Collaborative Intravenous Nursing Service (CINS) Guidelines

• Open out sterile pack to create a sterile field. Open remaining equipment ensuring nocontamination of sterile field.• Place 0.9% sodium chloride (saline) and if needed Heparinised Saline ampoule(s) nearto the working 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 0.9% sodium chloride ampoule, draw up 10mlof solution. Repeat this procedure using the Heparin 10units/ml in Sodium Chloride ifrequired. Dispose of the needle directly into sharps container; place the filled syringeon 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 Chlorhexidine impregnatedwipe, rubbing from the top of the needle free connector to the sides. Do this threetimes using different parts of the wipe, over a period of 30 seconds. Allow to dry.• Attach syringe with 0.9% sodium chloride and inject the flush using a push/ pauseaction, clamping as the last ml of solution is instilled into the catheter. If open endedPICC, repeat this procedure using Heparinised saline lock.• 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 then attach syringe with 0.9% sodiumchloride and inject the flush using a push/ pause action, clamping as the last ml ofsolution is instilled into the catheter. If open ended PICC, repeat this procedure usingHeparinised saline lock.• Remove the syringe and discard.• NEVER FORCE THE SOLUTION INTO THE CATHETER, this can damage thecatheter• Ensure that the catheter is secure and comfortable.• Remove dressing towel and discard. Remove gloves.Chlorhexidine based solutions arerecommended (in alcohol) as perpolicy (DOH 2001).There is no requirement to routinelywithdraw blood and discard it prior toflushing (except prior to bloodsampling although the first sample canbe used for blood cultures (RCN2005).There is an increased risk of infectionand occlusion when withdrawing bloodvia a central venous catheter (RCN2005), therefore for routine flushing ofa line withdrawal of blood is notrequired.The pulsated flush creates turbulencewithin the catheter lumen, removingdebris from the internal catheter wall(Goodwin & Carlson 1993, Todd1998).Positive pressure within the lumen ofthe catheter should be maintained toprevent reflux of blood (INS 2000).35The CINs group hereby assert their moral rights tothe works herein in accordance with the Data Protection Act 1988.Policy review date 01/10/10