Policy Number LCH-140 This document has been reviewed in line with the Policy Alignment Process for Liverpool Community Health NHS Trust Services. It is a valid Mersey Care document, however due to organisational change this FRONT COVER has been added so the reader is aware of any changes to their role or to terminology which has now been superseded. When reading this document please take account of the changes highlighted in Part B and C of this form. Part A – Information about this Document Policy Name Clinical Guidelines Intravenous Access Care and Maintenance for Adult Patients in hospital and at home Policy Type Board Approved (Trust-wide) ☐ Trust-wide ☐ Divisional / Team / Locality ☒ Action No Change ☐ Minor Change ☐ Major Change ☐ New Policy ☒ No Longer Needed ☐ Approval As Mersey Care’s Executive Director / Lead for this document, I confirm that this document: complies with the latest statutory / regulatory requirements, complies with the latest national guidance, has been updated to reflect the requirements of clinicians and officers, and has been updated to reflect any local contractual requirements Signature: Date: Part B – Changes in Terminology (used with ‘Minor Change’, ‘Major Changes’ & ‘New Policy’ only) Terminology used in this Document New terminology when reading this Document Part C – Additional Information Added (to be used with ‘Major Changes’ only) Section / Paragraph No Outline of the information that has been added to this document – especially where it may change what staff need to do Part D – Rationale (to be used with ‘New Policy’ & ‘Policy No Longer Required’ only) Please explain why this new document needs to be adopted or why this document is no longer required Part E – Oversight Arrangements (to be used with ‘New Policy’ only) Accountable Director Recommending Committee Approving Committee Next Review Date LCH Policy Alignment Process – Form 1
Index Page Background and Objectives 2 Terms of Reference 3 STC1 Care and Maintenance of a Skin Tunnelled Catheter 4 STC2 Skin Tunnelled Catheters - Saline Flush and Hepsal Lock 6 STC3 Skin Tunnelled Catheters – Blood sampling 9 STC4 Skin Tunnelled Catheters – Administration of antibiotics/infusion/additives 12 CVC1 Care and Maintenance of a non tunnelled Central Venous Catheter 17 CVC2 Central Non-Tunnelled Catheters - Saline Flush and Hepsal Lock 19 CVC3 Central Non-Tunnelled Catheters – Blood Sampling 22 CVC4 Central Venous Non-Tunnelled Catheters – Administration of antibiotics/infusion/ Additives 25 PL1 Care and Maintenance of a Peripheral Inserted Central Catheter (PICC) 30 PL2 Peripherally Inserted Central Catheter – Sodium Chloride Saline Flush 33 PL3 Peripherally Inserted Central Catheter – Blood Sampling 36 PL4 Peripherally Inserted Central Catheter – Administration of antibiotics/infusion/ additives 39 PM1 Care and Maintenance of a Peripheral Midline Catheter 45 PM2 Peripheral Midline - Saline Flush and Hepsal Lock 47 PM3 Peripheral Midline – Administration of antibiotics/infusion/additives 50 DST1 Disconnection of Ambulatory Chemotherapy Infusor from Central Venous Access Device 54 TIVAD1 Care and Management of an Implantable Venous Access Device 57 TIVAD2 Care and Management of an Implantable Venous Access Device 60 TIVAD3 Administration of antibiotics/infusion/additives via implantable port 63 PCN1 Care and Management of Peripheral cannula 66 NFS1 Changing a needle-free system 69 Trouble Shooting Guides 70 Care Plans 74 Appendix/Contributors The CINs group hereby assert their moral rights to 94
Skin Tunnelled Catheters – Blood Sampling (STC3) Action Rationale Equipment Required Dressing Pack containing sterile towel and gloves Chlorhexidine Gluconate 2% in 70% Isopropyl alcohol impregnated wipe (Sani Cloth) x 3 10ml syringes x 4 (or appropriate size syringe to collect the blood sample) 10ml 0.9% Sodium Chloride for injection prefilled syringe (or a 10ml ampoule of 0.9% Sodium Chloride) 5ml Heparin10units/ml in 0.9% Sodium Chloride One blue needle/filter straw. Sharps container Surgical tape Alcohol hand rub/gel Plastic apron Needle free I/V access connector change as per manufacturer’s guidelines see NSF1 Cins guideline NB 5ML HEPARIN 10 UNITS/ML IN SODIUM CHLORIDE WITH OPEN ENDED CATHETER 10 ml syringes should always be used. Smaller syringe sizes may damage the catheter (Hadaway 1998) Explain the procedure to the patient. Ensure that valid consent is gained. Check the patient identity, prescription and flush required in accordance with trust policy for the administration of medications. Before the procedure begins make sure that your hands are washed and dried thoroughly and that they continue to be decontaminated during the procedure. A plastic apron should be worn. Maintain aseptic technique at all times. Reduce anxiety Patient compliance To ensure that the procedure can be carried out safely. Reduce risk of infection To avoid contamination
contact the hospital team who placed the catheter for advice. Refer to trouble-shooting guide. Decontaminate hands Open sterile pack and use a non-touch technique to place inner pack onto clean working area. Open out sterile pack to create an aseptic field. Open remaining equipment using a non touch technique, ensuring no contamination of aseptic field. Loosen exit site dressing. To loosen dressing lift lower-end and gently ease the dressing off, from the skin. To allow for a sterile environment for accessing intravenous catheter, and to reduce incidence of infection. To prevent accidental removal of the catheter and friction or trauma to skin surface. Aseptically remove the dressing Decontaminate hands Put on sterile gloves Place sterile towel as near as possible to the catheter exit site. Clean around the catheter and exit site Chlorhexidine 2% impregnated applicator (SEPP). The solution should be applied with friction, but should not be too vigorous or the skin's natural defence may be destroyed. Using a Chlorhexidine 2% wipe, carefully clean the catheter from the exit site to the part of the catheter that will be covered by the sterile dressing. Allow to dry. Apply new securing device i.e. Skin closure strips or skin fixation device (if required) Apply new dressing to exit site without touching the adhesive site. Remove the dressing towel Remove gloves. Clear away equipment disposing of waste as per organisational policy. Wipe down the trolley that has been used during the procedure with multi-surface detergent wipes. Wash hands. Document care on patient’s records. Chlorhexidine based solutions are recommended (in alcohol) as per policy (DOH 2001). Alcohol Chlorhexidine combines the benefits of rapid action and excellent residual activity (DOH 2001). Semi-permeable transparent IV dressings are well tolerated by patients (Campbell et al 1999, Treston-Aurand et al 1997, Wille 1993) and are easy to apply and remove (Wille 1997).
List of contributors to the Venous Access Guidelines Name Organisation Job Title/Role Alison Young Royal Liverpool & Broadgreen University Hospital Trust Nurse Consultant in Nutrition Alison Smith Liverpool Community Health NHS Trust Lead Nurse IV community team Carol McCormick Clatterbridge Centre for Oncology Clinical Nurse Specialist IV and Interventional procedures Christine Cain Wirral University Teaching Hospital NHS Foundation Trust Paediatric Clinical Practice Development Nurse Christine Roberts Sefton PCT / University Aintree Hospitals Foundation Trust IV Therapy Lead Nurse Coral Hulse Leighton Hospital Trust Nurse Consultant in Intensive care Desmond Collins Wirral University Teaching Hospital NHS Foundation Trust Specialist Nurse Paediatric HDU, Paediatric Resusitation Nurse Helen Harker Royal Liverpool & Broadgreen University Hospitals NHS Trust Senior Nurse in Intravascular access Janine Grundy Warrington PCT Intravenous Therapy Team Leader Jo Marinas Royal Liverpool & Broadgreen University Hospitals NHS Trust Clinical Skills Manager Name Organisation Job Title/Role Karen Ellis University Aintree Hospitals Foundation Trust Clinical Skills / Practice Education Manager Karen Selwood Alder Hey Children’s NHS Foundation Trust Oncology Advanced Nurse Practitioner Liz Collins Wirral University Teaching Hospital NHS Foundation Trust Ward Manager Ward 11 Women & Children’s Division Lorraine Smith Wirral University Teaching Hospital NHS Foundation Trust Infection Control Nurse/Infection Control Surveillance Nurse Coordinator Malcolm Smith Mid Cheshire Hospitals Foundation Trust Clinical Skills Tutor Rebecca Molyneux Royal Liverpool & Broadgreen University Hospital Trust Nurse Consultant in Infection Control Ruth Glenn Halton & St Helens PCT IV Therapy Nurse Practitioner Sara Melville Alder Hey Children’s NHS Foundation Trust Paediatric IV Nurse Specialist Shirley Smith Liverpool Community Health NHS Trust Community IV Team Liverpool Sue O’Hanlon Halton & St Helens CHS IV therapy Nurse Specialist
Specific antidotes in the management of peripheral extravasation Drug/class of drug Warm/Cold compression Specific antidote Vinca Alkaloids Vincristine Vindesine Vinblastine Vinorelbine Warm compression- apply for 24 hours Hyaluronidase 1500 IU Draw up 1500IU hyaluronidase in 1 to 2ml water for injection or 0.9% sodium chloride. Inject 0.1 to 0.2ml subcutaneously at points of the compass around the circumference of the area of extravasation. Gently massage area to facilitate dispersal. Mustine Apply cold pack intermittently for 30minutes in every 2 hours for 24 hours. Place a piece of dry gauze between skin and cold pack 3% Sodium Thiosulphate – Dilute the solution provided before use – dilute 1.2ml of 50% sodium thiosulphate to 20ml with water for injections. Infiltrate the site with 1 to 3ml of diluted solution using multiple “pin cushion” injections around the circumference of the area. Apply topical hydrocortisone 1% cream four times a day for the next 7 days or for as long as erythema persists Anthracyclines Daunorubicn Doxorubicin Epirubicin Idarubicn Mitoxantrone Mitomycin C Apply cold pack intermittently for 30minutes in every 2 hours for 24 hours. Place a piece of dry gauze between skin and cold pack Topical DMSO 50% Apply Topical DMSO 50% using a cotton bud every 2 hours at the extravasation site for 24 hours. Avoid contact with good skin. For the next 7 days apply DMSO50% every 6 hours alternating with topical hydrocortisone 1% cream every 3 hours. Do not use an occlusive cover. If blistering occurs, stop DMSO and seek further advice. Any other cytotoxic drug (See appendix 1 for list.) Automatic cold or warm compression is not required. However if symptoms warrant then use intermittent cold compression except in the case of oxaliplatin, cisplatin, or carboplatin when warm compression may be used. No specific antidote needed If signs of erythema persist then topical 1% hydrocortisone cream may be used. Apply sparingly to the affected area 4 times a day while symptoms persist.