How do I write an order for a nurse to access a patient's unused port to draw blood in a Skilled Nursing Facility (SNF)?

Port Access Order for Blood Draw in SNF

For a non-accessed port in a skilled nursing facility, write an order specifying: use sterile technique with mask for staff and patient, clean the port site with alcoholic chlorhexidine >0.5% allowing adequate drying time, access with a non-coring Huber needle, aspirate and discard 5-10 mL of blood before collecting specimen, flush with 20 mL normal saline after blood draw, and document the procedure with date for weekly needle change tracking.

Essential Order Components

Pre-Access Assessment

• Verify port location and absence of infection by examining the port site for erythema, warmth, swelling, or drainage before any access attempt 1
• Document that the port is palpable and the overlying skin is intact 1
• Confirm patient has no fever or signs of systemic infection 1

Sterile Technique Requirements

• Staff and patient must wear surgical masks during the entire access procedure 1
• Use maximum barrier precautions including sterile gloves for the accessing nurse 1
• Prepare skin with alcoholic chlorhexidine >0.5% (preferred) or 70% alcohol, allowing adequate contact and drying time of at least 30 seconds 1
• Never use povidone-iodine as it is inferior for preventing contamination 1

Access Procedure Specifications

• Use only non-coring Huber needles to access the port septum 1, 2
• Select appropriate needle length based on port depth (typically 0.75-1 inch for most subcutaneous ports) 1
• Aspirate and discard 5-10 mL of blood before collecting the specimen to clear any heparin or saline lock solution and ensure catheter patency 1
• If no blood return is obtained, do not force flush—this indicates possible catheter malposition or thrombosis requiring physician evaluation 3

Post-Draw Protocol

• After blood collection, flush with 20 mL of normal saline 0.9% using push-pause technique 1
• Do not use heparin for routine locking—normal saline is equally effective and reduces biofilm formation risk 1, 4
• Apply sterile transparent dressing or gauze with tape over the accessed needle 1

Needle Dwell Time

• Replace the Huber needle at least once per week (every 7 days maximum) when the port remains accessed 1, 2
• Document the access date clearly on the dressing to track when needle change is due 5
• If the port will not be used continuously, remove the needle after the blood draw and flush with saline 1

Critical Safety Considerations

Common Pitfalls to Avoid

• Never access a port without confirming it is a port and not a different type of central line—ports require specific Huber needles 1
• Do not attempt access if you cannot clearly palpate the port boundaries, as this increases risk of needle dislodgement or extravasation 3
• Avoid using the port for blood draws if the patient has signs of port infection (fever, site erythema, purulent drainage), as this can seed a bloodstream infection 1

When to Escalate

• If unable to aspirate blood after proper needle placement, obtain imaging to assess catheter position and patency before further attempts 3
• Any signs of infection at the port site require immediate physician notification and blood cultures before accessing 1
• Resistance during flushing or patient complaints of chest pain/shoulder pain during flush indicate possible catheter malposition or thrombosis requiring evaluation 3

Sample Order Format

"RN to access subcutaneous port for blood draw using the following protocol:

1. Verify port site free of infection, document assessment
2. Apply masks to staff and patient
3. Prepare site with alcoholic chlorhexidine >0.5%, allow 30-second dry time
4. Access port with sterile non-coring Huber needle using sterile technique
5. Aspirate and discard 5-10 mL blood to clear line
6. Draw required blood specimens
7. Flush with 20 mL normal saline 0.9% using push-pause technique
8. If port to remain accessed: apply sterile dressing, document access date, plan needle change in 7 days
9. If port not to remain accessed: remove needle after flush
10. Notify MD immediately if: no blood return obtained, resistance to flushing, signs of infection, or patient discomfort during procedure"** 1, 5

This standardized approach ensures consistent evidence-based practice and minimizes the risk of catheter-related bloodstream infections, which occur at rates of approximately 0.3 infections per 1000 catheter days when proper technique is followed 3.