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

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Reference Guide for Implanted Ports 2R3 Indications: Securing the Line: Dressings: Patient requiring regular central access for longer than 4 weeks Fixed under the skin with dissolvable sutures. Site must be cleaned with 3ml applicator of 2% Chlorhexidine in 70% alcohol e.g. Chloraprep and left to dry. (Povidine iodine 10% solution if patient Chlorhexidine sensitive) General A sterile dressings pack must be used for all line care Visual phlebitis (VIP) or (CCAT) score must be documented within the patient record. If wound oozing or bleeding, sterile gauze should be used. Dressing must be checked and replaced 24-48 hours post insertion or sooner if Post Insertion integrity compromised. Once oozing/bleeding stopped and area has healed, no further dressing is required. Continued Care Site inspection required when accessing the line. Patency: Accessing the Line Documentation Contact Details FLUSH 5-10mL of 0.9% w/v sodium chloride and use Heparin 10 units/mL If needle left in 4 WEEKLY LOCK IF NOT 4-6mLs of heparin solution (Heparin 100 units/mL) direct into port IN FREQUENT USE Manipulations of the line should be kept to a minimum Sterile technique must be used. Access using specialised non-coring needles and extension sets (e.g. Huber) with a 10 mL syringe or larger Access points must be decontaminated with 2% Chlorhexidine in 70% alcohol All care (insertion, maintenance, access) must be documented within the patient record. A visual phlebitis score (VIP) must be recorded at each observation/ access of the port. Designated consultant lead for the line. 18 of 25
Appendix 3 Standard Operating Procedure for Flushing PICC line CVC SOP1 Procedure Equipment and documentation: Rationale To prepare for task Sterile dressing pack, Hand cleanser, Non sterile gloves, 10ml luer lock syringe, drawing up needle,10-20mls 0.9%Sodium Chloride flush, 2% Chlorhexidine 70% Alcohol wipe x 2, sharps bin, secondary securing dressing, care plan, prescription chart 1. Wash hands apply gloves and apron and gain informed consent To reduce risk of cross contamination and gain patient co-operation with the knowledge they or their carer understand the rationale for the task 2. Prepare sterile field and equipment Advanced preparation for task and reduce risk of contamination 3. Expose line and switch off any infusion and observe VIP/CCAT score whilst To allow easy access when sterile and reduce risk of infusion drips measuring external length of line on sterile field. Note early signs of phlebitis. Determine if line has moved 4. Clamp line and using ANTT disconnect any infusion seal giving set end with Allow access to port and reduce risk of contamination sterile Bung 5. Remove gloves, wash hands and apply sterile gloves and apron. Reduce risk of contamination 6. Prepare flush using sterile gauze to open flush Reduce risk of contamination 7. Using sterile gauze pick up clave end and clean with wipe for 30 seconds and Reduce risk of contamination allow drying for at least 30 seconds. 8. Attach syringe using luer locking system unclamp line and using a push pause Maintain a closed system and keep line patent by creating technique flush the line with 10mls turbulence in order to flush line thoroughly 9. Toward the last 1-2 mls clamp line but continue to flush To lock the system under positive pressure reduce risk of backflow and clot formation 10. Use second wipe to clean end as before Reduce risk of contamination 11. Apply secondary dressing (Loose Bandage, tube fast) To protect from snags 12. Dispose of all sharps and document action in care plan Reduce risk of contamination to others and maintain continuous record *PHNT and Royal Marsden guidelines 19 of 25
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