Collaborative Intravenous Nursing Service (CINS) Guidelines

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Ensure all equipment is gathered before commencing the procedure and all packagingis intact and in date.• Open sterile pack allowing inner pack to fall onto clean working area.• Open out sterile pack to create a sterile field. Open remaining equipment ensuring nocontamination of sterile field.• Place 0.9% sodium Chloride (saline) & Heparinised Saline ampoules near to theworking area but not on the sterile field. Pour out alcohol Chlorhexidine solution.• Ensure easy access to the needle free system.• Decontaminate hands.• Put on sterile gloves.• Connect needle/ filter straw to the syringe.• With a piece of sterile gauze pick up the Sodium Chloride 0.9% (saline) ampoule, drawup 10ml of solution. Repeat for Heparinised Saline. If used, dispose of the needledirectly into sharps container, place the filled syringes on the sterile field.• Place sterile towel as near as possible to the catheter• Using a piece of sterile gauze soaked in alcohol Chlorhexidine solution, scrub the topthen the sides of the needle free system connection and allow to dry.• Alternatively, scrub the hub of the needle free system with 2% Chlorhexidineimpregnated wipe, rubbing from the top of the needle free connector to the sides. Dothis three times using different parts of the wipe over a period of 30 seconds. Allow todry.• Attach syringe with 0.9% Sodium Chloride flush and inject the flush using apush/pause action, clamping as the last ml of solution is instilled into the catheter.• Remove the syringe and discard. If open ended skin tunnelled catheter repeat thisprocedure using syringe containing Heparin 10units/ml in 0.9% Sodium Chloride.• For Patients’ in the community discharged from Christie Hospital, Attach empty 10mlsyringe into needle free system and aspirate at least 10ml of blood from the catheterand discard. If unable to do so refer to The Christie management of problems relatedto central venous catheters in the community.• NEVER FORCE THE SOLUTION INTO THE CATHETER, this can damage thecatheter.• Ensure that the catheter is secure and comfortable.To maintain a sterile field.Chlorhexidine-based solutions arerecommended (in alcohol) as per policy(DOH 2001).10ml syringes should always be used;smaller syringe sizes may damage thecatheter (Hadaway 1998).There is no requirement to routinelywithdraw blood and discard it prior toflushing (except prior to blood samplingalthough the first sample can be used forblood cultures (RCN 2005).There is an increased risk of infection andocclusion when withdrawing blood via acentral venous catheter (RCN 2005),therefore for routine flushing of a linewithdrawal of blood is not required.The pulsated flush creates turbulencewithin the catheter lumen, removingdebris from the internal catheter wall(Goodwin & Carlson 1993, Todd 1998).Positive pressure within the lumen of thecatheter should be maintained to preventreflux of blood (INS 2000).9The CINs group hereby assert their moral rights tothe works herein in accordance with the Data Protection Act 1988.Policy review date 01/10/10
• Remove dressing towel and discard. Remove gloves. Wash hands.• Clear away equipment disposing of waste as per organisational policy.• Decontaminate hands• Document care in patient’s records.10The CINs group hereby assert their moral rights tothe works herein in accordance with the Data Protection Act 1988.Policy review date 01/10/10
Page 3 and 4: Intravenous Access Care and Mainten
Page 5: 4Cheshire and Merseyside NHS North
Page 8 and 9: Open sterile pack, allowing inner p
Page 12 and 13: Skin Tunnelled Catheters - Blood Sa
Page 14 and 15: catheter.• Ensure that the cathet
Page 16 and 17: • Open sterile pack allowing inne
Page 18 and 19: Algorithm persistent withdrawal occ
Page 20 and 21: The CINs group hereby assert their
Page 22 and 23: Care and Maintenance of a non tunne
Page 24 and 25: Central Non-Tunnelled Catheters - S
Page 26 and 27: Central Non-Tunnelled Catheters - B
Page 28 and 29: Central Venous Non-Tunnelled Cathet
Page 30 and 31: Algorithm persistent withdrawal occ
Page 32 and 33: 31References.1. Department of Healt
Page 34 and 35: • Open sterile pack, allowing inn
Page 36 and 37: • Open out sterile pack to create
Page 38 and 39: 37Peripherally Inserted Central Cat
Page 42 and 43: • Place 0.9% sodium chloride (sal
Page 44 and 45: References431. Department of Health
Page 46 and 47: Care and Maintenance of a Periphera
Page 48 and 49: Peripheral Midline - 0.9% Sodium Ch
Page 50 and 51: 49Peripheral Midline -Administratio
Page 56 and 57: Put on sterile glovesPlace sterile
Page 58 and 59: ampoule(s) near to the working area
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59Totally Implanted Venous Access D
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If TIVAD was accessed for flushing
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solution or open Chlorhexidine impr
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65Care and Management of Peripheral
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67Changing a Needle-free I/V access
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69EXIT SITE INFLAMMATION/PHLEBITISP
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SYSTEMIC INFECTION71Signs & Symptom
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FOR CARE OF PERIPHERAL VENOUS CANNU
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Bleeding from site / lineitself.Lin
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77Type of device Risks Actions Vari
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EVALUATION RECORD79DATE EVALUATION
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Type of device Risks Actions Variat
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EVALUATION RECORD83DATE EVALUATION
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87EVALUATION RECORDDATE EVALUATION
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91EVALUATION RECORDDATE EVALUATION
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2List of contributors to the Venous
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4PCTcoordinatorMalcolm Smith Mid Ch
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6University Hospital Aintree NHS Fo
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81. IntroductionThe purpose of this
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venous shock, flare or phlebitis. S
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12Hyaluronidase: Dilute 1500 units
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scheme is co-ordinated through the
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16Appendix 2Specific antidotes in t
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experience. Due to the volume of th
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20G. Infiltrate the site with 1-3ml
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Collaborative Intravenous Nursing Service (CINS) Guidelines

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