What are example orders for routine flushing and maintenance of a calf‑implanted port‑a‑cath?

Port-a-Cath Flushing Orders

Order normal saline 10 mL flush after each port access, and schedule monthly 10 mL normal saline flushes when the port is not in active use—heparin is not required for routine maintenance. 1

Routine Post-Use Flushing Protocol

Immediate flush after any access:

• Order 10 mL normal saline flush immediately following any infusion, blood draw, blood transfusion, or parenteral nutrition administration 1
• Verify blood return from the port before flushing to confirm catheter patency 1
• Use a 10 mL or larger syringe to prevent excessive pressure that can damage the catheter 1
• Employ a turbulent push-pause flushing technique for optimal catheter clearance 1

Scheduled Maintenance for Inactive Ports

Monthly maintenance protocol:

• Order 10 mL normal saline flush every 4 weeks (monthly) when the port is not being actively used 1
• This monthly schedule is the guideline-recommended standard despite low-quality evidence suggesting longer intervals might be safe 1
• Normal saline alone is sufficient—heparin provides no demonstrable advantage in preventing port occlusion 1

Optional Heparin Lock (When Manufacturer Recommends)

If heparin is used (though not required):

• Order heparin 100 units/mL solution for locking only if the port will remain unused for more than 8 hours 2, 1
• Always flush with 10 mL normal saline BEFORE any heparinization—this saline flush is more important than the heparin itself 2, 1
• Multiple meta-analyses demonstrate that normal saline is equally effective as heparin for maintaining port patency 1

Critical Safety Precautions

Contraindications and timing restrictions:

• Never use heparin immediately before or after lipid-containing infusions (parenteral nutrition, propofol) due to risk of lipid precipitation and emboli 2, 1
• Always interpose a saline flush between heparin and any lipid-containing solution 2
• Avoid heparin in patients with bleeding disorders, thrombocytopenia, or coagulation defects 1

Example Order Sets

For active port use:

1. Verify blood return from port
2. Flush with 10 mL normal saline using ≥10 mL syringe, push-pause technique
3. Administer ordered therapy
4. Flush with 10 mL normal saline using ≥10 mL syringe, push-pause technique
5. Clean injection port with 70% alcohol before and after access

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For inactive port maintenance:

1. Schedule: Every 4 weeks (monthly)
2. Verify blood return from port
3. Flush with 10 mL normal saline using ≥10 mL syringe, push-pause technique
4. Clean injection port with 70% alcohol before and after access

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Common Pitfalls to Avoid

• Do not use syringes smaller than 10 mL—smaller syringes generate excessive pressure that can rupture the catheter 1
• Do not skip the saline flush before heparinization—appropriate saline flushing is more critical than the heparin concentration itself 2
• Do not extend the flushing interval beyond monthly for standard practice, despite some evidence suggesting longer intervals may be feasible 1, 3
• Do not use heparin for continuous infusion scenarios or when the port is accessed frequently—it provides no benefit in these situations 2

Comparison with Other Central Lines

Port-a-caths require less frequent maintenance than other central venous access devices 1:

• Tunneled catheters/PICCs: Weekly flushing when not in use 1
• Implanted ports: Monthly flushing when not in use 1
• This reflects the lower infection and occlusion risk of fully implantable ports compared to externalized catheters 1