(CVC) Management Guidance - the Royal Cornwall Hospitals Trust ...

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11.3 Documentation of line removal must include: Reason for removal Length of catheter removed (which must be checked against insertion information) Confirm if the catheter tip has been sent for culture Technique used 12 CVC Infections Infection is one of the most frequently reported complications of CVC’s. If a catheter related blood stream infection is suspected or confirmed, alternative vascular access should be sought until the issue is resolved. The following guidance represents current best practice however; practitioners should seek guidance from appropriate medical staff, Infection prevention & control team, microbiology team and pharmacist. Practitioners need to audit their own practice as part of infection prevention measures by completing a Central catheter form, Each time a port is accessed there is a risk of infection. This guideline mandates ANTT when accessing a CVC which will further reduce the risks of bacteraemia in lines. The method of cleaning ports and hubs prior to access is the same as all vascular access devices. A Chlorhexidine 2% and Alcohol 70% (PDI or Clinell® wipe is to be used. For patients where there is an allergy/reaction likely to Chlorhexidine, a Povidine Iodine 10% aqueous solution should be used. 12.1 Suspected Insertion Site Infections A swab must be taken from the insertion site before commencing systemic antibiotic therapy. If a swab is taken the result must be followed up within 48 hours and discussed with the Medical Management Team. A daily assessment including VIP, Temperature, Pulse, Respirations and dressing change to be initiated. 12.2 Blood Cultures Where a catheter related blood stream infection is suspected a minimum of two blood culture samples are required. The cultures must be taken using a closed system. One set of cultures must be taken from the CVC (or a sample from each lumen) and the other taken peripherally before commencing antibiotic therapy. This is a procedure to be undertaken by medics only. 13 Education 13.1 Staff All registered practitioners accessing CVC’s should be fully trained in intravenous infusions, be deemed competent to PCH standards and have had additional teaching 10 of 25
and local assessment by a registered healthcare practitioner who themselves have experience in caring for CVC’s. Staff should also have completed the PCH infection control and ANTT training and be fully up to date with Anaphylaxis training. Training for CVC management will be provided by the IV link trainers Additional training may be required when accessing implanted ports and where an opportunity arises to gain this from an acute setting prior to discharge the staff should be encouraged to take the opportunity. 13.2 Patients If patients/carers are deemed able to self manage the CVC they should be made fully aware of the risks involved. They must be given advice and taught how to care for the line safely during their hospital stay and following discharge. The patient (and carer/other if appropriate) must be given advice verbally and this should be supported by written information in a format they understand. Contact details for 24 hour advice must be provided in case the patient has any concerns regarding line care. A full care plan/information pack must accompany the patient on discharge and the Community Teams must be included in the discharge planning. Dressing change must be done by the District Nurses/Community Matron when a patient is outside the hospital environment due to the risk of potential infection or displacement. 14 Risk Management Strategy Implementation 14.1 Implementation & Dissemination Via professional practice group, Intravenous therapy link nurses, educators, clinical leads, matrons, ward managers and through training department 14.2 Training and Support Refer to section 13 for further details 14.3 Document Control & Archiving Arrangements Once ratified, these guidelines will be loaded to the documents library. Any previous versions will be electronically archived by the Policy Administrator in the electronic Policy Drive Archive Folder. A signed hard copy of the guidelines will be forwarded to the Policy Administrator and an electronic copy will be saved by the Policy Administrator in the electronic Policy Drive. Further copies of current and archived policies can be obtained from the Policy Administrator including versions in large print, Braille and other languages. 11 of 25
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