Management of Central Venous Access Devices - Sydney South ...

Sydney South West Area Health ServicePolicy No: SSW_PD2009_049Date Issued: November 2009CENTRAL VENOUS ACCESS DEVICES: MANAGEMENT OF A CENTRAL VENOUSACCESS DEVICECONTENTS1. Introduction 32. Policy Statement 33. Principles/Guidelines 43.1 Accreditation3.2 Dressings3.3 Infusion Lines3.4 Heparin Locks4. Performance Measures 65. Definitions 66. References and links 6Compliance with this policy directive is mandatory Page 2 of 7

Sydney South West Area Health ServicePolicy No: SSW_PD2009_049Date Issued: November 20093.3 Administration Set Changes• Change administration sets / burettes at least every 72 - 96 hours.• IV administration / pump sets used for administering of lipid based (andsome blood) products should be changed minimum every 12 hours - this isrecommended by the CDC, CINA & RNAO (Canada), INS, AVA and manyother Parenteral Nutrition organisations (for 3:1 PN with lipids)• With some blood products (whole blood and components), administration setchanges should be every 2 hours or after 2 - 4 units (unless suspectedcontamination). Refer to SSWAHS Area policy on administration of bloodproducts. Policy No: SSW PD 2009 _005)http://intranet.sswahs.nsw.gov.au/SSWPolicies/pdf/pd2009005.pdf3.4 0.9 % Normal Saline / Heparin Lock• Each lumen must be 0.9% normal saline or heparin locked at least weeklywhen line is not in use. Heparin 50 units/5ml (Heparinised Saline) strength isused. Higher doses may be used for implanted devices or dialysis/apheresiscatheters.• Each lumen to be flushed with 0.9% normal saline prior to heparin orheparinised saline lock (to clear any medication / debris prior to instilling ofheparin for lock.• A positive pressure pulsatile flushing method to be used when flushing orapplying a locking solution in all situations. This will reduce incidence ofcatheter-related occlusions.4. Performance Measures• Random audits of compliance with the policy regarding the management of CVADwill be performed.• Review of clinical incidents via the Incident Information Management System(IIMS) related to the management of CVAD.5. DefinitionsCVAD:Central Venous Access Device. In the context of this policy this will includeany vascular device whereby the tip of the catheter is located in the SuperiorVena Cava.Clinician: In this policy, Clinician will mean Registered Clinician/Registered Nurse6. References and Links• Legislative Compliance: Organisation, Management and Staff Obligations –SSW_PD2007_005• Code of Conduct – SSW_PD2009_001Compliance with this policy directive is mandatory Page 6 of 7

Sydney South West Area Health ServicePolicy No: SSW_PD2009_049Date Issued: November 2009• Centres for Disease Control and Prevention (2001).Guidelines for preventinginfections associated with the insertion and maintenance of central venouscatheters. Journal of Hospital Infection (2001). 47 (Supplement): S47- S67.• Cancer Nurses Society of Australia (2007). Central Venous Access Devices:Principles for Nursing Practice and Education. Cancer Nurses Society of Australia.• Registered Nurses’ Association of Ontario (2005) Care and Maintenance toReduce Vascular Access Complications, Nursing Best Practice GuidelinesProgram http://www.rnao.org/bestpractices• Claire M Rickard; Jeff Lipman; Mary Courtney; Rosemary Siversen; Peter DaleyRoutine changing of intravenous administration sets does not reduce colonizationor infection in central venous catheters. Infection Control and HospitalEpidemiology; Aug 2004; 25, 8; Health & Medical Complete pg. 650.Compliance with this policy directive is mandatory Page 7 of 7