What to Expect at a Port Flush

An implanted port sits under the skin and is connected to a thin tube, called a catheter, that runs into a large vein.

The American Cancer Society (ACS) notes that ports "are usually put in the upper chest or arm, but can sometimes go in the abdomen (belly) or groin depending on the patient's anatomy or medical condition."

A line you cannot see still needs looking after, which is why maintenance visits exist.

To use a port, ACS explains, "a nurse or other health care provider will put a special needle through the skin and into the port. You might hear this called 'accessing' your port."

If someone unfamiliar with ports is about to access yours, it is fair to ask what needle they are using and whether they have done this before.

You can also ask about numbing. ACS notes that numbing cream may reduce discomfort when the needle goes in. Ask at booking rather than on arrival, so there is time to apply it.

MedlinePlus puts it in one line: "flushing helps keep the catheter clean. It also prevents blood clots from blocking the catheter."

Two solutions may be used, in order.

Saline comes first. This is sterile salt water, pushed in slowly. MedlinePlus describes the technique as "gently pushing on the plunger" in small amounts rather than all at once.

Heparin may follow. MedlinePlus explains that "heparin is a medicine that helps prevent blood clots." It is left sitting in the catheter as a lock between uses. Not every port needs it, and MedlinePlus says your provider will tell you whether this step applies to you. Ask which your center uses and note it.

ACS notes that ports "will be flushed before and after each use," so if you are in active treatment, flushing is already happening at every appointment.

ACS says that "if the port won't be used for a while, you may need to have it flushed occasionally to keep the line working."

The exact interval is set by your care team and varies by device and by center. Ask for yours in writing, and get the next appointment booked before you leave. Ask what happens if a flush is missed.

It is short. The nurse washes their hands, puts on sterile gloves, and wipes the access point with an alcohol wipe. MedlinePlus lists those steps for any central line. Then the special needle goes through the skin into the port, the nurse checks that it works, saline goes in slowly, heparin follows if it is prescribed, and the needle comes out.

If the needle stick hurts, or the skin over the port is sore, say so. Pain near the site is also a reason to contact your provider, per MedlinePlus.

Ports are not temporary. ACS says they "can stay in for months or years."

A blocked catheter may show up as trouble flushing. MedlinePlus lists trouble flushing the catheter, or a suspected blockage, as a reason to contact your provider. Ask what your team tries first if this happens.

Infection around a port needs prompt attention.

The Centers for Disease Control and Prevention (CDC) is unambiguous about fever during chemotherapy: "call your doctor immediately if you have a temperature of 100.4ºF (38ºC) or higher." CDC warns that "fever may be the only sign that you have an infection, and an infection during chemotherapy can be life-threatening," and advises taking your temperature "any time you feel warm, flushed, chilled, or not well."

Contact your team right away for:

• A temperature of 100.4 °F (38 °C) or higher, or chills.
• New redness, swelling, oozing or pus around the port site. ACS names "fever, chills, or new redness, swelling, or oozing around the site."
• Pain, bleeding, or fluid leaking at the site, or trouble flushing.
• Swelling or redness of the hand, arm, shoulder, or neck. ACS notes a clot "can cause redness or swelling in your hand, arm, shoulder, or neck."
• Shortness of breath or dizziness. If breathing is hard, or you have chest pain, call 911 instead: MedlinePlus says to call 911 right away for breathing difficulty.
• A leaking or damaged catheter, or one that has come loose.

The National Cancer Institute also flags "swelling or redness, especially where a catheter enters your body" as a reason to call during cancer treatment. NCI's fever line is 100.5 °F (38 °C), while CDC's is 100.4 °F (38 °C). Use the lower number, 100.4 °F, and call right away if you are unsure.

If you go in, follow CDC's advice: "tell the person checking you in that you are a cancer patient undergoing chemotherapy." That sentence changes how fast you are seen.

• How often does my port need flushing when I am not in treatment?
• Is heparin used here, or saline only?
• Can I have numbing cream, and how far ahead do I apply it?
• Who books my next flush, and what happens if I miss one?
• What are the signs of a blocked port, and what would you try first?
• Exactly what temperature should make me call, and what number do I use at night?

• MedlinePlus — Central venous catheter, flushing.
• MedlinePlus — Breathing difficulties, first aid.
• American Cancer Society — Intravenous (IV) Lines and Ports Used in Cancer Treatment.
• Centers for Disease Control and Prevention — Watch Out for Fever.
• National Cancer Institute — Infection and Neutropenia during Cancer Treatment.

Helpful next pages include Port Care at Home During Cancer Treatment, What to Expect at an Infusion Center, Blood Clots During Cancer Treatment, What to Expect at a Survivorship Visit, What to Expect When Cancer Treatment Is Delayed.