What is the appropriate protocol for administering chemotherapy when there is no blood return from the implanted port? 

Before administering medications or fluids through an implanted port, assessing the patency of the port should be your first priority. If you have no blood return, there are a number of things you can do. Listen to the patient—maybe this has happened before and the patient knows what helped the problem. Make sure that the port has been accessed correctly through the septum. You can have the patient change position, cough, or do a Valsalva maneuver. I have also heard that ambulating a patient has worked. If there is still no blood return, you can try instilling NS and heparin, repositioning the needle, or reaccessing. Do not forcefully irrigate the port. If these methods are still not successful, a fibrinolytic agent should be considered. Your facility should have a policy for this. Lastly, an imaging study can be done to determine position or occlusions. Under no circumstances should you administer chemotherapy through a port that does not have blood return. Keep the health care team informed of your interventions, and be sure to document what you have done. — Debra P. Shelton, EdD, APRN-CS, NE-BC, OCN, CNE