How to apply numbing cream prior to Huber needle insertion

Supplies needed

  • Numbing cream (L-M-X®)
  • Medium-sized clear dressing. If not available you can substitute cling wrap (such as Glad Press ‘N’ Seal®)
  1. Look at skin. If there is no swelling, redness, or pus, place a quarter sized amount of numbing cream on the skin over the port site.
  2. Lightly press down on the dressing/cling wrap to make it occlusive.
  3. Wait a minimum of 30 minutes before accessing port.

Preparing supplies to access the implanted port

  1. Prepare a clean work area. You can use a disinfectant spray or wipe to clean your work surface.
  2. Wash your hands. You may use soap and water or an alcohol-based hand sanitizer. Make sure to clean all surfaces of your hands and fingers. If using soap and water, wash for at least 15 seconds.
  3. Gather supplies:
    • chlorhexidine disinfectant swab
    • heparin syringe: concentration____________ volume____________
    • sterile normal saline syringe: volume_______________
    • injection cap
    • sterile gloves
    • sterile drape (If you do not have a sterile drape, the inside of the sterile glove wrapper can be used.)
    • masks for yourself, your child and anyone assisting you
    • port needle (Huber needle) with tubing: note correct size ________ length _________
    • transparent dressing, if you will leave the port needle in place
    • BioPatch® disk, if the port will be in use longer than 24 hours
    • sharps container for needles (If one is not available, contact your local health department for instructions on how to dispose of needles/medical waste.)
  4. Look at the prescribed solution to make sure it is the correct solution, the correct amount, and that it has not passed its expiration date. If the syringes appear cloudy or if there is sediment, throw them away.
  5. Remove occlusive dressing and wipe off numbing cream with gauze or paper towel. Never use an alcohol pad as it removes some of the effect of the numbing cream.
  6. Put a mask on your child, yourself and anyone assisting you.
  7. Open the sterile drape, being careful to touch only the outer edge of the drape as you do so. If you touch the middle of the drape, it is no longer sterile and you must start over with a new one.
  8. Put supplies onto the sterile drape by peeling back the packaging and dropping them onto the drape without touching them. If you touch any of the items inside the package, they are no longer sterile and you must start over. Also, be careful to drop only the supplies and not the packaging onto the drape, as the packaging is not sterile.
  9. Put on sterile gloves. Once you are wearing sterile gloves, you may only touch supplies that are already on your sterile drape.
  10. Screw the injection cap onto the end of the port needle tubing.
  11. Attach the sterile normal saline syringe onto the injection cap.
  12. Flush the sterile normal saline through the injection cap and tubing until a drop appears at the end of the port needle.
  13. Keep the sterile normal saline syringe connected to the injection cap and clamp the tubing.

Accessing the implanted port/Applying sterile dressing

  1. Clean port site for 30 seconds with chlorhexidine disinfectant swab using a gentle scrubbing technique moving up and down, back and forth, for approximately four inches in each direction. Allow the chlorhexidine to dry completely (at least 30 seconds) without fanning or blowing on the area.
  2. Hold the saline-filled port needle by the handle in one hand. Remove the needle cover. If needed, place BioPatch disk around needle prior to accessing with white side facing toward with the skin.
  3. Using your non-dominant hand (the hand that you don’t write with), stabilize the port between the thumb and index finger. Be careful not to touch the area where the needle will go into the port.
  4. Holding the needle at a 90-degree angle from the skin, aim for the center of the port. Firmly push the needle through the skin and into the port until it touches the back of the port chamber.
  5. Unclamp the tubing and pull back on the syringe to check for a blood return. If there is a blood return, flush with the normal saline and then remove the syringe from the injection cap.
  6. If there is no blood return, you may need to reposition the needle. If this does not work, you may need to re-access the port with a new needle (follow steps 1 through 12). If there is still no blood return, notify your doctor.
  7. Scrub the injection cap with an alcohol wipe for 15 seconds and let it dry for 15 seconds.
  8. Attach the heparin syringe and flush briskly with 2-3 ml of heparin. Discard the syringe.
  9. Apply skin prep to the outer edge of where you will place the dressing (like the frame of a picture). This helps the dressing stick to the skin.
  10. Apply transparent dressing over the needle and tubing being careful not to move the position of the needle. Make sure there are no open areas on the edge of the dressing.

Daily flush (steps 1-8 only) and removing the port needle (decannulation)

  1. Gather supplies:
    • Non-sterile gloves
    • Sterile normal saline syringe:
      volume:__________
    • Heparin syringe:
      concentration:___________
      volume:____________
    • Alcohol wipes (2)
  2. Look at the prescribed solution to make sure it is the correct solution, the correct amount, and that it has not passed its expiration date.
  3. Wash your hands.
  4. Put on non-sterile gloves.
  5. Scrub the injection cap with an alcohol wipe for 15 seconds, and let it dry for 15 seconds.
  6. Attach a normal syringe, unclamp tubing, and withdraw slowly to verify blood return. Flush briskly with 10ml of normal saline. When the syringe is empty, remove it from the injection cap.
  7. Scrub the injection cap with an alcohol wipe for 15 seconds, and let it dry for 15 seconds.
  8. Attach the heparin syringe and flush briskly with 2-3 ml of heparin. Discard the syringe.
  9. Remove the transparent dressing.
  10. Hold the port steady between the thumb and index finger of one hand.
  11. With your other hand, hold the port needle, and put one finger on the tip of the safety arm.
  12. Lift the safety arm straight back until it clicks. This removes the needle from the port and covers the tip of the needle.
  13. If bleeding occurs, apply pressure with sterile gauze until it stops. Apply a bandage if it is needed.

Please note: Discard all needles and syringes in needle box or as directed.

References

© Copyright 1995-2017 The Cleveland Clinic Foundation. All rights reserved.

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 6/12/2015…#15826