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Difficulty: HardPharmacological and Parenteral Therapies

An oncology registered nurse is preparing to obtain a blood specimen from a client's implanted venous access port. The nurse has gathered all necessary supplies. Arrange the following steps for accessing the port and drawing the blood specimen in the correct chronological sequence.

  1. 1Perform hand hygiene, don a face mask, and apply sterile gloves.
  2. 2Scrub the skin over the port septum with chlorhexidine and allow it to air dry.
  3. 3Stabilize the port with the non-dominant hand and insert a non-coring needle firmly through the septum.
  4. 4Aspirate to verify blood return, withdraw 5 mL of blood, and discard the syringe.
  5. 5Attach a sterile syringe to the extension tubing and withdraw the required blood sample.
  6. 6Flush the catheter with 20 mL of 0.9% sodium chloride, followed by the prescribed heparin flush.

Answer

The correct sequence is: apply sterile PPE, cleanse the port site, access the port with a non-coring needle, discard the initial 5 mL of blood waste, withdraw the required sample, and finally flush the port with saline and heparin.
Accessing an implanted venous access port requires precise chronological execution of parenteral safety standards. The nurse must first ensure strict asepsis by donning a mask and sterile gloves, followed by vigorously cleansing the site with chlorhexidine and allowing it to completely air dry. Next, the port is accessed using a non-coring (Huber) needle to prevent damage to the septum. Before the actual laboratory sample is collected, the nurse must aspirate and discard approximately 5 mL of blood; this clears the catheter of the heparin or saline locking solution that would otherwise contaminate the specimen. After the correct sample volume is obtained in a new syringe, the port must be flushed with a minimum of 10 to 20 mL of 0.9% sodium chloride to clear any remaining blood and prevent catheter occlusion, followed by a heparin flush to maintain patency if the port is being de-accessed or locked.

Step-by-Step Solution

1
Establish a sterile field and prepare the insertion site.
The nurse dons sterile PPE and cleanses the area with chlorhexidine.
Implanted ports are central venous access devices; accessing them requires strict asepsis to prevent life-threatening infections.
2
Access the implanted port.
A non-coring needle is inserted through the skin into the port's septum.
Using a non-coring needle prevents mechanical damage to the port's silicone seal, ensuring its longevity.
3
Clear the line of previous locking solutions.
The nurse aspirates and discards the first 5 mL of blood.
Failing to discard this initial volume will result in a specimen diluted with saline or contaminated with heparin, causing inaccurate lab values.
4
Collect the specimen and secure the line.
The diagnostic sample is drawn, and the line is flushed with saline and heparin.
Vigorous saline flushing removes residual red blood cells from the catheter, and heparin prevents clot formation within the lumen.

Key Concept

Implanted Venous Access Port Management and Blood Sampling
Estimated Time:1m 30s
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Topics

Pharmacological and Parenteral Therapies

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