Transcript Multidisciplinary Care in Regional Victoria

Management of
Central Venous Access Devices
1. INTRODUCTION
Nurse Education Workforce Strategy – Gippsland Region
Gippsland Oncology Nurses Group (GONG)
TUTORIAL
INTRODUCTION
Acknowledgements
CVAD Tutorials
This Tutorial
CVAD Description
CVAD Types
CVAD Choice
CVAD Indications
Key Principles of Care (1)
Key Principles of Care (2)
References (1-4)
GONG Products
Management of Central Venous Access Devices
Acknowledgements
This project is an initiative of :
Nurse Education Workforce Strategy –Gippsland
Content supplied by:
Gippsland Oncology Nurses Group (GONG)- an initiative of
Gippsland Region Integrated Cancer Services (GRICS)
Special thanks:
Anny Byrne (Gippsland Regional Integrated Cancer Services)
Anne Maree Day (West Gippsland HealthCare Group)
Dianne Fahy (Nurse Education Workforce Strategy)
Anne Johnson (Latrobe Regional Hospital)
Linda Langskaill (Central Gippsland Health Service)
Melanie Regan (Gippsland Regional Integrated Cancer Services)
See other sources and references at the end of this presentation.
Further reading is encouraged to complement these tutorials.
CVAD TUTORIAL SERIES
1. INTRODUCTION
2. HICKMAN CATHETER
3. PORT
4. PICC
TUTORIAL
INTRODUCTION
Acknowledgements
CVAD Tutorials
This Tutorial
CVAD Description
CVAD Types
CVAD Choice
CVAD Indications
Key Principles of Care (1)
Key Principles of Care (2)
References (1-4)
GONG Products
CVAD TUTORIAL SERIES
1. INTRODUCTION
2. HICKMAN CATHETER
3. PORT
4. PICC
Management of Central Venous Access Devices
CVAD Tutorials
1.
Introduction to
Central Venous
Access Devices
2.
Hickman Catheters
3.
Implantable Ports
4.
PICCs
TUTORIAL
INTRODUCTION
Acknowledgements
CVAD Tutorials
This Tutorial
CVAD Description
CVAD Types
CVAD Choice
CVAD Indications
Key Principles of Care (1)
Key Principles of Care (2)
References (1-4)
GONG Products
CVAD TUTORIAL SERIES
1. INTRODUCTION
2. HICKMAN CATHETER
3. PORT
4. PICC
Management of Central Venous Access Devices
Scope of this tutorial
•
•
•
•
•
•
•
•
What is a Central Venous Access Device (CVAD)?
Name three different types of CVADs
Name 5 indications for CVADs
What is a clean technique?
When is it used?
What is a sterile technique?
When is it used?
What is a pulsatile flushing technique and why is it
used?
TUTORIAL
INTRODUCTION
Acknowledgements
CVAD Tutorials
This Tutorial
CVAD Description
CVAD Types
CVAD Choice
CVAD Indications
Key Principles of Care (1)
Key Principles of Care (2)
References (1-4)
GONG Products
CVAD TUTORIAL SERIES
1. INTRODUCTION
2. HICKMAN CATHETER
3. PORT
4. PICC
Management of Central Venous Access Devices
Central Venous Access Devices
•
In Central Venous Access
Devices (CVADs), the tip of
the catheter resides in a
central vessel in the chest
that immediately connects
with the right atrium. This
is usually the Superior Vena
Cava (SVC)
•
Examples are Hickman
Catheters, Central Venous
Catheters, Implantable
PORTS and Peripherally
Inserted Central Catheters
(PICCs)
TUTORIAL
INTRODUCTION
Acknowledgements
CVAD Tutorials
This Tutorial
CVAD Description
CVAD Types
CVAD Choice
CVAD Indications
Key Principles of Care (1)
Key Principles of Care (2)
References (1-4)
GONG Products
CVAD TUTORIAL SERIES
1. INTRODUCTION
2. HICKMAN CATHETER
3. PORT
4. PICC
Management of Central Venous Access Devices
Types of CVADs
CVADs can be for short term (approximately 10 days to
6 weeks), intermediate term (2 weeks to 6 months) or
long term (6 weeks to years) therapy.
– Central Venous Catheter - for short term therapy, often
used in the ICU setting
– Hickman Catheter - for intermediate and long term
therapies. Often used in the haematology setting
– Implantable Ports - for long term therapies. Most often
used in the chemotherapy setting
– PICC - for intermediate and long term therapies, IV
antibiotics, continuous chemotherapy
TUTORIAL
INTRODUCTION
Acknowledgements
CVAD Tutorials
This Tutorial
CVAD Description
CVAD Types
CVAD Choice
CVAD Indications
Key Principles of Care (1)
Key Principles of Care (2)
References (1-4)
GONG Products
CVAD TUTORIAL SERIES
1. INTRODUCTION
2. HICKMAN CATHETER
3. PORT
4. PICC
Management of Central Venous Access Devices
Choice of Venous Access Device
Consider the following:
•
Length of treatment
•
Type of treatment
•
Frequency of treatment
•
Geographic location of the patient
•
Age of patient
•
Anatomical factors
•
Social setting i.e. impact on body
image, workforce issues
Hickman Catheter
TUTORIAL
INTRODUCTION
Acknowledgements
CVAD Tutorials
This Tutorial
CVAD Description
CVAD Types
CVAD Choice
CVAD Indications
Key Principles of Care (1)
Key Principles of Care (2)
References (1-4)
GONG Products
CVAD TUTORIAL SERIES
1. INTRODUCTION
2. HICKMAN CATHETER
3. PORT
4. PICC
Management of Central Venous Access Devices
Indications for CVADs
•
Difficult venous access
•
Multiple infusions eg long term chemotherapy, antibiotics
•
Continuous infusions of chemotherapy via a Continuous
Ambulatory Delivery Device (CADD) pump
•
Infusions of vesicant drugs, that may cause damage and/or
pain if infused peripherally
•
Bone marrow / stem cell transplants
•
ICU setting
•
Total Parenteral Nutrition infusion
TUTORIAL
INTRODUCTION
Acknowledgements
CVAD Tutorials
This Tutorial
CVAD Description
CVAD Types
CVAD Choice
CVAD Indications
Key Principles of Care (1)
Key Principles of Care (2)
References (1-4)
GONG Products
Management of Central Venous Access Devices
Key Principles of Care (1)
1.
2.
3.
4.
CVAD TUTORIAL SERIES
1. INTRODUCTION
2. HICKMAN CATHETER
3. PORT
4. PICC
Confirmation of placement – Always confirm placement
before commencing treatment and ensure there is a written
x-ray report confirming the placement of the device
Access - Always ensure a blood return before infusing any
fluids or drugs
Syringe size – Only use syringes 10 mls or larger, smaller
syringes increase the pressure in the catheter wall and
increase the risk of rupture of the catheter
Pulsatile flushing - always use a pulsatile (stop/start)
flushing technique, to create turbulence in the lumen of the
catheter, remove debris and avoid blockage of the catheter
TUTORIAL
INTRODUCTION
Acknowledgements
CVAD Tutorials
This Tutorial
CVAD Description
CVAD Types
CVAD Choice
CVAD Indications
Key Principles of Care (1)
Key Principles of Care (2)
References (1-4)
GONG Products
CVAD TUTORIAL SERIES
1. INTRODUCTION
2. HICKMAN CATHETER
3. PORT
4. PICC
Management of Central Venous Access Devices
Key Principles of Care (2)
5.
Aseptic technique – sterile tray and sterile gloves
for accessing an open system (when cap/bung is
removed)
6.
Clean technique - Wash hands, clean gloves and
clean bung with 3 alcohol swabs. Allow bung to air
dry before proceeding to access a closed system
(when cap/bung is in situ)
7.
Heparin Lock (Heparinization) – weak versus
strong
–
Strong Heparin Lock (1000u/s in 9ml Normal Saline give 5ml )
–
Weak Heparin Lock (50u/s in 5ml)
TUTORIAL
INTRODUCTION
Acknowledgements
CVAD Tutorials
This Tutorial
CVAD Description
CVAD Types
CVAD Choice
CVAD Indications
Key Principles of Care (1)
Key Principles of Care (2)
References (1-4)
GONG Products
CVAD TUTORIAL SERIES
1. INTRODUCTION
2. HICKMAN CATHETER
3. PORT
4. PICC
Management of Central Venous Access Devices
References (1/4)
More References
1. Arrow International. (2000). Peripherally Inserted
Central Catheters. Continuing Education Program.
Arrow, Reading, PA, USA.
2. Brown, J.D., Moss, H.A. & Elliott, T.S.J. (1997). The
potential for catheter microbial contamination from a
needleless connector. Journal of Hospital Infection. 36,
181-189.
3. Cancer Nursing website. (2005).
http://www.cancernursing.org
4. Dougherty, L. (2000). Central Venous Access devices.
Nursing Standard. 14(43):45-55.
5. Farley, K. (1998). Peripherally Inserted Central
Catheters: Patient selection, insertion and
maintenance. Johnson & Johnson Medical, USA.
6. Hadaway, L. Catheter related infections. Nursing 2002.
32(9), 46-48
TUTORIAL
INTRODUCTION
Acknowledgements
CVAD Tutorials
This Tutorial
CVAD Description
CVAD Types
CVAD Choice
CVAD Indications
Key Principles of Care (1)
Key Principles of Care (2)
References (1-4)
GONG Products
Management of Central Venous Access Devices
References (2/4)
More References
7.
ICU Medical. (2003). Extended Use Microbial Challenge and
Disinfection Study of the CLC2000. ICU Medical.
http://www.icumed.com/CLC2000.asp
8.
Intravenous Nurses Society. (2005). Infusion nursing
standards of practice. Journal of intravenous nursing.
23(6S).
9.
Catheter Care. Best Practice Statement.
www.joannabriggs.edu.au
10. Latrobe Regional Hospital. (2004). Central Venous CatheterPICC Management Policy & protocol. Latrobe Regional
Hospital-Policies and Protocols, pp.1-4.
CVAD TUTORIAL SERIES
1. INTRODUCTION
2. HICKMAN CATHETER
3. PORT
4. PICC
11. Lenhart, C. (2001). Preventing central venous access device
occlusions with saline only flush by use of an adapter.
Journal of Vascular Access Devices. Summer 2001.
12. Luptak, P. (2000). Prevention of PICC and midline occlusions
with the CLC2000. Abbott Laboratories.
TUTORIAL
INTRODUCTION
Acknowledgements
CVAD Tutorials
This Tutorial
CVAD Description
CVAD Types
CVAD Choice
CVAD Indications
Key Principles of Care (1)
Key Principles of Care (2)
References (1-4)
GONG Products
Management of Central Venous Access Devices
References (3/4)
More References
13. Masoorli, S. & Angeles, T. (2002). Getting a line on central
venous access devices. Nursing 2002. 32(4), 36-43.
14. NSW Cancer Institute. (2005).
http://www.cancerinstitute.org.au
15. Oncology Nursing Society. (1997). Access device guidelines:
Recommendations for nursing practice and education. Pp. 27, 40-46. Pittsburgh, PA, USA.
16. O’Grady, N., Alexander, M., Patchen-Dellinger, E.,
Gerberding, J., O’Heard, S., Maki, D., Masur, H., McCormick,
R., Mermel, L., Pearson, M., Raad, I., Randolph, A. &
Weinstein, R. (2002). Guidelines for the Prevention of
Intravascular catheter Related Infections. Infection Control
and Hospital Epidemiology. 23(12):759-769.
CVAD TUTORIAL SERIES
1. INTRODUCTION
2. HICKMAN CATHETER
3. PORT
4. PICC
TUTORIAL
INTRODUCTION
Acknowledgements
CVAD Tutorials
This Tutorial
CVAD Description
CVAD Types
CVAD Choice
CVAD Indications
Key Principles of Care (1)
Key Principles of Care (2)
References (1-4)
GONG Products
Management of Central Venous Access Devices
References (4/4)
End References
17. Pearson, M., The hospital Infection Control Practices
Advisory Committee. (1995). Guidelines for prevention of
intravascular device-related infections. National Center for
Infectious Diseases Centers for Disease Control and
Prevention. 17:438-473.
18. Peter MacCallum Cancer Centre. (2005). Principles of care of
central venous access devices. Peter MacCallum Cancer
Centre Policies and Procedures 31.1, pp. 1-4.
19. Pratt, R., Pellowe, C., Harper, P., Loveday, H & Robinson, N.
(2001). Preventing infections associated with central venous
catheters. Nursing Times. 97(15):38-39.
CVAD TUTORIAL SERIES
1. INTRODUCTION
2. HICKMAN CATHETER
3. PORT
4. PICC
20. Rummel, M., Donnelly, P. & Fortenbaugh, C. (2001). Clinical
evaluation of a positive pressure device to prevent central
venous catheter occlusion: results of a pilot study. Clinical
Journal of Oncology Nursing. 5(6);261-265.
21. Welker, D. (2004). Troubleshooting Vascular Access
Devices. Smiths Medical MD. Michigan, USA.
TUTORIAL
INTRODUCTION
Acknowledgements
CVAD Tutorials
This Tutorial
CVAD Description
CVAD Types
CVAD Choice
CVAD Indications
Key Principles of Care (1)
Key Principles of Care (2)
References (1-4)
GONG Products
CVAD TUTORIAL SERIES
1. INTRODUCTION
2. HICKMAN CATHETER
3. PORT
4. PICC
Management of Central Venous Access Devices
GONG Products
www.gha.net.au/grics