Procedure for commencing an infusion to a port that has been accessed

NHS Ayrshire & Arran guidelines
NHS Ayrshire and Arran

An aseptic technique must be adhered to when commencing an infusion to a port. A trolley should be set up in the same way as to do the dressing change and flushing the line with the required equipment. The giving set must be primed using an aseptic technique and must not be run over a sink (This would significantly increase the risk of infection from sink organisms from splash back).

Do not prime giving sets prior to starting the procedure.

Equipment required for commencing an infusion to a port that has already been accessed

  • sterile dressing pack
  • one pair of sterile gloves
  • plastic apron
  • disposal bag and sharps bin
  • Antiseptic hand hygiene product
  • chlorhexidine gluconate BP 2% & isopropyl alcohol 70% wipe
  • 2x 10mls 0.9% sodium chloride or 2x 10ml PosiFlush XS may be used – ensure the packaging stipulates XS as only these syringes are externally sterile
  • 10ml luer-lok syringes
  • blunt needle
  • sterile infusion giving set
  • sterile prescribed infusion product for administration
  • infusion pump to deliver the product - Infusion devices must always be used when delivering treatment or fluids via a CVAD to reduce the risk of CVAD complications.

Procedure for commencing an infusion to a port that has already been accessed

Please note: if your hands are not socially clean and you need to wash your hands with soap and water (rather than alcohol gel), this must be carried out a minimum of 2 meters away from the working surface/dressing trolley and any CVAD equipment.

  1. Clean working surface/dressing trolley with detergent wipe and allow to fully dry for at least 30 seconds. Clean hands with alcohol gel as per the WHO 5 moments for hand hygiene. Put on a plastic apron.
  2. Open dressing pack onto clean area and open the necessary equipment onto the dressing pack aseptically.
  3. Wipe away surface anaesthesia at needle insertion site prior to the procedure and dispose (if applicable)
  4. Using aseptic technique draw up 2x 10ml 0.9% sodium chloride for flushing into Luer-Lok syringe or use 2x 10ml PosiFlush XS 0.9% sodium chloride syringes – ensure the packaging stipulates XS as only these syringes are externally sterile. Prime the sterile giving set with the sterile infusion fluid and keep on sterile field.
  5. Remove the port protector at the end of the infusion set. Clean the needle free device at the end of the line thoroughly with chlorhexidine gluconate BP2% & isopropyl alcohol 70% wipe and allow to dry.
  6. Attach a sterile 10ml Luer-lok syringe. Open the clamp and withdraw 5-10mls stagnant blood from port. Close clamp. Discard syringe containing this blood into the sharps container.
  7. Flush the port with the 2x 10ml sterile 0.9% sodium chloride for flushing.
  8. Aseptically attach the sterile giving set to the port. Open clamps. Use an infusion pump. Start the infusion.
  9. Remove PPE and perform hand hygiene as per the WHO 5 moments for hand hygiene.
  10. Dispose of all waste appropriately as per waste management guidelines:
    1. NHS Ayrshire & Arran segregation of waste policy
    2. NHS Ayrshire & Arran waste disposal policy.
  11. Document procedure any problems, action taken and review date in the care bundle DRS 6104 (appendix 5) and appropriate notes.

All equipment should be appropriately disposed of after connection. The contents of the sterile dressing pack should never be kept for disconnecting the infusion, no matter how short the duration of the infusion as this significantly increases the chance of infection.