What should I do if a port doesn’t have blood return and can I use the port for chemotherapy if blood return is absent?

Catheter occlusion can occur as the result of several etiologies. The cause of the occlusion will help drive the appropriate interventions, so a thorough assessment of the catheter is a key initial step. Assessment should include whether the occlusion is partial (able to flush but not withdraw blood) or complete (unable to flush or withdraw blood), if the patient has any risk factors for occlusion (e.g., history of venous thromboembolism, specific cancer types such as lung, history of recent surgery), and if there is any pain or edema. Repositioning of the patient (e.g., lay flat, raise lateral arm, take deep breaths) should be attempted. Diagnostic testing and treatment will depend on the symptoms and cause of the occlusion. The Access Device Guidelines: Recommendations for Nursing Practice and Education contains algorithms for partial and complete occlusions as well as the assessment, testing, and treatment recommended (pages 81-82 and table 9-2 on pages 83-85).

There is no definitive evidence to guide surveillance intervals to determine 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 antineoplastic agents in the absence of blood return.
• Attempt to flush with 0.9% sodium chloride solution, using gentle pulsatile (push-pause) technique.
• Attempt repositioning of the patient or encouraging coughing and deep breaths.
• Obtain an order for a declotting procedure, as appropriate.
• Obtain an order for imaging studies, as appropriate.

Reference

Matoush, J.A. (2023). Complications of central venous access devices. In C. Backler and J. Kirmse (Eds)., Access device guidelines: Recommendations for nursing practice and education (4th ed., pp. 73-91). Oncology Nursing Society.