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A port is a small disc under the skin of the chest or arm that lets nurses give treatment and take blood through a special needle. Each time it is used the nurse should clean their hands and your skin, check that blood comes back before giving treatment and flush it with salt water, and between courses it is usually flushed about every four weeks.
Port care rests on general central line infection prevention rather than port-specific trials. Hand hygiene before and after accessing (CDC/HICPAC Category IB) and aseptic technique (CDC IB; NICE CG139 names ANTT as one framework) come first. Skin and hub antisepsis is chlorhexidine in alcohol: CDC IA (>0.5% with alcohol, during dressing changes), epic3 IVAD23 Class A (2% chlorhexidine in 70% isopropyl alcohol, allowed to air dry), ESMO [I, A]. Hubs and connectors are scrubbed before each access (CDC IA, SHEA moderate quality, epic3 IVAD30 Class D/GPP for at least 15 seconds). Drying times beyond 'allow to dry' come from manufacturers and local policy.
Access is with a non-coring needle under aseptic technique, and blood return is confirmed before treatment; no guideline read grades either step, and the INS standards, which do address port access, could not be read. The site of an accessed port is covered with a sterile transparent dressing changed every 7 days or sooner if lifted or damp (NICE 1.4.3.4; CDC Category II for implanted sites). Needle change intervals are not stated in the national guidelines read; UK local policy changes the needle weekly.
Flush with 0.9% saline after every infusion or sample (ESMO [II, B]; epic3 IVAD34 Class A for frequently accessed lumens). On the lock, the evidence favours saline: the Cochrane review (2022, 12 RCTs, 2422 adults) found low-certainty evidence of fewer occlusions with heparin (RR 0.70, 95% CI 0.51 to 0.95) and was uncertain of any benefit; in ports specifically, a randomised trial of 802 patients found saline non-inferior to heparin 300 U/3 ml. NICE keeps heparin where the port maker recommends it (1.4.4.7, 2003). For ports not in use ESMO recommends a four-weekly flush [III, C]; a 2025 meta-analysis of 11 mostly observational studies tended to support three months, with caution.
No national or international guideline read recommends a mask for the clinician or the patient, or the patient turning their head away, at port access or dressing change; masks in these guidelines are for line insertion or splash risk. Some local policies require both (variants).
Why: Redness, swelling, pain or discharge over the port can mean the pocket is infected, and pushing a needle through it can carry germs into the blood.
“Monitor the catheter sites visually when changing the dressing or by palpation through an intact dressing on a regular basis, depending on the clinical situation of the individual patient.”
CDC/HICPAC 2011 · Category IB
Why: Hands are the commonest route by which germs reach a line.
“Hand hygiene should be performed before and after palpating catheter insertion sites as well as before and after inserting, replacing, accessing, repairing, or dressing an intravascular catheter.”
CDC/HICPAC 2011 · Category IB
Why: The port's catheter ends in a large vein near the heart, so anything that touches the needle or hub must stay sterile.
“An aseptic technique must be used for vascular access device catheter site care and when accessing the system”
NICE 2012 · [new 2012]
Why: Chlorhexidine with alcohol kills skin bacteria best, and it only works fully once it has dried; drying also stops it being carried into the skin by the needle.
“Use a single-use application of 2% chlorhexidine gluconate in 70% isopropyl alcohol (or povidone iodine in alcohol for patients with sensitivity to chlorhexidine) to clean the central catheter insertion site during dressing changes, and allow to air dry.”
Journal of Hospital Infection (Loveday et al., commissioned by the Department of Health) 2014 · Class A
Why: An ordinary needle cuts a core out of the port's silicone membrane and can make it leak; a non-coring needle parts it so it reseals.
Common practice: No national guideline that could be read grades or states the needle type, because each assumes it: ESMO names 'huber needle dislodge' among causes of occlusion, and the port manufacturers' instructions and every local policy read (NHS Borders, Shared Health Manitoba) specify a non-coring needle. The INS standards, which address it, could not be read.
Why: Blood coming back shows the needle is in the port and the catheter is open; without it a drug may be going into the tissue instead of the vein.
Common practice: No guideline read grades this step, though all assume it: ESMO lists catheter dysfunction and failure of aspiration among signs of occlusion and infection, and the port trial of Goossens 2013 counted 'easy injection, impossible aspiration' as its primary outcome. NHS Borders states it as a rule (see variants).
Why: The connector is touched many times during a course of treatment and is a main route for germs into an accessed port.
“Minimize contamination risk by scrubbing the access port with an appropriate antiseptic (chlorhexidine, povidone iodine, an iodophor, or 70% alcohol) and accessing the port only with sterile devices”
CDC/HICPAC 2011 · Category IA
Why: Flushing clears blood and drug from the catheter so it does not clot or let incompatible drugs mix.
“Routine flushing with saline, after the completion of any infusion or blood sampling, is recommended”
ESMO (Annals of Oncology) 2015 · [II, B]
Why: A sealed clear dressing keeps germs out and lets the site be checked without removing it.
“Change the transparent semipermeable membrane dressing covering a central venous access device insertion site every 7 days, or sooner if the dressing is no longer intact or moisture collects under it.”
NICE 2012 · [2012]
Why: Soaking the needle site lets water and germs under the dressing.
“Do not submerge the catheter or catheter site in water.”
CDC/HICPAC 2011 · Category IB
Why: Trials in adults have not shown clearly that heparin keeps ports open better than saline, and heparin can rarely cause bleeding or a drop in platelets.
“Preferably, a sterile 0.9 percent sodium chloride injection should be used to flush and lock catheter lumens.”
NICE 2012 · [2003]
Why: Steadying the port stops the needle springing back and causing a needlestick injury; pressure stops bleeding.
“Decontaminate the injection port or vascular access device catheter hub before and after accessing the system using chlorhexidine gluconate in 70% alcohol.”
NICE 2012 · [new 2012]
Why: A regular flush keeps the catheter from blocking; some centres now leave longer gaps (see variants).
“To maintain patency of subcutaneous ports that are not in active use, a four weekly flush is recommended”
ESMO (Annals of Oncology) 2015 · [III, C]
Why: Most problems start between visits, and the person living with the port is the first to see them.
“Encourage patients to report any changes in their catheter site or any new discomfort to their provider.”
CDC/HICPAC 2011 · Category II
Why: Infection of the port or bloodstream needs blood cultures before antibiotics and can need the port removed; in someone with low white cells it is an emergency.
“If CRBSI is suspected, collect paired blood (acquiring the same volume of blood) from the catheter and from a peripheral vein”
ESMO (Annals of Oncology) 2015 · [II, A]
Why: A blocked port or a clot around the catheter needs to be found and treated rather than forced.
“Doppler ultrasound should be carried out if thrombosis is suspected”
ESMO (Annals of Oncology) 2015 · [III, A]
How care is usually carried out, read from the guidelines and standards cited. Your own team's protocol and their judgement come first; this page is for understanding it, not for doing it yourself.
Hand hygiene, aseptic technique, chlorhexidine in alcohol on the skin and hub allowed to dry, a non-coring needle, a check for blood return, a 0.9% saline flush after every use, a transparent dressing changed every 7 days while accessed, and a four-weekly flush when the port is not in use (ESMO 2015 [III, C]). On the lock, the guidelines differ. ESMO 2015 and epic3 (Class A for frequently accessed lumens) favour saline, supported by a port-specific randomised trial (Goossens 2013, saline non-inferior to heparin in 802 patients) and a Cochrane review (2022) that could not show heparin is better; NICE CG139 (2003 wording) keeps heparin where the port manufacturer recommends it, and ESMO says that if heparin is used it should be more than 500 units. Masks for the clinician or patient, and the patient turning their head away, are not part of any national or international guideline read; they are local practice.
ESMO (Annals of Oncology) 2015 · CDC/HICPAC 2011 · Journal of Hospital Infection (Loveday et al., commissioned by the Department of Health) 2014 · NICE 2012 · Cochrane Database of Systematic Reviews 2022 · Annals of Oncology (Goossens et al.) 2013
Where it differs: Locks the port with heparinised saline (often 100 units/ml) after the saline flush, instead of saline alone. NHS Borders locks with 4 ml of 100 units/ml when the port is not in use; the Manitoba procedure locks with 3 or 6 ml of 100 units/ml depending on port size.
Evidence: Cochrane 2022 (12 RCTs, 2422 adults, two oncology studies): low-certainty evidence that heparin may give fewer occlusions (RR 0.70, 95% CI 0.51 to 0.95), no clear difference in patency duration, bloodstream infection or bleeding, and too few patients to detect heparin-induced thrombocytopenia. Goossens 2013 (802 port patients): saline lock non-inferior to heparin 300 U/3 ml. NICE keeps heparin where the manufacturer recommends it.
Cochrane Database of Systematic Reviews 2022 · Annals of Oncology (Goossens et al.) 2013 · NICE 2012 · NHS Borders 2020 · Shared Health Manitoba 2025
Where it differs: Flushes a port that is not in use every two to three months, or longer, rather than every four weeks.
Evidence: ESMO notes reports of every 8 weeks or every 3 to 4 months and calls for prospective study. A 2025 meta-analysis of 11 studies (4924 participants, mostly observational) tended to support three-monthly flushing with no expected rise in occlusion or overall complications, to be read with caution; one analysis showed more occlusion at two to three months (RR 1.50) that did not survive sensitivity analysis. A single-centre retrospective study in 617 people with breast cancer found no difference in complications with intervals of 91 to 120 days.
ESMO (Annals of Oncology) 2015 · International Journal of Clinical Oncology (Liu et al.) 2025 · Frontiers in Oncology (Wang et al.) 2022
Where it differs: The clinician wears a procedure mask, a mask is placed on the patient and anyone staying nearby, and the patient lies flat with their head turned away from the port during access. Shared Health Manitoba P02.2 states: "Put a procedure mask on. Place a mask on the patient, as well as any other individuals who will remain in the vicinity." and "Have the patient lay supine, and turn their head away from the port." The procedure applies to all ages, has a sterile field and drape, and is written for paramedic practitioners.
Evidence: No national or international guideline read recommends it (ESMO 2015, CDC/HICPAC 2011, SHEA 2022, epic3, NICE CG139). Those guidelines specify masks only as part of maximal sterile barrier precautions for inserting a central line, or where blood or body fluid may splash (epic3 SP29, Class D/GPP H&S). The rationale is to keep droplets from the mouth and nose off the sterile field; no trial of it at port access was found.
Shared Health Manitoba 2025 · CDC/HICPAC 2011 · SHEA, IDSA, APIC (Infection Control and Hospital Epidemiology) 2022 · Journal of Hospital Infection (Loveday et al., commissioned by the Department of Health) 2014
Where it differs: NHS Borders changes the needle weekly if the port is in constant use, using a different puncture site, and lets chlorhexidine dry for at least a minute; it also makes blood return a rule before any intravenous therapy.
Evidence: Local policy (issue 2, August 2020; its review date of July 2023 has passed). The national guidelines read give no needle change interval and no drying time beyond 'allow to dry'.
Some hospitals ask the nurse to wear a mask, put a mask on the patient and ask the patient to turn their head away while a chemotherapy port is accessed. No national guideline read asks for this, and no study of whether it prevents port infections was found. A comparison would settle whether it should be standard or can be dropped.
| Recommendation | Grade, as printed | Source |
|---|---|---|
| Hand hygiene before and after accessing or dressing an intravascular catheter | Category IB | CDC/HICPAC 2011 |
| Chlorhexidine above 0.5% with alcohol for skin preparation during dressing changes “Prepare clean skin with a >0.5% chlorhexidine preparation with alcohol before central venous catheter and peripheral arterial catheter insertion and during dressing changes.” | Category IA | CDC/HICPAC 2011 |
| 2% chlorhexidine in 70% isopropyl alcohol at the central catheter site during dressing changes, allowed to air dry | Class A | Journal of Hospital Infection (Loveday et al., commissioned by the Department of Health) 2014 |
| Chlorhexidine above 0.5% with alcohol for antisepsis, as a main strategy against catheter infection “Use of >0.5% chlorhexidine skin preparation with alcohol for antisepsis [I, A]” | [I, A] | ESMO (Annals of Oncology) 2015 |
| Scrub the access port with an antiseptic and access it only with sterile devices | Category IA | CDC/HICPAC 2011 |
| Disinfect hubs, needleless connectors and injection ports before access “Disinfect catheter hubs, needleless connectors, and injection ports before accessing the catheter (Quality of Evidence: MODERATE)” | Quality of Evidence: MODERATE | SHEA, IDSA, APIC (Infection Control and Hospital Epidemiology) 2022 |
| Decontaminate the access port or hub with 2% chlorhexidine in 70% alcohol for at least 15 seconds and let it dry “The hub should be cleaned for a minimum of 15 s and allowed to dry before accessing the system.” | Class D/GPP | Journal of Hospital Infection (Loveday et al., commissioned by the Department of Health) 2014 |
| Saline flush after every infusion or blood sample | [II, B] | ESMO (Annals of Oncology) 2015 |
| Sterile normal saline to flush and lock lumens accessed frequently “Use sterile normal saline for injection to flush and lock catheter lumens that are accessed frequently.” | Class A | Journal of Hospital Infection (Loveday et al., commissioned by the Department of Health) 2014 |
| Heparin versus saline flushing made no difference to thrombosis rates “However, when compared with 0.9% normal saline flushing, no differences in thrombosis rates were found [I, C]” | [I, C] | ESMO (Annals of Oncology) 2015 |
| Heparin lock may reduce occlusion compared with saline (RR 0.70, 95% CI 0.51 to 0.95) | low-certainty evidence | Cochrane Database of Systematic Reviews 2022 |
| Four-weekly flush for ports not in active use | [III, C] | ESMO (Annals of Oncology) 2015 |
| Replace transparent dressings on implanted CVC sites no more than once a week, unless soiled or loose, until the site has healed “Replace transparent dressings used on tunneled or implanted CVC sites no more than once per week (unless the dressing is soiled or loose), until the insertion site has healed.” | Category II | CDC/HICPAC 2011 |
| Paired blood cultures from the catheter and a peripheral vein when line infection is suspected | [II, A] | ESMO (Annals of Oncology) 2015 |
| Remove the line for, among others, port abscess, tunnel infection or severe sepsis “Indications to remove the CVC are: severe sepsis, suppurative (septic) thrombophlebitis, endocarditis, tunnel infection, port abscess” | [II, A] | ESMO (Annals of Oncology) 2015 |
| Masks and eye protection where blood or body fluid may splash into the face and eyes (the only epic3 mask recommendation relevant to line care) “Fluid-repellent surgical face masks and eye protection must be worn where there is a risk of blood or body fluids splashing into the face and eyes.” | Class D/GPP H&S | Journal of Hospital Infection (Loveday et al., commissioned by the Department of Health) 2014 |
| Maximal sterile barrier precautions, including a mask, for inserting central lines, PICCs or a guidewire exchange (not for accessing a port) “Use maximal sterile barrier precautions, including the use of a cap, mask, sterile gown, sterile gloves, and a sterile full body drape, for the insertion of CVCs, PICCs, or guidewire exchange” | Category IB | CDC/HICPAC 2011 |
Shares Implanted ports for chemotherapy (port-a-cath, power-injectable, apheresis and intraperitoneal ports), Infusion pumps, ports, and ambulatory chemotherapy devices, Central venous access (port, PICC line).
Shares Implanted ports for chemotherapy (port-a-cath, power-injectable, apheresis and intraperitoneal ports), Central venous access (port, PICC line).
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