Is it safe to access a port in a patient with presumed sepsis?

From the Guidelines

Accessing a port in a patient with presumed sepsis is generally safe and often necessary, but should be done with careful consideration, as recommended by the Surviving Sepsis Campaign guidelines 1. When managing patients with severe sepsis or septic shock, establishing vascular access and initiating aggressive fluid resuscitation are the first priorities, and accessing a port can be a crucial step in this process 1. If the port itself is not suspected as the source of infection, it can be used for administering antibiotics, fluids, and other medications needed for sepsis treatment. However, if the port is suspected to be the source of infection (catheter-related bloodstream infection), blood cultures should be drawn from both the port and a peripheral site before starting antibiotics, and the port may need to be removed depending on the causative organism, as suggested by the guidelines 1. Some key points to consider when accessing a port in a patient with presumed sepsis include:

• Using strict aseptic technique, including thorough hand hygiene, use of sterile gloves, mask, and chlorhexidine-based skin antisepsis
• Drawing blood cultures from both the port and a peripheral site before starting antibiotics if the port is suspected to be the source of infection
• Removing the port if it is infected with certain organisms like Staphylococcus aureus, Pseudomonas, fungi, or mycobacteria
• Considering antibiotic lock therapy for ports infected with coagulase-negative staphylococci The decision to continue using or remove the port depends on the patient's clinical status, the suspected source of sepsis, and the type of pathogen if identified, and should be made on a case-by-case basis, taking into account the latest guidelines and evidence-based practices 1.

From the Research

Safety of Accessing a Port in a Patient with Presumed Sepsis

• The decision to access a port in a patient with presumed sepsis should be made with caution, considering the potential risks and benefits 2, 3, 4, 5.
• Studies have shown that the use of subcutaneous infusion ports can be associated with complications such as local infection or sepsis, thrombosis of the catheter or central vein, and extravasation from the port secondary to needle dislodgement 2.
• However, one study found that leaving the port accessed immediately after placement does not increase the risk of infection or other complications 3.
• Another study suggested that using a patient's port as the preferred intravenous route rather than inserting an additional venous access may not be recommended, as it can increase the risk of complications, particularly in non-specialty wards 4.
• The risk of bloodstream infection associated with the use of totally implantable access ports and central lines has been shown to increase with the duration of use, with a cutoff time of 33 days for ports and 10 days for central lines 5.
• Preexisting sepsis has been identified as a significant risk factor for device-associated bloodstream infection, with an odds ratio of 7.843 (95% CI, 4.666-13.184; P < .001) 5.

Considerations for Port Access in Sepsis

• The patient's condition and the potential benefits of accessing the port should be carefully weighed against the potential risks of complications 6, 2, 3, 4, 5.
• The decision to access a port in a patient with presumed sepsis should be made on a case-by-case basis, taking into account the individual patient's needs and circumstances 4.
• Appropriate precautions and protocols should be in place to minimize the risk of complications, such as infection and thrombosis, when accessing a port in a patient with presumed sepsis 2, 3, 5.