There isn’t enough evidence to make a definitive recommendation of whether to use a port without a blood return for chemotherapy infusion. There also is no definitive evidence to guide surveillance intervals to determine the ongoing accuracy of vascular access device placement. Research also has not indicated which imaging study is best to determine if a vascular access device without blood return is safe to use. This may depend on patient-specific factors and should be discussed with the interdisciplinary team. Current recommendations include the following:  

• Do not administer cytotoxic agents in the absence of blood return 
• Attempt to flush using push-pause technique 
• Attempt repositioning of the patient, coughing, deep breaths 
• Obtain an order for declotting procedure, as appropriate
• Obtain an order for imaging studies, as appropriate 
• Verification of the catheter placement and function should be established through imaging studies prior to use of the catheter 
• If the position and integrity have been verified, obtain a provider order to use the catheter when there is no blood return 

References:  

Camp-Sorrell, D., & Matey, L. (Eds.). (2017). Access device standards of practice for oncology nursing. Pittsburgh, PA: Oncology Nursing Society