefilled 10 ml barrel size syringe with 5 ml of heparin (100 unit/ml);
c. Sterile central line dressing kit;
d. Needleless access device;
e. Non-coring needle;
f. Sharps container; and
g. Alcohol wipes.
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Equipment and 4. Removal of needle at end of therapy:

© 2001 MED-PASS, Inc. (Revised December 2011)

Supplies (continued) a. One prefilled 10 ml barrel size syringe with 5 ml preservative-free 0.9%
sodium chloride (saline);
b. One prefilled10 ml barrel size syringe with 5 ml heparin (100 unit/ml);
c. Non-sterile gloves;
d. Sharps container; and
e. Alcohol wipes.

Steps in the 1. Assemble supplies.

Procedure 2. Perform hand antisepsis.
3. Explain procedure to resident.
4. Don non-sterile gloves.
5. Prime syringes.
6. Daily maintenance:
a. Clean the end of needleless access device with alcohol wipe.
b. Connect saline-filled syringe. Flush using push-pause technique. Repeat with
heparin (100 unit/ml).
c. Remove syringe. Dispose of syringe in sharps container.
d. Clamp catheter.
7. Flushing with intermittent medications:
a. Clean needleless access device with alcohol wipe.
b. Use SASH procedure – flush with preservative-free 0.9% sodium chloride
(saline), administer medications, flush with preservative-free 0.9% sodium
chloride (saline), flush with heparin (100 unit/ml).
c. Clamp catheter. Dispose of syringes in sharps container. Remove gloves.
8. Monthly access when not using medications:
a. Prepare sterile equipment.
b. Remove clothing around port area to create field.
c. Flush non-coring needle with preservative-free 0.9% sodium chloride (saline),
clamp, and place on side of sterile field.
d. Prime heparin syringe and place on side of sterile field.
e. Open sterile central line dressing kit. Place mask on face. Don sterile gloves.
Open antimicrobial cleaning supplies.
f. Clean port area with antimicrobial cleaning supplies (per manufacturer
instructions).
g. Allow to AIR DRY.
h. Place non-coring needle into center of port, flush with small amount of
preservative-free 0.9% sodium chloride (saline), and check for blood return.
i. Finish preservative-free 0.9% sodium chloride (saline) flush, clamp, remove
saline syringe, unclamp, and attach heparin (100 unit/ml), flush.
j. Remove heparin syringe and clamp.
k. Remove non-coring needle. Dispose of needle in sharps container.
l. Cover port with sterile gauze and tape, or a band-aid. Leave on for 24 hours.
m. Dispose of equipment properly.
n. Assess resident for tolerance of procedure.
9. Removal of needle at end of therapy:
a. Clean needleless access device with alcohol wipe.
b. Flush with sodium chloride. Flush with heparin (100 unit/ml).
c. Remove syringe, clamp, remove non-coring needle and cover with sterile
gauze/tape or band-aid. Leave on for 24 hours.
d. Dispose of needle in sharps container and other supplies as appropriate.

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Documentation 1. Document the following in the resident’s medical record:

© 2001 MED-PASS, Inc. (Revised December 2011)

 a. Location of the catheter, type and amount of flush used.
b. Result of blood return, any resistance felt.
c. Condition of insertion site and condition of dressing (if present).
d. Any complications and interventions necessary.
e. Resident tolerance of procedure.
f. Any communication with physician, supervisor, or oncoming shift.
g. Any change in size of non-coring needle that was used.

Reporting 1. Report any complications/interventions.

2. Report any communication with physician, supervisor, or oncoming shift.

References
MDS (CAAs) Section O
F328; See also INS 2008 Flushing Protocol; INS 2011 Standard 39,
Survey Tag Numbers
Practice Criteria F
Related Documents
Risk of Exposure

Date:________________ By:__________________
Procedure Date:________________ By:__________________
Revised Date:________________ By:__________________
Date:________________ By:__________________

© 2001 MED-PASS, Inc. (Revised December 2011)