What are the guidelines for blood draw from a chemotherapy port (central venous access device)?

From the Guidelines

Drawing blood from a chemotherapy port is generally safe and appropriate when done by properly trained healthcare professionals, with the most recent guidelines suggesting access using sterile technique with a special non-coring needle (Huber needle) and flushing with 10ml of normal saline to ensure patency 1. The port should be accessed using sterile technique with a special non-coring needle (Huber needle). Before drawing blood, the port should be flushed with 10ml of normal saline to ensure patency. After accessing the port, discard the first 5-10ml of blood to avoid contamination with saline or medications, then collect the required blood samples. After collection, flush the port with 10-20ml of normal saline followed by heparin solution (typically 5ml of 100 units/ml) to prevent clotting, unless institutional protocols specify otherwise. This approach is preferred for patients undergoing chemotherapy as it preserves peripheral veins, reduces discomfort from repeated venipunctures, and provides reliable access. However, certain blood tests like coagulation studies may be affected if drawn immediately after chemotherapy administration through the same port, so timing should be considered. Some key considerations for accessing a chemotherapy port include:

• Using sterile technique to minimize the risk of infection 1
• Flushing the port with normal saline to ensure patency 1
• Discarding the first 5-10ml of blood to avoid contamination 1
• Using heparin solution to prevent clotting, unless contraindicated 1
• Considering the timing of blood draws in relation to chemotherapy administration 1. It's also important to follow proper procedures for connecting and disconnecting the CVC, such as those outlined in the KDOQI clinical practice guideline for vascular access 1. Overall, drawing blood from a chemotherapy port can be a safe and effective way to monitor patients undergoing chemotherapy, as long as proper techniques and precautions are followed.

From the Research

Blood Draw from Chemo Port

• The process of drawing blood from a chemo port is a common practice in patients undergoing chemotherapy, and several studies have investigated the safety and efficacy of different locking solutions to maintain port patency 2, 3.
• A study published in 2022 found that locking with heparin every 4 months or saline every 2 months did not show differences in safety maintenance, infection, or thrombosis compared to heparin every 2 months 2.
• Another study published in 2012 found that normal saline solution was as effective as heparinized solution for keeping patent implanted ports in adult cancer patients, with no statistically significant differences in implanted ports survival free from failure for occlusive events between the two solutions 3.
• However, a study published in 2022 found that heparin sodium injection could significantly lower the incidence rate of PICC-related venous thrombosis in NSCLC patients during postoperative chemotherapy, with a higher dose of heparin sodium injection showing a better thromboprophylaxis effect 4.
• A systematic review and meta-analysis published in 2021 found that venous access ports (PORTs) had similar clinical effects to peripherally inserted central catheters (PICCs) in cancer patients receiving chemotherapy, but PORTs were associated with fewer complications, including occlusion and thrombosis 5.
• A study published in 2003 highlighted the lack of scientific research on optimal methods to obtain blood samples from catheters and provided recommendations for current practice, including the use of evidence-based techniques for drawing blood samples from vascular access devices 6.

Locking Solutions

• Heparin and saline are commonly used locking solutions to maintain port patency, with studies suggesting that both solutions are effective in preventing occlusions and thrombosis 2, 3.
• The choice of locking solution may depend on the individual patient's needs and the specific type of port or catheter being used, with some studies suggesting that heparin may be more effective in preventing thrombosis in certain patient populations 4.

Complications

• Occlusion and thrombosis are common complications associated with the use of ports and catheters, with studies suggesting that the risk of these complications can be reduced with the use of appropriate locking solutions and evidence-based techniques for drawing blood samples 2, 3, 5.
• Other complications, such as infection and venous thrombosis, can also occur, and studies have investigated the risk factors for these complications and strategies for prevention 4, 5.