Intravenous Therapy Nursing Management POLICY FOR THE NURSE MANAGEMENT OF ANTIMICROBIAL by gko95621

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									                POLICY FOR THE NURSE MANAGEMENT OF

               ANTIMICROBIAL INTRAVENOUS THERAPY IN
                    CHILDREN AND YOUNG PEOPLE


                                          August 2008




       Lead Post :           Lead Nurse Specialist Services for Children and Young People
       Policy approved by: Clinical Governance and Risk Committee BCHS
       Date Approved: 6 November 2008
       Ratified by: Bedfordshire PEC
       Date:19.03.09
       Review Date: March 2011
       Version: 1




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                                              Contents

       1.0          Introduction and purpose of policy/policy statement

       2.0          Scope of the policy

       3.0          Key principles

       4.0          Responsibilities

       5.0          Prescribing

       6.0          Responsibilities for Administration

       7.0          Training requirements

       8.0          Related Documents

       9.0          Procedure Guidelines and Appendices

       Appendix 1          -      General principles

       Appendix 2          -      Acceptable Criteria – IV Antimicrobial Therapy

       Appendix 3          -      Management of patients with central line in situ

       Appendix 4          -      Algorithm – Persistent withdrawal occlusion

       Appendix 5          -      Drug administration via central line

       Appendix 6          -      Drug administration via peripheral cannula

       Appendix 7          -      Blood sampling from central line

       Appendix 8          -      Maintaining patency of central line/changing
                                  connector port

       Appendix 9          -      Dressing Change on PICC and central lines

       10.0         Document replaces
       11.0         References




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       1.     Introduction/purpose of the policy/policy statement
       1.1    This policy aims to provide a broad evidence-based standard on which to approach
              the safe administration of intravenous (IV) drug therapy to children and young
              people in community settings. This may include patients’ homes, health centres
              and community hospitals

       1.2    This policy principally covers the delivery of antimicrobial intravenous (IV) drug
              therapy to children and young people in community settings.


       2.     Scope of the policy
       2.1     This policy applies to all registered nurses employed by NHS Bedfordshire (the
               Trust) who have completed the required training and have been assessed as
               having the necessary skills and competences to administer IV therapy within the
               community setting

       2.2.    Registered nurses wishing to undertake the safe administration on IV therapy to
               children and young people should also complete the Administering Medicines
               Intravenously to Children and Young People workbook outlined under the Royal
               College of Nursing (RCN) Competency Framework. (RCN 2005)

       2.3     IV therapy specifically refers to drugs or solutions administered via the intravenous
               route. Blood and blood product administration to children and young people
               is not dealt with in this policy.

       2.4.   This policy covers all intravenous devices which may be used in the community
              including peripheral cannulae, midline catheters, peripherally inserted central
              catheters (PICCs), tunnelled central venous catheters (CVC’s) and implanted ports.

       3.      Key principles
       3.1    To ensure the adherence to evidence based practice.

       3.2    To ensure Registered Nurses are competent and confident practitioners in relation
              to the safe direct delivery of intravenous drugs.

       3.3     Equitable service delivery across NHS Bedfordshire.

       4.     Responsibilities

               Line Managers have responsibility for ensuring that the current policy is available
               for all staff and for supporting and encouraging education for all registered nurses
               who administer IV therapy.

               All registered nurses are individually responsible and personally accountable for
               their practice and as such must adhere to the Code (Nursing and Midwifery
               Council {NMC} 2008).




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                 Registered nurses have the right to refuse to administer a drug via the IV route if
                 there is no valid/legible prescription available and they are responsible for
                 questioning the prescription if there is a doubt about any aspect of it working to the
                 NMC standards for medicines management 08.07.

                 Registered nurses have the right to refuse to administer a drug via the IV route if
                 they do not feel they have the skills or are competent to deliver the therapy via that
                 route to a specific client group.

                 It is the responsibility of the registered nurse to carry an appropriate anaphylaxis kit
                 at all times when delivering IV therapy.

       5.        PRESCRIBING

       5.1       All IV drugs including diluents and flushes must be prescribed by a medical
                 practitioner with clear written instructions as to how the drug is to be administered.
                 This must include clear instructions on the mixing of drugs. (Medical and
                 Healthcare products Regulatory Agency (MHRA) statement on non medical
                 prescribing and mixing medicines in palliative care).

       5.2       The medical practitioner must specify on the Drug administration sheet or chart:

                       •   Patient details
                               o Patient Name
                               o Address
                               o Date of Birth
                               o National Health Number
                               o Patient specific Allergies
                       •   Name and dosage of drug
                       •   Route of administration
                       •   All diluents and flushes
                       •   Frequency and duration of therapy (including start date)
                       •   If possible the current weight of the child if under 12 years old (British
                           National Formulary for Children (BNF-C)2008)

      5.3        Where appropriate displacement values should be specified and recorded on the
                 Drug administration sheet or chart.
       .


       6          RESPONSIBILITIES FOR ADMINISTRATION

                 6.1    The registered nurse administering IV therapy will be experienced in
                        administering medicines intravenously to children and young people.
                 6.2    The registered nurse administering IV therapy has a responsibility to ensure
                        that he/she has the knowledge and understanding of the medicine to be
                        administered, including

             •   Indication for use
             •   Recommended dose and frequency of use
             •   Methods of preparation and administration
             •   Rate of administration



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             •   Any special monitoring or health and safety requirements
             •   Adherence to the infection control policy (2007) including safe disposal of sharps
             •   Contra-indications
             •   Side effects and potential adverse reactions and the appropriate interventions
                 particularly related to the management of anaphylaxis

       The registered nurse administering the medicines must be satisfied with the Drug
       administration sheet or chart: ensuring it is clear and unambiguous and appropriate for the
       patient’s age, weight and condition.

       Prior to administration the nurse should check
                     • The patients name and address
                     • Date of birth
                     • NHS number
                     • Correct prescription medicine name, form and strength
                     • Drug allergies
                     • Dose to be given
                     • Route of administration
                     • Time and date of administration
                     • Frequency of administration
                     • Expiry Date of the medicine and dilutent (if required)
                     • Method of administration
                     • Dilutent/further dilution if required
                     • Contraindications

       If concerned the registered nurse should delay administration and seek immediate advice
       from the prescriber.

       The registered nurse is responsible for:-

                       •   Explaining the procedure to the patient and/or parent or guardian
                       •   Obtaining verbal consent from the patient and/or parent or guardian
                       •   Caring for the IV device as appropriate
                       •   Encouraging the patient and/or parent or guardian and the nurse to
                           report any problems
                       •   A Care Plan detailing the care of site, line and medication regimen. It
                           should include problem solving advice and emergency plan.
                       •   Administering the drug safely taking into account displacement values,
                           drug concentrations and dose calculations (RCN 2005)
                       •   Providing contact details for help/advice
                       •   Documentation and record keeping

       7          TRAINING REQUIREMENTS
       ..
       7.1       The Trust will facilitate the provision of appropriate training and updates in
                 administration of IV therapy and care of IV devices for all registered nursing staff
                 expected to administer this therapy. RCN 2005.The administration of medicines
                 intravenously is a practical skill which is underpinned by theoretical knowledge.
       7.2       Registered nurses will attend the appropriate training as identified through the
                 RCN Competencies: an education and training competency framework for
                 administering medicines intravenously to children and young people.



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                       •   be assessed as competent by a designated assessor who has who is
                           experienced in administering intravenous medication regularly.
                       •   arrange/request more supervised practice should skills not be used
                           enough to maintain competence/confidence.

       7.3       Registered nurses should have training specific to any medical device they may be
                 required to use such as infusion pumps (Medical Devices Alert (MDA) 2001).
                 Registered nurses should have specific training related to the use of such devices
                 for children and young people.

       7.4       All registered nurses administering IV therapy must attend annual anaphylaxis
                 training and Cardio-Pulmonary Resuscitation (CPR).

       7.5        All registered nurses administering IV therapy must attend appropriate updates in
                 order to maintain their competence as they feel necessary recording assessments
                 and training appropriately. (Knowledge and Skills Framework (eKSF)).

       8.          RELATED DOCUMENTS

       This policy should be read in conjunction with:

                       • Resuscitation Policy
                       • Anaphylaxis Policy
                       • Consent Policy
                       • Infection Control Policy
                       • Medicines Management Policy
                       • Risk Management Policy
                       • Record Keeping Policy

       9          PROCEDURAL GUIDELINES AND APPENDICES

       9.1       Appendix 1

       General Principles

             •   Use of aseptic/non-touch technique is essential in intravenous procedures in order
                 to prevent microbial contamination and appropriate gloves should be worn.

             •   Hand washing should be a routine practice using antibacterial liquid soap and water
                 before putting on and after removal of gloves.


             •   Alcohol based hand rub may be used when hands are clinically clean or if running
                 water is unavailable

             •   Occlusive transparent sterile dressings should be used on all vascular access
                 devices. If the site is bleeding or oozing e.g. during the first 24-48 hours after
                 insertion of a central line, a sterile gauze dressing may be used. This should be
                 changed when it becomes contaminated, loosened or soiled.

             •   Dressings should remain in place no longer than 7 days for central lines. Dressings
                 should be changed at the time of cannula site rotation for peripheral cannulae


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              normally every 72 hours. Dressings on all devices should be changed immediately
              if they become visibly soiled, contaminated or loose.

          •   Splints and bandages may be used to maintain peripheral canulae function for
              young children. Bandages should be removed at each administration and at least
              daily. Bandages should be changed every 72 hours or sooner if soiled. Splints
              should be replaced with a clean one when the cannula is re-sited.

          •   Care of vascular access sites should coincide with canulae dressing changes.
              Care should consist of cleansing the site with an appropriate antimicrobial solution
              i.e. chlorhexidine either as a single agent or in combination with alcohol or aqueous
              solution. The solution should be allowed to air dry before applying a sterile
              dressing. Manufacturers’ recommendations regarding potential damage to catheter
              material should be checked prior to using solutions, containing alcohol.

          •   The injection access port/bung should be cleaned with alcohol e.g.
              Mediswab/Alcowipe, or a solution of chlorhexidine and alcohol and allowed to air
              dry before being used to access the system.




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       9.2 Appendix 2

                         Acceptable Criteria – IV Antimicrobial Therapy

          •   All patients should be referred to the Community Paediatric Nursing service at least
              48 hours before a planned discharge. Acceptance may be dependent on available
              community resources and at weekends/bank holidays contact must be made
              directly via the Children’s Intermediate Care Team on call process.

          •   Responsibility for the patient’s treatment and drugs remain with the prescribing
              doctor/hospital (EL(95)5).

          •   At least 3 doses of each antibiotic to be given intravenously prior to discharge.

          •   The registered nurse must be aware of and must have copies of discharging
              hospital IV policy.

          •   Whenever possible the antibiotics used should be prescribed as once daily bolus
              doses. If this is not possible then the community paediatric nursing team will plan
              how care will be managed across the 24hrs. If patients are to be discharged with a
              peripheral cannula in situ a definite time, date and venue for routine re-siting every
              3 days (DOH Winning Ways 2003) should be arranged. Peripheral cannulae are
              not normally acceptable for patients receiving more than 7 days of therapy,
              however each patient should be assessed individually and appropriate care
              organised by the accepting healthcare professional.

          •   All drugs and flushes must be prescribed on the discharging NHS hospital
              prescription chart and any changes should be written and signed (no verbal
              instructions will be accepted).

          •   All drugs, diluents, flushes, bungs and other specialist equipment should be
              supplied for the duration of the therapy by the prescribing hospital (EL(95)5).

          •   Ancillaries (syringes, needles etc) should be provided for one week to enable
              community paediatric nursing staff to order stock.

          •   A drug data sheet should be included with the drugs sent home so that
              reconstitution of the drug and its correct storage can be checked and in place prior
              to discharge.

          •   There must be at least telephone advice available 24 hrs a day from the
              discharging ward and open access back if a problem should arise. Written details
              with a contact number must be given to the patient on discharge.




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       9.3       Appendix 3




                            Management of patients with central line in situ


       Good practice states that the registered nurse should aspirate the catheter and check
       blood return to confirm patency prior to administration of medications and/or solutions
       (INS 2000).

       If resistance is met and absence of blood return is noted, the registered nurse should take
       further steps to assess patency of the catheter prior to administration of medications
       and/or solutions. Follow the relevant algorithm (See Appendix 4).

             •   Lines should always be flushed under positive pressure, pushing in the last 0.5ml of
                 the flush whilst applying the clamp on a clamped line or removing the device from
                 the bung for a valved line. This prevents any backflow of blood into the line and
                 possible clot formation.

             •   When dealing with a central line never use a syringe smaller than 10mls as there is
                 the potential for the pressure that smaller syringes create to lead to the rupture of
                 the catheter.

             •   It is preferable to use a needleless system to administer bolus doses or infusions
                 and for the withdrawal of blood specimens

             •   Before accessing a bung it should be cleaned with a Mediswab/Alcowipe or
                 sprayed with alcohol. The bung should be left to air dry before proceeding. A new
                 swab must be used each time

             •   Bungs should be changed weekly or after 100 uses whichever is the sooner (see
                 separate guideline)

             •   A line which is not in use should be flushed at least weekly. The type of flush,
                 volume and frequency should be prescribed in a Drug administration sheet or chart:

             • A line should be flushed before and after each administration of medication and
                 after obtaining blood specimens.

       Where Heparinised flushes are used care must be taken to ensure the correct strength
       and volume of Heparinised sodium chloride is used for the appropriate device. (SABS
       NPSA 2008-RRR 002)




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        9.4       Appendix 4

                                       Algorithm – persistent withdrawal occlusion

        i.e. fluids can be infused freely but blood cannot be withdrawn from the catheter

        (Adapted from RCN Standards for infusion Therapy 2007)


               Blood return is                          Ask patient to cough, deep        Blood return obtained –
                   absent                               breathe, change position          use central venous
                                                                                          catheter as normal




                                                             Blood return is still
                                                                  absent




                                                           Flush central venous
                                                           catheter with 0.9%
                                                           sodium chloride in
                                                           10ml syringe using a
                                                           brisk ‘push pause’
                                                           technique. Check for
                                                           flashback of blood



                                                             Blood return is still
                                                                  absent



                                              Yes                                    No



                   Patient to receive
                   highly irritant/vesicant                                                Use central
                   drugs                                                                   venous
                                                                                           catheter as
                                                                                           normal

          No                            Yes




  Refer to IV Nurse                           Refer to hospital
  Specialist for advice                       which sited the device
                                              for confirmation of
                                              further management




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       9.5     Appendix 5

                                   Drug Administration via Central Line

       Equipment required

       Drug administration sheet or chart:
       Prescribed drugs and appropriate diluents
       70% alcohol wipes
       Alcohol based hand rub
       Sterile gloves and disposable apron (Addenbrooke’s Hospital)
       Clinically clean receiver or tray
       Luer lock syringes as required (minimum size 10mls)
       Blue needles
       Sufficient ampoules Sodium Chloride 0.9% 10mls for flushing (I flush before and I flush
       after each drug)
       Heparinised Sodium Chloride (in 10ml syringe) if required as prescribed
       Sharps bin

       PROCEDURE                                          RATIONALE
       1.    Explain and discuss procedure with           To ensure patient (and/or Guardian)
             patient (and/or Guardian)                    understands the procedure and gives
                                                          his/her valid consent
       2.  Check Drug administration sheet or chart:      To ensure correct drug is being
           and confirm patient’s name and date of         administered to correct patient
           birth
       3. Check all drugs are free from                   To protect the patient from harm
           contamination and are in date
       4. Clean hands thoroughly with soap and            To minimise the risk of infection
           water and assemble necessary equipment
       5. Inspect exit site of catheter for signs of      To ensure the line is safe to use and no
           inflammation or leakage                        sign of infection
       6.   Clean hands with alcohol handrub and          To minimise the risk of infection
           put on gloves and apron
       7. Draw up drugs as prescribed, sodium             To prepare for administration
           chloride flushes for before, between and
           after drugs and Heparinised sodium
           chloride if required and place in clinically
           clean receptacle
       8. Do not resheath needles                         To avoid risk of needlestick injury
       9. Clean connector port with an alcohol swab       To ensure complete disinfection has
           for at least 30 secs, and allow to air dry.    occurred
           Hold the line in the non dominant hand to
           prevent recontamination.
       10. Insert syringe containing 0.9% sodium          To confirm patency of device
           chloride into connector (open clamp if
           present) inject (close clamp) and remove
           syringe
       11. Insert syringe containing drug into            To administer medication
           connector port (open clamp if present)
           inject drug at specified rate (close clamp)
           and remove syringe
       12. Repeat procedures 10 and 11 for each


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            drug administered
       14. After administration of medication, repeat To flush line
            procedure 10 as above
       15. Insert syringe containing Heparinised      To prevent catheter clotting between
            Sodium Chloride, inject using a pulsating uses
            method closing clamp whilst giving last
            0.5ml in order to maintain positive
            pressure
       16. Dispose of used needles and syringes into To avoid needlestick injury
            sharps bin and other waste into
            appropriate plastic bags
       17. Record procedure on drug sheet and in      To maintain accurate records
            nursing notes
       N.B. If medication is due more than once daily heparinised sodium chloride only
       needs to be administered once (after last dose of the day)




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       9.6    Appendix 6


                             Drug administration via peripheral cannula
       Equipment required

       Drug administration sheet or chart:
       Clinically clean receiver or tray
       Drugs to be administered and appropriate diluents
       Sterile luer lock syringes of appropriate size
       Blue needles
       Sodium Chloride 0.9% 5ml x 2
       Sharps bin
       Alcohol based hand rub
       Sterile gloves and apron


       PROCEDURE                                           RATIONALE
       1.    Explain and discuss the procedure with        To ensure patient (and/or Guardian)
             patient (and/or Guardian)                     understands the procedure and gives
                                                           his/her valid consent
       2.  Check Drug administration sheet or chart:       To ensure correct drug is being
           and ask patient to confirm name and date        administered to correct patient
           of birth
       3. Check all drugs are free from                    To protect the patient from harm
           contamination and are in date
       4. Wash hands thoroughly with soap and              To prevent bacterial contamination
           water
       5. Assemble necessary equipment in a                To minimise the risk of contamination
           suitably clean area
       6. Reconstitute drugs in accordance with            To prevent infusion of foreign bodies
           manufacturers’ instructions and draw up.
           Check for discolouration or particles
       7. Do not resheath needles                          To avoid risk of needlestick injury
       8. Wash or clean hands with alcohol based           To reduce risk of bacterial
           handrub and put on gloves                       contamination
       9. Remove any bandages and inspect                  To detect any inflammation/infiltration
           cannula insertion site for signs of phlebitis   and act accordingly
           & if present take appropriate action.
           Replace bandage as required.
       10. Clean connector/access port with an             To ensure complete disinfection has
           alcohol swab for at least 30 secs, and          occurred
           allow to air dry
       11. Inject 2-3mls sodium chloride 0.9% via          To ensure patency of cannula
           extension set or cannula port to check
           patency
       12. Inject drug via extension set or cannula        To ensure patient safety and comfort
           port at specified rate, observing patient for
           any reaction



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       13. Flush cannula with 5mls sodium chloride     To maintain cannula patency
           0.9% using a pulsating method i.e. 1ml at
           a time
       14. If more than one drug is being given, the   To prevent drug interactions and
           cannula should be flushed with sodium       maintain cannula patency
           chloride 0.9%between each drug and on
           completion of therapy
       15. Dispose of needles and syringes into        To avoid risk of needlestick injury
           sharps bin and other waste into
           appropriate plastic bags
       16. Record procedure on drug chart and in       To maintain accurate records
           nursing notes




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        9.7   Appendix 7


                                  Blood sampling from central line



       Equipment

       Sterile towel
       Clinically clean receiver/tray
       10ml luer lock syringes x 4
       Blue needles as necessary
       Sterile gloves and apron
       Alcohol impregnated wipes
       Alcohol based hand wash solution
       Sodium chloride 0.9% 10mls for flushing
       Heparinised Sodium Chloride 5mls (appropriate strength)
       Blood cards and specimen tubes
       Sharps bin

       N.B. When using a dual lumen catheter, the larger lumen should always be used for blood
       sampling/administration of blood or blood products

       PROCEDURE                                          RATIONALE
       1.     Explain and discuss procedure with the      To ensure patient (and/or Guardian)
              patient (and/or Guardian)                   understands the procedure and gives
                                                          his/her valid consent
       2.     Assemble necessary equipment in a           To minimise the risk of contamination
              suitably clean area
       3.     Wash hands thoroughly with soap and         To minimise the risk of introducing
              water or use alcohol based hand rub and     infection and prevent contamination of
              put on gloves                               practitioner’s hands with blood
       4.     Draw up sodium chloride and                 To prepare for flushing
              Heparinised Sodium Chloride
       5.     Do not resheath needles                     To avoid needlestick injury
       6.     Clean IV connector with Alcowipe (if        To enable disinfection process to be
              infusion is in place this must be stopped   completed
              and removed first)Allow connector to air
              dry before connecting syringe
       7..    Attach a 10ml syringe release clamp if      To remove blood and heparin from the
              present and withdraw 10mls blood            ‘dead space’ of the catheter.
       8..    Reclamp catheter and discard at the         Samples from this ‘dead space’ may
              sample and syringe                          cause inaccurate results
       9..    Attach a new syringe of appropriate size,   To obtain the sample
              release clamp and withdraw required
              amount of blood
       10.    Reclamp catheter and remove syringe         To prevent blood loss or air embolism
       11.    Attach new syringe containing sodium        To create turbulence, ensure blood is
              chloride 0.9% and flush using the push-     removed from the line and prevent
              pause method i.e. 1ml at a time.            occlusion
              Reclamp catheter and remove syringe



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       12.   Attach new syringe containing               To maintain positive pressure and
             heparinised sodium chloride release         prevent catheter clotting in between
             clamp and flush line using pulsating        uses
             method and closing clamp whilst giving
             last 0.5mls
       13.   Fill appropriate specimen tubes label and   To enable requested tests to be
             place in specimen bag for transfer to       performed
             laboratory
       14.   Dispose of sharps into sharps bin and       To avoid needlestick injury
             other waste into appropriate plastic bags
       15.   Record procedure in nursing notes           To maintain accurate records




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        9.8   Appendix 8

                  Maintaining Patency of a Central Line/Changing Connector Port

       Lines should be flushed after each use or weekly if not in use. The line should be flushed
       with 0.9% sodium chloride before injecting Heparinised Sodium Chloride if blood sampling
       has taken place. Needleless IV connectors (e.g. Bionectors) should be changed weekly
       or after 100 uses (whichever is the sooner) for devices with more than one lumen
       remember to flush each lumen.

       Equipment required

       Sterile towel
       Alcohol impregnated swabs e.g. Alcowipes
       Connector x 1 per lumen if required
       10ml luer lock syringes as required
       Blue needles
       Sodium chloride 0.9% 10mls per lumen
       Heparinised Sodium Chloride 5mls per lumen if required (appropriate strength)
       Alcohol based hand rub
       Clinically clean gloves and apron
       Sharps bin

       PROCEDURE                                          RATIONALE
       1.        Explain and discuss procedure with       To ensure patient (and/or Guardian)
                 the patient (and/or Guardian)            understands the procedure and gives
                                                          his/her valid consent
       2.        Prepare equipment. Wash hands            To reduce the risk of contamination
                 and put on gloves and apron. Draw
                 up sodium chloride & Heparinised
                 Sodium Chloride.
       3.        Do not resheath needles                  To avoid the risk of needlestick injury
       4.        Pick up the central line catheter with   To reduce the risk of contamination and
                 an alcohol impregnated wipe.             the entry of air into the line
                 Ensure line clamp (if present) is
                 closed
       5.        Remove IV connector (if changing)        To minimise risk of contamination at
                 with alcohol swab and clean catheter     connection
                 hub for a minimum of 30 seconds.
                 Allow to air dry.
       6.        Connect new IV connector, unclamp        To confirm patency of the device
                 line and inject 5mls sodium chloride
                 0.9% Re-clamp line
       7.        Connect syringe containing 5mls          To create turbulence ensuring thorough
                 Heparinised Sodium Chloride              flushing of catheter and to maintain
                 unclamp line and inject Heparinised      positive pressure preventing backflow of
                 Sodium Chloride using a pulsating        blood into catheter and possible clot
                 flushing technique. Re-clamp line.       formation
       8.        Dispose of sharps into sharps bin        To avoid needlestick injury
                 and other waste into appropriate
                 plastic bags
       9.        Record in nursing notes                  To maintain accurate records



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       9.9    Appendix 9


                           Dressing Change on PICC and central lines
       Equipment required

       Clear film dressing (such as Opsite 3000 IV)
       Clinically clean receiver or tray
       Sodium Chloride 0.9%
       Sterile Gauze
       Alcohol based hand rub
       Clinically clean gloves x 2 pairs
       Apron

       Dressing should be changed every 7 days and any intervention recorded in the nursing
       notes. Dressings may be changed sooner if soiled.

       PROCEDURE                                       RATIONALE
       1.    Explain and discuss procedure with the    To ensure patient (and/or Guardian)
             patient (and/or Guardian)                 understands the procedure and gives
                                                       his/her valid consent
       2.    Prepare equipment. Wash hands and         To reduce the risk of contamination
             put on gloves and apron.
       3.    Remove the old dressing                   To avoid the risk of infection
       4.    Inspect site for redness or oozing, if    To reduce the risk of contamination.
             present take a swab for microscopy,
             culture and sensitivities (MC&S), clean
             site with sterile gauze and saline and
             inform medical staff
       5.    Remove gloves, wash hands and put on      To reduce the risk of contamination
             a clean pair.
       6.    Apply new dressing. Ensure line is        To prevent the line being dislodged
             secured to prevent accidental
             tugs/pulls/displacement of line.
       7.    Dispose of all used clinical waste        To reduce the risk of contamination
             according to trust Policy
       8.    Remove gloves, apron and perform hand     To reduce the risk of contamination
             hygiene
       9.    Document in nursing evaluation            To maintain accurate records




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       10.0 Document replaces
       Joint policy for the nursing management of intravenous therapy for Bedfordshire
       Heartlands PCT and Bedford PCT.

       11.0 References
       Addenbrooke’s (2008) Aseptic Non-Touch Technique (ANTT) for Administering Drugs and
       Fluids by Intravascular Devices – Procedure

       Addenbrooke’s (2007) IV- Peripheral Intravenous (IV) Cannula Management in Children

       Addenbrooke’s (2007) IV- Indwelling Port (Portacath/Vascuport) in Children, Accessing
       and Accessed Port

       Addenbrooke’s (2007) IV- PICC Line (Percutaneous Indwelling Central Catheter) in
       Children

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       related Bloodstream Infection, oral presentation NAVAN Conference San Diego CA



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       Medical Devices Agency, Dept of Health (2001) Devices in Practice – a guide for health &
       social care professionals.

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       Healthcare-Associated Infections in NHS Hospitals in England

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       community setting. Guidance for nursing staff

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       Young People: A competency framework. A workbook to assist practitioners in developing
       competence

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       SABS NPSA 2008-RRR 002: Risks With Intravenous Heparin Flush Solutions

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       Younger G, Khan M (2008) Setting Up and Priming an Intravenous Infusion




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