Management of Implantable Ports

Routine Maintenance and Flushing

• The European Society for Medical Oncology (ESMO) recommends flushing subcutaneous ports every 4 weeks with normal saline when not in active use, and immediately after any infusion or blood sampling 1, 2
• The American College of Clinical Nutrition suggests using a 10 mL or larger syringe to prevent excessive catheter pressure that can cause damage 3
• The European Society for Clinical Nutrition and Metabolism recommends employing turbulent push-pause technique for optimal catheter clearance, however this is based on a guideline from Praxis Medical Insights, an alternative source is preferred but not available 4

Managing Port Malfunction

• The Clinical Nutrition journal suggests using a 10 mL or larger syringe for clearance attempts to avoid high pressures, and selecting thrombolytic agent based on presumed obstruction type 3, 5
• The European Society for Medical Oncology (ESMO) recommends using urokinase or recombinant tissue plasminogen activator (rTPA) for blood clots, ethanol for lipid aggregates, NaOH or HCl for drug precipitates, and NaHCO3 for contrast medium 1, 2, 5

Managing Suspected Port Infection

• The European Society for Medical Oncology (ESMO) recommends obtaining blood cultures before starting antibiotics, and collecting paired blood samples: one from the catheter and one from a peripheral vein 1, 2
• The Infectious Diseases Society of America recommends starting vancomycin immediately for suspected catheter-related bloodstream infection (CRBSI) before culture results, and considering daptomycin if high nephrotoxicity risk or high MRSA prevalence with vancomycin MIC ≥2 μg/ml 1, 2
• The European Society for Medical Oncology (ESMO) recommends removing the port if severe sepsis or hemodynamic instability, tunnel or port pocket infection/abscess, bloodstream infection persisting despite 48-72 hours of appropriate antibiotics, infection with S. aureus, fungi, or mycobacteria, or suppurative thrombophlebitis or endocarditis 6, 7

Insertion Best Practices

• The European Society for Medical Oncology (ESMO) recommends inserting ports under strict sterile conditions in operating room, avoiding femoral vein insertion due to increased infection and thrombosis risk, and using chlorhexidine solutions with alcohol for skin preparation 1, 2, 8
• The American College of Surgeons recommends verifying catheter tip position at junction of superior vena cava and right atrium with fluoroscopy or chest X-ray 1, 2, 8