Is it safe to access an implantable venous access port (mediport) that has not been accessed or flushed for several years?

Accessing a Long-Unused Mediport: Safety Considerations

It is generally safe to access an implantable port that has not been flushed for several years, but you must first perform a thorough clinical assessment for complications before attempting access, and be prepared to manage potential occlusion or infection. 1

Pre-Access Assessment Protocol

Before attempting to access a port that has been unused for years, you must evaluate for:

• Pocket infection signs: Inspect for redness, swelling, warmth, tenderness, or drainage over the port site 2
• Systemic infection indicators: Check for fever, chills, or malaise that could suggest catheter-related bloodstream infection 2
• Thrombosis symptoms: Look for ipsilateral arm swelling, venous congestion, visible collateral veins, or pain 2
• Port integrity: Palpate the port to ensure it remains in proper position and the pocket feels normal 1

Safe Access Procedure

When accessing a long-unused port:

• Use only non-coring Huber needles to prevent irreversible septum damage 3, 2
• Apply maximal sterile barrier precautions including sterile gloves, gown, and large sterile drape 1, 2
• Scrub the access site with 2% chlorhexidine in 70% alcohol or 70% alcohol alone, allowing complete air drying before needle insertion 3, 2
• Use syringes of 10 mL or larger to avoid excessive pressure that could rupture the catheter 2

Managing Potential Occlusion

A port unused for years will likely contain old heparin lock solution and may have developed intraluminal thrombus:

• Attempt gentle aspiration first before flushing to assess patency 2
• Never force flush against resistance, as this can cause thromboembolism or catheter rupture 2
• If blood return is absent but the port flushes easily, this may indicate a fibrin sheath rather than complete occlusion 1
• If completely occluded, thrombolytic therapy may be required before the port can be used 2

Post-Access Verification

After successfully accessing the port:

• Flush with at least 10 mL of 0.9% sodium chloride to clear old lock solution and verify patency 2
• Confirm blood return by aspirating before and after flushing 1
• Lock with heparin 100 U/mL if the port will remain accessed but not in continuous use 4

Key Clinical Pitfalls

The most critical errors to avoid:

• Do not use standard IV needles instead of Huber needles, as this destroys the septum 3, 5
• Do not assume patency without first attempting gentle aspiration 2
• Do not ignore signs of pocket infection, as port abscess always requires device removal 1
• Do not leave the Huber needle in place for more than 7 days during continuous therapy 3

When to Remove Rather Than Access

The port should be removed rather than accessed if you find:

• Port pocket abscess or tunnel infection 1
• Clinical signs of septic shock 1
• Evidence of complicated infection such as endocarditis or septic thrombosis 1

Future Maintenance Schedule

If the port is successfully accessed and will remain in place but not in active use:

• Flush every 4 weeks with normal saline according to ESMO guidelines 1
• Consider extending to 8-week intervals, as recent evidence shows this is safe and may improve quality of life 4, 6, 7
• Use heparin 100 U/mL as lock solution after saline flush if the port will remain closed for more than 8 hours 1, 4

The Association of Anaesthetists emphasizes that with appropriate infection control measures, long-term devices already in situ can be safely used for resuscitation, anesthesia, or critical care, though staff must be properly trained in accessing these devices 1