Collaborative Intravenous Nursing Service (CINS) Guidelines

ampoule(s) near to the working area but not on the sterile field. Pour out chlorhexidinesolution or open Chlorhexidine impregnated applicator.Decontaminate handsPut on sterile gloves connect the needle/filter straw to the syringeWith a piece of sterile gauze pick up the 0.9% Sodium Chloride (saline) ampule, draw up10ml. Repeat for Heparinised saline. If a needle is used dispose directly into the sharpscontainer. Place the filled syringes on the sterile field.Prime the non-coring needle device including its tubing with 0.9% Sodium Chloride andclamp extension tube, remove syringe.Remove anaesthetic cream if used, locate septum of TIVAD by palpation, remove gloves.Decontaminate hands and put on new pair of sterile gloves.Place dressing towel as near as possible to TIVAD siteClean the skin covering the TIVAD with gauze soaked in Chlorhexidine Gluconate 2% in70% Isopropyl alcohol or Chlorhexidine Gluconate 2% in 70% Isopropyl alcoholimpregnated applicator. Allow to dry Remove needle cover from non-coring needle device. Insert the non-coring needle at 90-degree angle through the skin into the septum of the TIVAD until the needle comes intocontact with the metal backing.Needle free device must be cleaned prior to reattaching syringe – thoroughly clean thehub of the needle free system with 2% Chlorhexidine impregnated wipe or sterile gauzesoaked in 2% Chlorhexidine, rubbing the top of the needle free connector to the sides.This should be done 3 times over a period of 30 seconds. Allow to dry. Attach syringe with 0.9% Sodium Chloride, aspirate enough blood to colour the solutionand inject the flush using a push pause action clamping as the last ml of the solution isinstilled into the catheter. Remove the syringe and discard.If there is no flash back of blood or if there is swelling around the TIVAD site assess forcorrect needle placement, remove the needle and re-access.Following successful saline flush, repeat the flushing procedure using the Heparinisedsaline.If TIVAD was accessed for flushing purposes only, remove the needle and apply pressureover puncture site for a few minutes until bleeding stops.If the needle is to remain in situ ensure the needle is secured using steri-strips andappropriate highly permeable dressing.57The CINs group hereby assert their moral rights tothe works herein in accordance with the Data Protection Act 1988.Policy review date 01/10/10