40-5091-24B IFU PAC-PACII.indd - Smiths Medical

10. Using a second 10-ml or larger syringe, fl ush the system with 10-ml of normal
saline, taking care not to apply excessive force to the syringe. Diffi culty in injecting
or infusing fl uid may indicate catheter blockage.
During this saline fl ush, observe the portal pocket and catheter tract for swelling
and inquire or observe whether the patient is experiencing burning, pain, or
discomfort at the portal site. If any of these symptoms are noted and/or swelling
of the portal pocket and catheter tract is observed, fl uid extravasation into the
portal pocket or catheter tract should be suspected.
NOTE: If the system is dual-lumen, repeat steps 1 through 10 for the other
portal chamber.
A.1 System Integrity is Verifi ed – Portal Will
Not Be Used Immediately
1. Attach a 10-ml or larger syringe fi lled with 5 ml of heparin solution (10 to 100
IU/ml).
2. Establish a heparin lock by instilling 5 ml of heparin solution (10 to 100 IU/ml).
To maintain positive pressure, clamp the extension set tubing while injecting the
last 0.5 ml of heparin solution.
3. Withdraw the non-coring needle.
NOTE: If using a straight, non-coring needle, stabilize the portal and withdraw
the syringe and non-coring needle while injecting the last 0.5 ml.
4. Discard the needles and syringes according to established protocol.
A.2 System Integrity Is Verifi ed – Injection Or
Infusion Will Be Initiated Immediately
1. Secure the non-coring needle according to established protocol. Replace the
syringe with an injection cap, IV tubing, or needleless access device.
2. Clean the injection cap or extension set hub according to established protocol.
3. Connect the fl uid delivery system according to established protocol.
NOTE: Follow the Centers for Disease Control and Prevention (CDC) guidelines
or established hospital/institutional policy for changing tubing.
4. Secure all connections.
5. Begin the infusion or give the injection.
WARNING: To avoid a possible drug precipitation and resulting catheter occlusion,
thoroughly fl ush the system with an appropriate solution before and after each
injection or infusion when administering medications that may be incompatible with
one another. Refer to the manufacturer’s specifi c instructions and labeling for each
medication before administration.
6. Upon completion of the infusion or injection, fl ush the system with 10 ml of
normal saline using a 10 ml or larger syringe and do one of the following:
• Give another injection or begin the next infusion.
• Establish a heparin lock by instilling 5 ml of heparin solution (10 to 100 IU/ml).
To maintain positive pressure, clamp the extension set tubing while injecting the
last 0.5 ml of heparin solution.
NOTE: If using a straight, non-coring needle, stabilize the portal and withdraw
the syringe and non-coring needle while injecting the last 0.5 ml.
7. Discard the needles and syringes according to established protocol.
B. Flushing Schedule
System integrity must be verifi ed before fl ushing the portal (refer to Determining
System Integrity).
For venous systems, maintain system patency by fl ushing it with heparin solution at
least once every four weeks when not in use.
For arterial systems, maintain system patency by fl ushing it with heparin solution at
least once every week when not in use.
NOTE: The self-sealing septum of a PORT-A-CATH® vascular portal allows up to
2000 punctures (1500 punctures for Low Profi le ports) with a 22 gauge (0.7 mm)
PORT-A-CATH® access needle.
C. Blood Sampling Procedure
(Venous Systems Only)
System integrity must be verifi ed before doing a blood sampling procedure (refer to
Determining System Integrity).
NOTE: It is recommended that a 10-ml or larger syringe be used for injecting or
infusing fl uids through the system.
1. Flush the system using a non-coring PORT-A-CATH® access needle with 10 ml
of normal saline to verify that the system is not occluded.
2. Slowly withdraw at least 5 ml of blood and dis card.
3. Withdraw the volume of blood required.
4. Immediately inject 20 ml of nor mal saline.
5. Establish a heparin lock by instilling 5 ml of heparin solution (10 to 100 IU/ml).
Maintain positive pressure by withdrawing the syringe while injecting the last 0.5
ml of heparin solution.
6. Discard the needles and syringes according to established protocol.
D. Discontinuing System Use
If it is determined that the system is no longer required for therapy, the clinician
should consider explantation of the system. If the system is left in place, then periodic
x-ray with the patient in an upright, arms-at-sides position is recommended to
detect problems with the system, such as pinching of the catheter between the
clavicle and fi rst rib which could result in catheter fragmentation and subsequent
embolization. 1,4,5,8
E. References
1. Klotz HP, Schopke W, Kohler A, Pestalozzi B, Largiader F. Catheter Fracture: A Rare Complication
of Totally Implantable Subclavian Venous Access Devices. J Surgical Oncol 1996; 62:222.
2. Vadlamani P, Dawn B, Perry MC. Catheter Fracture and Embolization from Totally Implanted
Venous Access Ports. J Vascular Dis 1998; 12:1013.
3. Monsuez JJ, Douard MC, Martin-Bouyer Y. Catheter Fragments Embolization. J Vascular Dis
1997;2:117.
4. Ramsden WH, Cohen AT, Blanshard KS. Case Report: Central Venous Catheter Fracture Due to
Compression Between the Clavicle and First Rib. Clinical Radiology 1995;50:59.
5. Coles CE, Whitear WP, Le Vay JH. Spontaneous Fracture and Embolization of a Central Venous
Catheter: Prevention and Early Detection. Clinical Oncology 1998;10:412.
6. Kossoff EH, Poirier MP. Peripherally inserted central venous catheter fracture and embolization
to the lung. Pediatric Emer Care 1998;6:403.
7. Lafreniere R. Indwelling Subclavian Catheters and a Visit With the “Pinched-Off Sign”. J Surgical
Oncol 1991;47:261.
8. Hinke DH, Zandt-Stastny DA, Goodman LR, Quebbeman EJ, Krzywda EA, Andris DA. Pinch-off
Syndrome: A Complication of Implantable Subclavian Venous Access Devices. Radiology
1990;177:353
9. Franey T, Demarco LC, Geiss AC, Ward RJ. Catheter fracture and embolization in a totally
implanted venous access catheter. J Parent Ent Nutr 1988;12:528
10. Moureau NL, McKinnon BT, Douglas CM. Multidisciplinary management of thrombotic
catheter occlusions. J Vasc Acces Dev
1999; summer:22
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