Documentation of Chest Wall Port Use
When documenting approval to use a chest wall port, clearly state: "Chest wall port may be accessed for [specific indication] per standard sterile technique with non-coring needle" and include verification of proper function, absence of complications, and appropriateness for the intended therapy. 1
Essential Documentation Elements
Device Verification
- Confirm port type and specifications: Document whether single or double lumen, and verify power-injectable capability if contrast administration is planned 1, 2
- Assess port function: Note patency via blood return and ability to flush without resistance 1
- Verify tip position: Confirm catheter tip location in lower third of superior vena cava or upper right atrium via prior imaging 1, 3
Clinical Appropriateness Assessment
Document the specific indication for port use, as chest wall ports are specifically designed for certain therapies:
- Appropriate uses include chemotherapy administration (especially vesicant drugs), intermittent infusions, blood transfusions, and contrast administration for imaging if power-injectable 1, 2
- Inappropriate uses that should prompt alternative access include continuous infusions, frequent daily access, or non-oncologic ward admissions where specialized port care may be unavailable 2
Critical Safety Documentation
Record absence of contraindications:
- No signs of infection (erythema, warmth, tenderness at port site, fever with positive blood cultures) 1, 4
- No evidence of thrombosis (arm swelling, collateral vein development) 1, 4
- No catheter malfunction (inability to aspirate blood, resistance to flushing) 1, 4
- No skin breakdown or port erosion 5, 4
Specific Documentation Template
A complete note should include:
"Chest wall port examined and deemed appropriate for use:
- Port type: [single/double lumen, manufacturer]
- Indication: [chemotherapy/transfusion/contrast/other]
- Assessment: Port site without erythema, warmth, or tenderness. No arm swelling. Blood return present, flushes easily without resistance
- Plan: Access with non-coring needle per sterile technique. [Specific therapy to be administered]"** 1, 4
Critical Pitfalls to Avoid
Never document approval for continuous use that transforms the port into an external device, as this eliminates the infection-prevention advantage of subcutaneous placement while adding needle-related complications 2
Do not approve port use in non-specialty settings without confirming staff competency in port access technique and complication management, as improper use carries high risk of device loss 2
Avoid using patient's oncology port for routine hospital care (antibiotics, fluids, non-chemotherapy medications) as this significantly increases infection and mechanical complication rates; instead, place a peripheral IV or PICC for these indications 2
Special Considerations
For imaging contrast administration: Explicitly document that the port is power-injectable and rated for the planned injection pressure and flow rate, as not all ports are suitable for this purpose 2
In neutropenic patients: Note absolute neutrophil count and document heightened infection prevention measures, as over 60% of catheter-related sepsis occurs during neutropenic periods 3
For patients with prior complications: Document resolution of previous issues (infection cleared, thrombosis resolved) before approving resumed use 1, 4