Collaborative Intravenous Nursing Service (CINS) Guidelines

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• 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) and Heparinisedsaline ampoules near to the working area but not on the sterile field.• Pour out alcohol Chlorhexidine solution.• Ensure easy access to the needle free system.• Put on sterile gloves. Connect needle or filter straw to the syringe.• Pick up a piece of sterile gauze and with it pick up the 0.9% Sodium Chloride forinjection ampoule, then draw up 10ml of solution, Repeat for second 0.9% SodiumChloride and Heparin 10units/ml in 0.9% Sodium Chloride. Dispose of the needledirectly into the 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 2% Chlorhexidine solution, scrub the top thenthe 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 for injection, aspirate enough blood to colour0.9% Sodium Chloride solution then inject the flush using a push pause actionclamping as the last ml of the solution is instilled into the catheter. Remove the syringeand discard.• If unable to aspirate blood from the line continue to administer prescribed medicationunless this is a vesicant drug/infusion, in this case refer to algorithm onpersistant withdrawal occlusion.• NEVER FORCE THE SOLUTION INTO THE CATHETER, this can easily damage thecatheter.• Administer IV antibiotics/infusion/additives as prescribed following trust policy.• Flush catheter again with 10ml 0.9% Normal Saline using a push/pause action.• Remove the syringe and discard.• If open ended skin tunnelled catheter and this is the final dose of treatment for the day,repeat this procedure using Heparin 10units/ml in 0.9% sodium chloride clamping asMaintain asepsis.To check catheter patency and toremove residual solution from catheter.The RCN Standards for infusion Therapystate, “the nurse should aspirate thecatheter and check for blood return toconfirm patency prior to theadministration of medications and/orsolutions (INS 2000). On no accountshould a vesicant drug or vesicantinfusion be administered through avascular access device where difficulty isexperienced in withdrawing blood(Masoorli 2003).Creates turbulence in catheter,preventing clotting in the catheter.Maintains positive pressure and preventsbackflow of blood into the catheter.15The CINs group hereby assert their moral rights tothe works herein in accordance with the Data Protection Act 1988.Policy review date 01/10/10
the last ml of solution is instilled into the catheter to maintain catheter patency.• Remove the syringe and discard• Ensure that the catheter is secure and comfortable.• Remove dressing towel and discard. Remove gloves. Clear away equipment used.Dispose of waste as per organisational policy.• Wash hands• Document care in patient’s records.16The 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 10 and 11: Ensure all equipment is gathered be
Page 12 and 13: Skin Tunnelled Catheters - Blood Sa
Page 14 and 15: catheter.• Ensure that the cathet
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
Page 60 and 61: 59Totally Implanted Venous Access D
Page 62 and 63: If TIVAD was accessed for flushing
Page 64 and 65: 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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