Is it okay to draw blood from a chemotherapy (chemo) port?

Blood Drawing from Chemotherapy Ports: Safety and Recommendations

Blood can be safely drawn from chemotherapy ports, but routine blood sampling should be avoided when possible due to an increased risk of complications, particularly catheter-related bloodstream infections.

Safety of Blood Drawing from Ports

Chemotherapy ports (also called implantable venous access ports) are designed to provide reliable long-term venous access for various purposes, including:

• Administration of chemotherapy
• Delivery of parenteral nutrition
• Blood product transfusions
• Blood sampling

Benefits of Using Ports for Blood Drawing

• Eliminates the need for repeated peripheral venipuncture 1
• Reduces access-related anxiety and pain for patients 1
• Particularly valuable in patients with difficult venous access

Risks and Considerations

The European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines specifically state that "routine drawing of blood samples from CVAD should be avoided if possible due to an increased risk of complications" 2. This recommendation is based on evidence that obtaining blood from central venous catheters has been reported to be a risk factor for catheter-related bloodstream infection (CRBSI) occurrence 2.

Best Practices When Blood Drawing is Necessary

If blood drawing from a port is necessary, follow these protocols to minimize risks:

Proper Aseptic Technique

1. Clean injection ports thoroughly with 70% alcohol or an iodophor before accessing the system 1
2. Use bidirectional strokes for up to 30 seconds when applying antiseptic 3
3. Allow the skin to dry completely for 30 seconds before accessing 3
4. Use proper Aseptic Non-Touch Technique (ANTT) 3

Port Access Procedure

1. Verify proper port placement and function before drawing blood
2. Always check for blood return before proceeding with blood sampling
3. After blood drawing, flush properly with saline solution (10-20 ml) 2
4. Cap all stopcocks when not in use 1

Special Considerations for Multi-lumen Catheters

For patients with multi-lumen catheters, the ESPEN guidelines recommend:

• Use a dedicated lumen for parenteral nutrition infusion 2
• Consider dedicating a separate lumen for blood sampling if frequent draws are necessary 1

Port Complications to Monitor

When using ports for blood sampling, be vigilant for these potential complications:

1. Infection risk: Ports have the lowest reported rates of catheter-related bloodstream infections (0.1 per 1,000 days) compared to other central venous access devices, but the risk still exists 1

2. Mechanical complications: These include:

   • Catheter occlusion
   • Fibrin sheath formation
   • Needle dislodgment
   • Catheter malposition 4

3. Thrombotic complications: Port-related thrombosis can occur and may require anticoagulation 4

Conclusion

While blood can be safely drawn from chemotherapy ports, this practice should not be routine and should be performed only when necessary, following strict aseptic protocols. The decision should balance the benefit of avoiding peripheral venipuncture against the potential increased risk of catheter-related complications, particularly infections.

When blood sampling from ports is necessary, proper technique, thorough training of healthcare personnel, and vigilant monitoring for complications are essential to minimize risks.