Bard Port Inservice presentation incl Care and Maintenance.ppt

BAS Confidential and Proprietary. For Educational Purposes Only
PORT-insertion, care &
maintenance

Bard Implanted Ports
Setting the standard with a comprehensive family of ports

PORT-insertion, care &
maintenance
Dr. Sunil Agarwal
Surgical Oncologist
SUM Hospital, Bhubaneswar

Content
• Introduction
• Featured Products
• Indications, Contraindications and Precautions
• Connect Catheter to Port
• Use and Maintenance Instructions
NOTE: Please consult product labels and inserts for full information on
any indications, contraindications, hazards, warnings, cautions and
Instructions for Use

INTRODUCTION

Benefits of Ports
• Lower infection risk
• Underneath the skin
• Less manipulation
• Lifestyle
• Normal day-to-day activities
• Comfort
• Need for fewer needle sticks
• Increased privacy and appearance
• No exposed device and no bruised arms
• Long-term health
• Port access reduces the likelihood of damaging the
peripheral vein in your arm or hand

Early Patient Assessment
“The goal is to use the least invasive device
with the lowest risk of complications that will
last the length of therapy or be managed with
minimal replacements. Preservation of the
existing veins for potential future therapies
also is a consideration.”
Markel Poole, S., Quality Issues in Access Device Management. Journal of
Intravenous Nursing. 22(6S), S26-S31

Quality Port
• Easy to palpate and access
• Large septum
• Stable and not likely to move
or flip
• Ability to withstand numerous
accesses with a variety of
needle gauges
• Able to deliver the therapy
(flow rates)
• Able to aspirate for blood
return and blood work

Points to Consider
• Size of portal body– height,
weight, diameter
• Titanium or plastic
• Shape
• # of needle punctures
• Type & size of catheter –
polyurethane vs. silicone; open
ended or valved
• Pre-attached or attachable

Bard Access Systems
Sets the standard for implanted ports
• Offering a comprehensive family of implanted ports, which
include:
• Port sizes: Standard, Intermediate and low-profile / slim
• Catheter types: Groshong, Hickman and Chronoflex polyurethane
• Catheter sizes: 6.0 – 12.0 French with single or dual lumen configurations
• Attachable or pre-attached catheters
• Kit options on most ports: Basic, Intermediate and MicroIntroducer
• The convenience of BardPort’s Cath-Lock compression lock for easy
catheter assembly
• More BardPortsTM are placed worldwide than any other port

FEATURED PRODUCTS
Bard Access Systems
Source: Bard Access Systems. (2003). Setting the standard with a
comprehensive family of ports. [Brochure]. Bard Access Systems,
Salt Lake City, UT.

X-Port isp Implanted Port
Compact, intermediate-sized Port
X-Port isp TM
Port Body Material Plastic
Port Base Diameter (mm) 22.6 x 28.2
Port Height (mm) 11.7
Port Weight (grams) 5.2
Port Internal Volume (ml) 0.6
Suture Mechanism Silicone-filled
Septum Diameter (mm) 12.7
Septum Punctures 1200 - 2000
Catheters (Preconnected
or Attachable)
8 Fr Groshong
9.6 Fr Open-Ended Silicone
6 Fr ChronoFlex Open-Ended
Large septum for easy
needle insertion
Tapered port design for
ease of insertion
Silicone-filled suture
holes secure and
stabilize portc
Cath-lock mechanism
easily secures catheter
Radiopaque ring ensures accurate
visualization of locking mechanism
Small footprint
enables small
port pocket
Plastic
material
reduces MRI
distortion

M.R.I. Implanted Port
MRI Port
Port Body Material Plastic & Silicone
Port Base Diameter (mm) 31.5
Suture Mechanism Slots & Holes
Catheters (Preconnected or
Attachable)
8 Fr Groshong
needle insertion
Beveled rim is easy to
palpate and helps guide the
needle into the septum
Biocompatible silicone base
encourages tissue recovery
of port pocket
Cath-lock
mechanism
easily secures
catheter
Radiopaque ring
ensures accurate
visualization of
locking mechanism
Plastic
material
reduces MRI
distortion
Suture slots &
orientation holes
simplify
implantation &
secure the port

M.R.I. Low-Profile Implanted Port
MRI Low-Profile Port
Port Body Material Plastic
Suture Mechanism Holes
Catheters
(Attachable)
7 Fr Groshong
needle insertion
Low-Profile ideal for pediatric
patients, cachectic patients &
patients with smaller bodies
Cath-lock
mechanism
easily secures
catheter
Radiopaque ring
ensures accurate
visualization of
locking mechanism
Plastic
material
reduces MRI
distortion

Titanium Implanted Port
Titanium Implanted Port
Port Body Material Titanium & Silicone
Suture Mechanism Slots & Holes
Catheters (Preconnected
or Attachable)
8 Fr Groshong
14.3 Fr Peritoneal Silicone
needle insertion
Biocompatible
silicone base
encourages tissue
recovery of port
pocket
Cath-lock
mechanism
easily secures
catheter
Radiopaque ring
ensures accurate
visualization of
locking mechanism
Suture slots &
orientation
holes simplify
implantation
& secure the
port

X-Port Titanium Implanted Port
X-Port Titanium Port
Port Body Material Titanium
Port Base Diameter (mm) 21.7 x 24.7
Suture Mechanism Silicone-filled
Catheters
(Attachable)
Elevated
septum for
guides needle
insertion
Tapered port design for
ease of insertion
Stable base secures
placement
Cath-lock
mechanism
easily secures
catheter
Radiopaque ring ensures accurate
visualization of locking mechanism
Sized for arm
placement and
chest placement
in smaller
patients
Silicone-filled
suture holes
secure and
stabilize port

Titanium Low-Profile Implanted Port
Titanium Low-Profile Port
Port Body Material Titanium
Suture Mechanism Holes
Catheters
(Attachable)
Elevated
septum for
guides
needle
insertion
Low-Profile ideal for
pediatric patients, cachectic
patients, patients with
smaller bodies, and upper
arm placement
Locking
mechanism on
attachable
catheter is
engineered for
security and
ease of
attachment

Groshong* Valved Catheter
• Negative pressure opens the valve inward,
permitting blood aspiration
• Positive pressure opens the valve outward,
allowing infusion
• At neutral pressure, valve remains closed,
reducing the risk of air embolism, blood
reflux, and clotting
• Bullet nose, less traumatic on the vessel
The 3-way Groshong* valved catheter valve allows for infusion and blood
aspiration while reducing the risk of air embolism, blood reflux, and
clotting.
Routine maintenance is simplified and the need for heparin is virtually
eliminated

ChronoFlex* Polyurethane Catheters
• ChronoFlex* polyurethane is
statistically proven to be stronger
before exposure to Taxol* or
Taxotere* chemotherapy drugs than
Tecoflex* polyurethane
• ChronoFlex* polyurethane is 153%
stronger than Tecoflex* polyurethane
after exposure to Taxol* or Taxotere*
chemotherapy drugs
• ChronoFlex* polyurethane is exclusive
to Bard Access Systems
Scanning Electron microscope images of 100X
magnifiation at 6 weeks of implantation with no
exposure to Taxol* or Taxotere* hemothearapy
drugs.
Data on file

ChronoFlex* Polyurethane Catheters
• Barium range 13%-20% maintaining
visibility and improving catheter
strength
• Firmness and rounded tip facilitate
advancement into vein
• Thin catheter walls offer increased
flow-rate capabilities
• Catheter shear and compression
fracture resistance reduces risk of
pinch-off
• Incremental depth markings simplify
assessment of insertion depth
Data on file

Open-End Silicone Catheters
• Soft, atraumatic tip offers added safety during
implanttion
• Catheter configurations include single and dual
lumen design and a range of sizes from 6.6 to 12
French
• Medical grade radiopaque silicone construction
ensures biocompatibility

DELRIN – polyoximethylene thermoplastic
• Material used in Hickman cath injection caps & luer adapters
on all BAS VAD products
• Delrin is the biomaterial of choice for total hip prosthesis ,
intra-luminal stents & heart valves due to durability &
superior mechanical strength
• BAS has performed tests to assure Delrin meets the USA
Pharmacopeia Class VI requirements for medical grade plastic
• Tests have shown Delrin to demonstrate lack of hemolysis ,
cytotoxicity & pyrogenicity
• It is shown to be biocompatible (ASTM STP 684 std)

SEPTUM MATERIAL
• BAS implanted port septums are made of LSR
(liquid silicone rubber ) which is dramatically
superior in its needle retention & securement
properties compared to other types of silicone
septums
strong septum
steady needle

Tray Components
Tray components are approximate

X-Port isp with Groshong Catheter
Intermediate Kit

INDICATIONS, CONTRAINDICATIONS
AND PRECAUTIONS
Source: BardPort and X-Port Implanted Port with Groshong and
Open-Ended Catheter Instruction For Use (2007)

Indications For Use
• Patient therapies requiring repeated access to
the vascular system. The port system can be
used for infusion of medications, IV fluid,
parenteral nutrition solutions, blood products,
and for the withdrawal of blood samples

Contraindications
• The presence of device related infection, bacteremia, or
septicemia
• The patient’s body size is insufficient to accommodate the
size of the implanted device
• The patient is known or is suspected to be allergic to
materials contained in the device
• Severe chronic obstructive lung disease exists
• Past irradiation of prospective insertion site
• Previous episodes of venous thrombosis or vascular surgical
procedures at eh prospective placement site
• Local tissue factors will prevent proper device stabilization
and/or access

Pinch-off Prevention
• Catheters placed percutaneously or
through a cut-down, into the
subclavian vein, should be inserted at
the junction of the outer and middle
thirds of the clavicle, lateral to the
thoracic outlet
• The catheter should not be inserted
into the subclavian vein medially,
because such placement can lead to
compression of the first rib and the
clavicle, which can cause damage and
even severance of the catheter

Medial Placement Lateral Placement

• More lateral approach to
axillary vein protects the
catheter within the vein
• Internal jugular approach
• The preferred central
venous access route for
long term tunneled
vascular access

• A radiographic
confirmation of catheter
placement should be
made to ensure that the
catheter is not being
pinched by the first rib
and clavicle
Catheter Fracture from Pinch Off

Tip Position
• Recommend tip position is at
the junction of the SVC and
Right Atrium
• Tip position is vital to good
outcomes –catheter tip not in
adequate position will
increase risk of complications
Reference: BardPort* SlimPort* and X-Port* implanted ports with Open Ended Catheters IFU page 7

Upper SVC
Lower SVC
CA Jxn

Catheter Tip Movement
• Catheter tip position changes when a patient changes
position
• Variables include:
• Type of catheter
• Insertion site
• Size of patient
• Catheter inserted in the subclavian or internal jugular
will likely exhibit a range of movement extending 2 – 3
cm cephalad
• Outcomes can be significantly affected by catheter tip
position!
• Vesely, Dr. T.; J Vasc Interv Radiol 2003; 14:527–534

Precautions
• Do not use a syringe
smaller than 10 cc. Infusion
pressure greater than 25
psi (172 kPa) may damage
blood vessels and viscus
and is not recommended
• Use only non-coring
needles with the port

CONNECT CATHETER TO PORT

Connect Catheter to Port
1. Flush all air from the port body using a 10ml syringe
with a non-coring needle filled with sterile normal
saline. Insert the needle through the septum and
inject the fluid while pointing the stem up
2. Cleanse all system components with irrigation
solution
3. Connect catheter to port:

Single Lumen Ports
a. Align port stem with catheter
b. Advance catheter over port stem
to midway point
c. Advance catheter lock straight
until flush with port
Note: when using a clearlock catheter
lock be sure the end containing a black,
radiopaque ring is distal to the port

Groshong Single Lumen Catheter
1. Remove warning tag 2. Hook up the syringe 3. Catheter flushing
4. Remove guidewire 5. Trim proximal catheter 6. Align port stem with catheter

Groshong Single Lumen Catheter
7. Advance catheter over port
stem to midway point
8. Advance catheter lock straight
until flush with port
Note: when using a clearlock
catheter lock be sure the end
containing a black, radiopaque
ring is distal to the port

USE AND MAINTENANCE
INSTRUCTIONS
I. Site Preparation
II. Accessing Single Implanted Ports
III. Bolus Injection Procedure
IV. Continuous Infusion Procedure
V. Blood Sampling Procedure
VI. Lock Procedure for Catheters
VII. Recommended Flushing Port
VIII. Use of Fibrinolytic Agent for Catheter Blockage

I. Site Preparation
• Always inspect and aseptically prepare the
injection site prior to accessing the port
• Equipments:
• Alcohol or chlorhexidine wipe
• Antiseptic swabs (3)
• Sterile gloves
NOTE: Follow established hospital or institutional policy for changing IV
Tubing and accessing cannula, The Center for Disease Control (CDC) or
Oncology Nursing Society (ONS) may have recommended guidelines

Procedure:
1. Explain procedure to patient. Warn of needle
prick sensation. (Sensation of needle insertion
decreases over time. Use of a topical anesthetic
may be appropriate)
2. Wash hands thoroughly
3. Put on sterile gloves
4. Paint area with alcohol or chlorhexidine wipe
starting at the port and working outward in a
spiral motion over an area 10-13 cm in
diameter
5. Repeat Step 4 with antiseptic swabs three times
I. Site Preparation

• Equipment:
• Non-coring needle
• Choose a needle length based on
reservoir depth, tissue thickness,
and the thickness of any dressing
beneath the bend of the needle
• Syringe, 10 ml or larger

Procedure:
1. Perform aseptic site preparation
2. Locate port septum by palpation
• Locate base of port with non-dominant hand
• Triangulate port between thumb and first two fingers
of non-dominant hand. Aim for center point of these
three fingers
3. Insert needle perpendicular to port septum.
Advance needle through the skin and septum
until reaching bottom of reservoir
4. Verify correct needle placement by blood
aspiration
5. Always flush the port following injection
6. Perform saline / heparin lock procedure

• Equipment:
• Wing Infusion Set or non-coring
needle
reservoir depth, tissue thickness,
and the thickness of any dressing
• Extension set with clamp
• 10 ml syringe filled with sterile
normal saline

Procedure:
Review Site Preparation and Accessing
Implanted port sections before proceeding
with this section
1. Explain procedure to patient and prepare
injection site
2. Attach Wing Infusion Set or non-coring
needle to extension set and 10 ml syringe
filled with sterile normal saline. Expel all
air and clamp extension
3. Aseptically locate and access port.
Confirm correct positioning of the needle
within the port reservoir by aspiration of
blood (“flashback”)

Procedure:
4. Flush port with 10 ml sterile normal
saline. Clamp the extension set and
remove the syringe
5. Connect syringe containing the drug to
extension set. Release clamp and begin
to administer injection
6. Examine the injection site for signs of
extravasations; if noted, immediately
discontinue the injection and initiate
appropriate intervention

Procedure:
7. When the injection is completed, clamp the extension set
8. Flush after each injection with 10 ml of sterile normal saline
to help prevent interaction between incompatible drugs
9. For open-ended catheters: Flush port with 5 ml heparinized
saline after every use and at least once every 4 weeks
For Groshong catheters: A sterile normal saline lock may be
used. Flush port with 5 ml of sterile normal saline at least
once every 4 weeks.

Procedure:
10. When deaccessing the port, the needle
should be removed using the positive
pressure technique.
Positive pressure is maintained while flushing the
accessed port by clamping the infusion set tubing, while
still flushing the line.
This helps reduce the potential for blood backflow into
the catheter tip, which could encourage catheter
clotting

• Equipment:
• Prescribed IV solution
• 10 ml syringe filled with sterile normal saline
• Wing Infusion Set or non-coring needle
• Choose a needle length based on reservoir depth,
tissue thickness, and the thickness of any dressing
• IV pole
• IV pump (if ordered)
• Transparent dressing
• Antibacterial ointment
• 2 in x 2 in (5 cm x 5 cm) gauze pads

Procedure:
Implanted port sections before proceeding
with this section
1. Explain procedure to patient and prepare
injection site
2. Attach Wing Infusion Set or non-coring
needle to extension set and 10 ml syringe
filled with sterile normal saline. Expel all
air and clamp extension
3. Aseptically locate and access port.
Confirm correct positioning of the needle
within the port reservoir by aspiration of
blood (“flashback”)

Procedure:
4. Secure needle with transparent dressing
to help prevent inadvertent dislodgement.
NOTE: Change Wing Infusion Set or non-
coring needle, and transparent dressing
every week
5. Open clamp and flush port with sterile
normal saline. Clamp the extension set
and remove the syringe
6. Connect fluid delivery system (IV set or
infusion pump as indicated). Note: Always
use luer lock connections on all tubing and
connections. Never use a slip tip
connection. Pump pressure < 25 psi

Procedure:
7. Release clamp and initiate infusion. Examine the infusion site for
signs of extravasations; if noted, or if patient experiences pain,
immediately discontinue infusion and initiate appropriate
intervention
8. When infusion is completed, clamp extension set and then
remove the fluid delivery system
9. Flush after each injection with 10 ml of sterile normal saline to
help prevent interaction between incompatible drugs
For open-ended catheters: Flush port with 5 ml heparinized
saline after every use and at least once every 4 weeks
For Groshong catheters: A sterile normal saline lock may be
used. Flush port with 5 ml of sterile normal saline at least once
every 4 weeks.

Procedure:
pressure technique.
clotting

• Equipment:
• Wing Infusion Set or non-coring
needle
reservoir depth, tissue thickness, and the
thickness of any dressing beneath the
bend of the needle
• 10 ml syringe filled with sterile normal
saline
• Syringe (2) or evacuated blood
collection vials (2)
• Sterile normal saline

Procedure:
Implanted port sections before
proceeding with this section
1. Explain procedure to patient and
prepare injection site
2. Aseptically locate and access port with
Wing Infusion Set or non-coring needle.
Confirm correct positioning of the
needle within the port reservoir by
aspiration of blood (“flashback”)
3. Flush port with sterile normal saline
4. Withdraw at least 5 ml of blood and
discard syringe

Procedure:
5. Aspirate desired blood volume into second syringe or evacuated
blood collection system
6. Once sample is obtained, perform saline lock procedure by
immediately flushing the system with 20 ml of sterile normal saline
7. Transfer sample into appropriate blood sample tubes
8. For open-ended catheters: Perform heparin lock procedure.
For Groshong catheters: A sterile normal saline lock may be used.

Procedure:
pressure technique.
clotting

• To help prevent clot formation and catheter blockage,
implanted ports should be flushed per institutional protocol
using a turbulent push-pause flushing method after each use
• Clamp the tubing while infusing the last 0.5 ml of fluid to
reduce potential for blood back-flow into the catheter tip,
which could encourage catheter clotting
• If the port remains unused for long period of time, the 5 ml
heparin solution or sterile normal saline solution should be
changed at least every 4 weeks
Caution: Some patients may be hypersensitive to heparin or
suffer from heparin induced thrombocytopenia (HIT) and
these patients must not have their port locked with
heparinized saline

For example:
• Patient have an X-Port isp with 8 Fr ChronoFlex catheter implanted.
Her catheter was trimmed to 30 cm length
• X-port isp Internal Volume (Port Reservoir): 0.6 ml
• 8 Fr ChronoFlex catheter: original length is 61 cm with 1.2 ml. Therefore,
Catheter Volume is 0.02 ml /cm
• 30 cm x 0.02 ml/cm + 0.6 ml = 1.2 ml
How to determine Total Priming Volume for patient port and catheter?

Procedure Open
Ended Ports
Volume (100 U/ml)
Port not in use 5 ml heparinized
saline every 4 weeks
After each infusion
of medication or
TPN
10 ml sterile normal
saline then
5 ml heparinized
saline
After blood
withdrawal
saline then 5 ml
heparinized saline
10 ml syringe filled with sterile heparinized saline
100U/ml. Determination of proper concentration
and volume should be based on patient’s
medical condition, laboratory tests and prior
experience.
Procedure
Groshong* Distally
Valved Ports
Volume (100 U/ml)
Port not in use 5 ml sterile normal
saline every 4 weeks
After each infusion
of medication or
TPN
saline
After blood
withdrawal
saline
Reference: X-Port IFU for Groshong catheters pg. 24 and X-Port IFU for open ended catheters page 25

• Equipment:
• Wing Infusion Set or non-coring needle
• Choose a needle length based on reservoir
depth, tissue thickness, and the thickness of
any dressing beneath the bend of the needle
• 10 ml syringe filled with sterile normal
saline (Groshong catheter) or heparinized
saline (open-end catheter) (100 U/ml)

Procedure:
Review Site Preparation and Accessing Implanted port
sections before proceeding with this section
1. Explain procedure to patient and prepare injection site
2. Attach a 10 ml syringe filled with sterile normal saline or
heparinized saline (as applicable) to needle
3. Aseptically locate and access port with Wing Infusion Set or
non-coring needle.
4. After therapy completion, flush port per institutional
protocol. Close clamp while injecting last 0.5 ml of flush
solution

VIII. Use of Fibrinolytic Agent for
Catheter Blockage
• Use of a fibrinolytic agent has successfully cleared
clotted catheters when gentle irrigation and
aspiration have failed. The instruction provided by
the drug manufacturer should be followed
• Alcohol should not be used to soak or declot
polyurethane catheters because alcohol is known to
degrade polyurethane catheters over time with
repeated and prolonged exposure

ADDITIONAL INFORMATION
MC-PP-495

Care and Maintenance
• Care & Maintenance is vital to ensure full functionality of
the port.
• Tip position and location of portal body is equally as
important.

Accessing the Port
• Non-coring needle – appropriate gauge and
length
• Dual lumen port – separate needle for each lumen
• Rotate site of port access with every needle
change
• # of punctures is calculated on an equal access
basis to entire portal septum
• DO NOT ACCESS if port pocket infection is
suspected

Dressing
• Commonly changed at the same time as the
port needle
• If the dressing needs changing at another
time, care needs to be taken so as not to
dislodge the port needle
Standards of Care
According to Infusion Nurses Society (2006), “When a port is accessed, the non-coring needle
should be changed at least every 7 days” (p. S46).
“If gauze is used to stabilize the access needle and does not obscure the catheter skin
junction, the dressing is not considered a gauze dressing and should be changed at least
every 7 days” (p.S46).

Potential Port Specific Complications
• Needle dislodgement
• Weight gain/loss
• Skin breakdown
• Port/Catheter separation
• Occlusion
• Release of sutures – “Twiddler’s Syndrome”
• Pinch-Off syndrome
• Other

Occlusions
• Managed as for all CVAD
• Fibrin – tPa
• Precipitates –
•Sodium Bicarbonate
•O.1N HCl
•Sodium Hydroxide

Port may fill with fibrin/sludge and
cause occlusions.
Flushing is paramount to prevent
this!

Instillation of Lysing Solution
• Partial occlusion – inject solution
• Complete occlusion
• Stop cock technique
• Two needle technique

Stop-cock Technique

Potential Port Complications
• Twiddler’s Syndrome
• Patient is constantly “manipulating or twiddling” their port
• Can cause sutures to release and port to flip and/or
migrate
• A well stabilized port and patient education will help to
eliminate this potential risk

Troubleshooting common
Implanted Port problems (Mills, 2004)
Problems/Possible Causes Nursing Interventions
INABILITY TO FLUSH OR WITHDRAW BLOOD
1. Kinked tubing or closed clamp •Check tubing and/or clamp
2. Catheter lodged against vessel
wall
•Reposition the patient
•Raise the arm on the same side as the port
•Roll the patient onto his opposite side
•Have the patient cough, sit up, or deep breath
•Flush or infuse 10ml of normal saline into the port/catheter
•Re-access port using a new needle
3. Incorrect needle placement of
needle not advanced through the
septum
•Re-access the port
•Push down firmly on the non-coring needle device to
ensure placement, verify correct needle placement by
aspirating for blood return and flushing with 10ml
normal saline

Troubleshooting common
Implanted Port problems (Mills, 2004)
Problems/Possible Causes Nursing Interventions
INABILITY TO FLUSH OR WITHDRAW BLOOD
4. Clot formation •Assess patency by trying to aspirate or by gently flushing
(avoid forcibly flushing the port)
•Notify the physician: obtain an order for a fibrinolytic agent
5. Kinked catheter, catheter
migration, or port
rotation
•Notify physician immediately
INABILITY TO PALPATE THE PORT
1. Deeply implanted port •Note port scar
•Use deep palpation technique
•Ask another nurse to try locating the port device
•Use a 1 ½” or 2” non-coring needle to gain access to the
port

References
• Bard Access Systems. (2003). Setting the standard with a comprehensive
family of ports. [Brochure]. Bard Access Systems, Salt Lake City, UT.
• Bard Access Systems. (2007). BardPort and X-Port Implanted Port with
Groshong and Open-Ended Catheter Instruction For Use. Bard Access
Systems, Salt Lake City, UT.
• Camp-Sorrell, C. (Ed.). (2004). Access device guidelines: Recommendations
for nursing practice and education (2nd ed.). Pittsburgh, PA: Oncology
Nursing Society.
• Infusion Nurses Society. (2011). Infusion Nursing Standards of Practice.
Journal of Infusion Nursing.
• Mills, E J. (Ed.). (2004). Nursing Procedures (4th ed.). Philadelphia, PA.:
Lippincott Williams & Wilkins
• Markel Poole, S., Quality Issues in Access Device Management. Journal of
Intravenous Nursing. 22(6S), S26-S31
• Vesely, Dr. T.; J Vasc Interv Radiol 2003; 14:527–534

Questions?
*Bard, Groshong, M.R.I., SlimPort, X-Port isp, ChronoFlex and Advancing the
Delivery of Healthcare are trademarks and/or registered trademarks of C.R. Bard,
Inc. © 2013 C. R. Bard, Inc. All Rights Reserved. MC-PP-495 ROA

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