How to Give Factor Through a Subcutaneous Port

You have been asked to give your child factor medicine at home through a subcutaneous port. Factor helps treat and control your child’s bleeding problem.

This information will tell you how to place a special needle (Huber needle) in your child’s subcutaneous port to give (infuse) the factor medicine and how to remove the needle from the port when you are finished.

Your care team will teach you how to place the needle and give the infusion. Always follow the instructions given to you by your care team. Read these instructions and prepare your supplies before you begin.

Safety reminders for giving factor

Before giving any new medicine to your child, read the “Patient Medication” handout for the medicine. Or ask your child’s doctor, nurse, or pharmacist these questions:

• What are the possible side effects of this medicine? And what do I do to lessen those?
• What should I do if my child has a bad reaction?
• How should I store this medicine? Keep all medicines out of children’s reach.
  

Clean your work area and gather supplies

• Pick a well-lit work area.
• Clean and disinfect your workspace. Use an alcohol prep pad or antibacterial cleaner. Clean an area that is large enough to accommodate all of the supplies you need. Throw away the alcohol pad when you are finished cleaning.
• Check the labels on the saline, heparin, and the factor. Check for the name of the medicine, the correct dose, and the expiration date. Allow the medicine to warm to room temperature.
• Wash your hands for 15–20 seconds with soap and water. Dry your hands well with paper towels. Then, use the same towels to turn off the water faucets.

Mix factor and prepare the syringes

1. Peel open the syringe packages and use the clear part of the package as a clean tray for the syringes.
2. Remove the plastic caps from the factor and the diluent.
3. Use 1 alcohol pad to clean the rubber top on the factor.
4. Use a second, new alcohol pad to clean the rubber top of the diluent.
5. Mix the factor with the diluent according to the package insert.
6. Fill the empty syringe with the correct amount of factor.
7. Check the syringes of saline, heparin, and factor for air bubbles:
   1. With the needle pointing upward, gently tap the syringe with your hand to make the air bubbles float to the top.
   2. Use the plunger to push the air out until you see a drop of fluid at the top of the needle.
8. Place each syringe back into the clear package so it remains clean.

How to find the port under the skin

• Use your hand to feel for all the edges of the port before you clean the skin. If you cannot feel the edges, then reposition your child. (Have them lie down or set them up if they are already lying down.)
• If you still have trouble finding the subcutaneous port, call the clinic or a line nurse for help.

Place the Huber needle in the port

1. Open the package containing the Huber needle. Keep the package to use as a clean tray.
2. Wash your hands for 15–20 seconds with soap and water. Dry your hands well with paper towels. Then, use the same towels to turn off the water faucets.
3. Pick up the end of the tubing that has the yellow end with the white cap. Remove the white cap. Do not touch the yellow end of the tubing.
4. Pick up 1 of the saline syringes that contain 5 mL of saline. Twist off the needle. Attach the syringe to the end of the tubing. Push a little saline into the tubing until you see it come out of the Huber needle. Lay the tubing back down in the package.
5. Feel the location of the port with 2 fingers, placing them on both sides of the port. Have your child lie down if needed to feel the port.
6. Clean the port site with the Chloraprep applicator:
   1. Pinch the wings of the applicator to release the solution; you should hear it pop.
   2. Press the sponge to the center of the port site. 
   3. Using an up-and-down then back-and-forth motion, cover about 3 inches for about 30 seconds.
   4. Allow the skin to air dry completely. Do not blow on the site.
7. Wash your hands for 15–20 seconds with soap and water. Dry your hands well with paper towels. Then, use the same towels to turn off the water faucets.
8. Open the package of sterile gloves. Put on the sterile gloves. Note: if you touch something that is not sterile, you must remove the gloves, wash your hands, and change into a new pair of sterile gloves.
9. Pick up the Huber needle and remove the cover. Do not touch the needle. Fold back the plastic wings and hold the needle by the wings.
10. Place the fingers of your other hand on each side of the port, holding it firmly between your fingers. Insert the Huber needle straight down into the port, pushing firmly until you feel the needle touch the back of the port. Do not tilt or rock the needle in the port. When you feel the needle touch the back of the port, stop pushing on the needle.
11. Pull back on the plunger of the syringe until you see blood. Push 4ml of saline into the port, using a pulsing motion. While flushing with the last 1 ml of saline, close the clamp. The port should be easy to flush. Do not force it. If the line will not flush, check to make sure the clamp is open and that the tubing is not kinked. If you still cannot flush the port, please call your clinic.

Give the factor through the port

1. Remove the first saline flush from the line. Do not lay the end of the tubing down.
2. Clean the end of the line with an alcohol pad for 7 seconds. Let it dry for 7 seconds. Do not blow on the tubing.
3. Pick up the syringe containing factor and twist off the needle.
4. Attach the syringe to the tubing. Open the clamp.
5. Slowly push the factor into the line. Close the clamp.
6. Remove the factor syringe from the line.
7. Clean the end of the tubing again with alcohol for 7 seconds. Let it dry for 7 seconds. Do not blow on the tubing.
8. Pick up the second saline syringe and twist off the needle.
9. Attach the saline flush to the line. Open the clamp.
10. Slowly flush the saline into the line, using a pulsing motion. While flushing in the last 1 mL of saline, close the clamp.
11. Remove the saline syringe from the line.
12. Clean the end of the tubing again with an alcohol pad for 7 seconds. Let it dry for 7 seconds. Do not blow on the tubing.
13. Pick up the heparin syringe and twist off the needle.
14. Attach the heparin syringe to the line. Slowly push the heparin into the line, using a pulsing motion. As you push the last 1 mL of heparin into the line, close the clamp. This leaves a positive pressure in the line.

Remove the needle from the port

1. Place the needle remover on top of the port and apply gentle downward pressure.
2. Remove the needle from the port with your other hand, grasping the wings and pulling straight up and out.
3. Stick the needle into the handle of the needle-removing device for disposal
4. Use a gauze pad and hold pressure over the port where the needle was. Hold pressure until bleeding stops. Cover the site with a self-stick bandage.

Dispose of used supplies and document the infusion

• Place the needle into a sharps container.
• Throw away other used supplies in the regular trash.
• Clean your hands after throwing away used supplies.
• Learn how to get rid of used needles and other sharps safely. See “Best Way to Get Rid of Used Needles and Other Sharps” from fda.gov.
• Document the lot number, date, and time of every infusion in your factor log.

Tips and troubleshooting

Problems flushing the port

• If the Huber needle is in the port, but you cannot flush it, then Ask yourself these questions:
  • Did I feel the needle go through the port?
  • Did the needle hit the back of the port?
• If you answered no, then you may not be in the port or you may have to push the needle farther into the port to hit the back of the port.
• Feel the sides of the port to make sure you are in the center of the port. If you are not in the center, you might need to try placing the needle again.
• Look to see if you opened the clamp on the line.
• You may also turn the needle in a circular motion to see if you can flush. Do not pull the needle out of the port or skin when you do this.
• If the wings of the needle are pressed to the skin, you may need a longer needle. Please talk to a line nurse about this.
• Sometimes there is a clot in the port. The patient would need to come into the clinic to be examined.

NEVER force a flush into the port.

No blood return after needle placement and flushing

• Ask your child if it hurts when you flush. If it hurts your child, the needle may not be in the port. Check the needle placement.
• If it does not hurt your child when you flush, use a pulsing flush with saline. You may need to try several saline flushes and pull back slowly to check for blood return.
• Reposition your child. Try moving them from seated to lying down or vice versa. Sometimes it can help if they cough, lean forward, or put their arms up or down.
• If the port flushes and your child does not complain of pain, please call the clinic or a line nurse for help.

When to call your care team

Report any fever and signs and symptoms of infection (redness, swelling, drainage, or fever) to your care team right away.

If you see signs of infection or have other questions or concerns, please call the Hematology clinic at 901-595-5041.

If you are calling after hours or on the weekend, dial 901-595-3300 and ask for the nursing coordinator or the doctor-on-call. If you are outside the Memphis area, dial toll-free 1-866-278-5833 and press 0 when the call connects.