How to perform phlebotomy from a vascular access port (VAP)?

From the Guidelines

Phlebotomy from a vascular access port (VAP) should be performed using proper training and sterile technique, with the most recent and highest quality study recommending the use of chlorhexidine for skin cleansing and sterile devices for port access 1. To perform phlebotomy from a VAP, the following steps should be taken:

• Gather all necessary supplies, including sterile gloves, mask, chlorhexidine or alcohol swabs, a port access kit with Huber needle, syringes, vacuum tubes, and dressing supplies.
• Identify the port location and cleanse the site with chlorhexidine using a circular motion from center outward for at least 30 seconds, allowing it to dry completely, as recommended by the guidelines for the prevention of intravascular catheter-related infections 1.
• Don sterile gloves, stabilize the port with your non-dominant hand, and insert the Huber needle perpendicular to the port septum until you feel it touch the back of the port.
• Apply negative pressure with a syringe to confirm proper placement by observing blood return.
• Attach vacuum tubes to collect blood samples, always discarding the first 3-5 mL to avoid contamination with saline or heparin.
• After collection, flush the port with 10-20 mL of normal saline using a pulsatile technique, as recommended by the central venous access in oncology guidelines 1. Some key considerations for maintaining patency and preventing complications include:
• Flushing the catheter ports regularly to maintain patency and reduce the risk of thrombosis and infection, with the ideal flush solution, concentration, and flushing interval not yet defined 1.
• Using catheters made from less thrombogenic materials and placing the catheter tip in the caudal SVC to reduce the risk of thrombosis 1.
• Avoiding the use of antimicrobial prophylaxis to prevent catheter colonization, as it is not recommended by the central venous access in oncology guidelines 1.

From the Research

Phlebotomy from a Vascular Access Port (VAP)

To perform phlebotomy from a VAP, the following steps can be considered:

• The use of non-coring needles is recommended when accessing ports 2
• Education on the use of VAPs is essential to increase their longevity and ensure safe phlebotomy practices 2
• When obtaining blood samples from a VAP, it is crucial to discard a certain volume of blood to avoid contamination and ensure accurate test results 3
• The volume of blood to be discarded can depend on the dead space of the catheter and extension set, with a recommendation of discarding at least 2 times the dead space 3

Considerations for VAP Implantation and Maintenance

• VAPs are typically implanted in interventional radiology departments, with techniques varying depending on the operator 4
• Complications associated with VAPs can include procedural and early complications, such as hematoma and catheter malposition, as well as late problems like thrombotic complications and infections 4
• Regular follow-up and maintenance of VAPs are necessary to prevent complications and ensure safe use 4

Pain Management during Phlebotomy

• The use of local anesthetics can help minimize pain during phlebotomy, with studies suggesting that alkalinization of the anesthetic solution can improve patient comfort 5
• Effective methods for painless venipuncture, particularly in children, have been reviewed and can be applied to phlebotomy practices 6