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Intravenous (Iv) Medication and Fluid Therapy Administration Through a Central Venous Access Device (Cvad)

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Intravenous (Iv) Medication and Fluid Therapy Administration Through a Central Venous Access Device (Cvad) IV POLICY – INTRAVENOUS (IV) MEDICATION AND FLUID THERAPY ADMINISTRATION THROUGH A CENTRAL VENOUS ACCESS DEVICE (CVAD) POLICY Reference CPG-TW-CVAD Approving Body Drugs & Therapeutics/Medicines Optimisation Committee Date Approved 13th July 2018 Issue Date 21st September 2018 Version 1.0 Summary of Changes from Previous Not applicable Version Supersedes Not applicable Document Category Policy Consultation Undertaken Tracy Smith: Ward Leader Meeting 1:1 Welcome Treatment Centre 16/5/18 25/5/18 14/08/18 Email: 1/6/18 Meeting: 4/9/18 Meeting 11/9/18 Tom Bell: Divisional Lead Meeting 1:1 Pharmacist for Surgery Division and 5/8/18 Women & Children’s Division Email:16/8/18 Critical Care Lead Pharmacist Mandy Coggon: Clinical Educator Meeting 1:1 ICCU 10/5/18 Email:10/4/18 Emaill:1/6/18 Hazel Saddington: Nutritional Nurse Meeting 1:1 Specialist Email:10/4/18 Email:1/6/18 Helen Hume: Training and Email:1/6/18 Development Meeting 29/8/18 Meeting 11/9/18 Elwin Masih: Training and Meeting Development Email:10/4/18 Email: 1/6/18 Justin Wyatt: Ward Leader WD 43 Meeting Email:10/4/18 Email: 1/6/18 Christopher Smith: Emergency Meeting ODP Team Leader Email:10/4/18 Email:1/6/18 Rosie Dixon: Nurse consultant Email:10/4/18 infection Prevention and Control Email:1/6/18 Email : 7/9/18 Steve May: Chief Pharmacist. Email: 10/4/18 Email:1/6/18 Title: IV Policy - Intravenous (IV) Medication and Fluid Therapy Administration Through a Central Venous Access Device Version: 1.0 Issued: September 2018 Page 1 of 73 Carl Miller: Superintendent Email: 8/6/18 Radiographer Joanna Freeman: Highly specialist Email: 26/6/18 Pharmacist Nursing, Midwifery and Allied Meeting: 15/6/18 Health Professional Board Kelly Mitchell: Training and Email:10/4/18 Development Paediatric Governance Group Email Kerry Morris PDM Meeting Michael Yanney Consultant 28/08/2018 Paediatrician 2/8/18 & Bernadette Barlow Paediatric- 22/8/18 Respiratory Specialist Nurse 23/8/18 Andrea Rumsby (Deputy Sister) 22/8/18 TIVAD Robert Gullett-Smith (Deputy element only Charge Nurse) Carol Hind (Acting 23/8/18 Deputy Sister) Diane Parsons (Deputy Sister) 24/8/18 Verbal consultation/review Sarah Limb (Sister) 25/8/18 Meetings with corporate Matrons: 26/8/18 28/8/18. 2/5/18 (RH) 9/6/18 (RH) 23/6/18 (RH) 6/7/18 (RH) 28/8/18 (AD) Janice Mighten,(Children’s Email 30/8/18 Respiratory Nurse) Nottingham Children’s Hospital 7/9/2018 Final email sent for final comments Date of Completion of Equality Impact 18/8/2018 Assessment Date of Environmental Impact Not applicable Assessment (if applicable) Legal and/or Accreditation Not applicable Implications Target Audience Registered Nurses and Midwives, Operating Department Practitioners, Medical Staff , Allied Health Professionals Review Date July 2021 Sponsor (Position) Suzanne Banks, Chief Nurse Andy Haynes, Medical Director Author (Position & Name) Yvonne Christley (Head of Professional Practice Development) Rebecca Herring (Practice Development Matron) Alison Davidson (Practice Development Matron) Kerry Morris (Paediatric Practice Development Matron) Kate Rodgers (Neonatal Practice Development Matron) Title: IV Policy - Intravenous (IV) Medication and Fluid Therapy Administration Through a Central Venous Access Device Version: 1.0 Issued: September 2018 Page 2 of 73 Lead Division/ Directorate Corporate Lead Specialty/ Service/ Department Nursing/ Practice Development Team Position of Person able to provide Practice Development Team Further Guidance/Information Associated Documents/ Information Date Associated Documents were reviewed Not Applicable Not Applicable CONTENTS Item Title Page 1.0 INTRODUCTION 6 2.0 POLICY STATEMENT 7 3.0 DEFINITIONS/ ABBREVIATIONS 7-8 4.0 ROLES AND RESPONSIBILITIES 8-9 5.0 APPROVAL 9 6.0 DOCUMENT REQUIREMENTS 10-14 7.0 MONITORING COMPLIANCE AND EFFECTIVENESS 15 8.0 TRAINING AND IMPLEMENTATION 16 9.0 IMPACT ASSESSMENTS 16-18 10.0 EVIDENCE BASE (Relevant Legislation/ National Guidance) and 19-22 RELATED SFHFT DOCUMENTS APPENDICES AS LISTED BELOW Title: IV Policy - Intravenous (IV) Medication and Fluid Therapy Administration Through a Central Venous Access Device Version: 1.0 Issued: September 2018 Page 3 of 73 APPENDICIES 11.0 APPENDIX ONE: (ADULT PROCEDURAL GUIDANCE) 23-43 Central Venous Catheters (CVC). 11.0 Dressing change for a CVC 11.1 Changing needle free access devices for a CVC 11.2 Administration of intermittent/bolus Intravenous Medication via a CVC 11.3 Administration of Continuous Infusions via a CVC 11.4 Disconnecting an intravenous infusion from a CVC Adult Procedural Guidance for PICC Lines 11.5 Dressing Change for a PICC Line 11.6 Changing the Needle Free Access Device via a PICC line 11.7 Administration of intermittent/bolus Intravenous medication via a PICC Line 11.8 Administration of Continuous Infusions via PICC Line 11.9 Disconnecting an Intravenous Infusion from a PICC Line Adult Procedural Guidance for Hickman Lines (skin tunneled catheters) 11.10 Dressing Change for a Hickman Line 11.11 Changing the Needle Free access Device for a Hickman Line 11.12 Administration of intermittent/bolus Medication via a Hickman 11.13 Administration of Continuous Infusions via a Hickman Line 11.14 Disconnecting an Intravenous Infusion from a Hickman Line Adult Procedural Guidance for Port Access Device (Portacath) 11.15 Insertion of a Gripper Needle/non –coring needle 11.16 Changing the Needle Free Access Device for an Implanted Port 11.17Administration of intermittent/bolus Intravenous Medication for an Implanted Port 11.18 Administration of Continuous Infusions via an Implanted Port 11.19 Disconnecting an Intravenous Infusion from an Implanted Port 11.20 Removal of a Gripper Needle(non –coring) needle from an Implanted Port Adult Procedural Guidance for Midline Catheters (Midline) 11.21 Dressing Changes for a Midline catheter 11.22 Changing the Needle Free Access Device on a Midline 11.23 Administration of intermittent/bolus Intravenous medication via a Midline 11.24 Administration of Continuous Infusions via a Midline 11.25 Disconnecting an Intravenous Infusion from a Midline Title: IV Policy - Intravenous (IV) Medication and Fluid Therapy Administration Through a Central Venous Access Device Version: 1.0 Issued: September 2018 Page 4 of 73 12.0 APPENDIX TWO: (PAEDIATRICS PROCEDURAL GUIDANCE) 44-60 Paediatric Procedural Guidance for PICC (Lines also known as long lines) 12.0 Dressing Change for a PICC 12.1 Changing the Needle Free Access Device for a PICC 12.2 Administration of intermittent/bolus Intravenous Medication via a PICC 12.3 Administration of Continuous Infusions via a PICC 12.4 Disconnecting an Intravenous Infusion from a PICC Paediatric Procedural Guidance for a Hickman Line 12.5 Dressing Change for a Hickman Line 12.6 Changing the Needle Free Device for a Hickman Line 12.7 Administration of intermittent/bolus Intravenous Medication via a Hickman 12.8 Administration of Continuous Infusions via a Hickman Line 12.9 Disconnecting an Intravenous Infusion from a Hickman Line Paediatric Procedural Guidance for Port Access Device (Portacath) 12.10 Insertion of a Gripper Needle/ non-coring needle 12.11 Changing the Needle Free Access Device for an Implanted Port 12.12 Administration of intermittent/bolus Intravenous Medication for an Implanted Port 12.13 Administration of Continuous Infusions via an Implanted Port 12.14 Disconnecting an Intravenous Infusion for an Implanted Port 12.15 Removal of a Gripper Needle for an Implanted Port 13.0 APPENDIX THREE: (NEONATES PROCEDURAL GUIDANCE) 61-69 13.0 Care of a Baby with a Central Line (Umbilical Venous/ Umbilical Arterial Catheters / Long Lines) 13.1 General Care of Neonate with a Central Line 13.2 Dressing changes 13.3 Changing the Needle Free Access Device for umbilical Venous / Umbilical Arterial Catheters / Long Lines 13.4 Administration of intermittent/bolus Intravenous Medication for Umbilical Venous/ Umbilical Arterial Catheters / Long Lines 13.5 Administration of Continuous Infusion for Umbilical Venous/ Umbilical Arterial Catheters / Long Lines 13.6 Disconnecting an Intravenous Infusion For Umbilical Venous / Umbilical Arterial Catheters / Long Lines 14.0 APPENDIX FOUR : 70-71 Risks associated with CVADs 15.0 APPENDIX FIVE : 72 Types/Common Insertion sites/ Use and longevity of Central venous Access devices 16.0 APPENDIX SIX : 73 Quick guide to heparin flushes Parenteral Access Devices 17.0 APPENDIX SEVEN : Hyperlinked to intranet Central Venous Access Device Monitoring Record Title: IV Policy - Intravenous (IV) Medication and Fluid Therapy Administration Through a Central Venous Access Device Version: 1.0 Issued: September 2018 Page 5 of 73 1.0 INTRODUCTION This policy refers to the administration of intravenous medication and fluid therapy (including dressing changes) via a Central Venous Access Device (CVAD) The Trust uses a number of Central Venous Access Devices (CVAD) to provide either therapeutic (administration of medications, fluids and/or blood products) or diagnostic (blood sampling, central venous pressure [CVP] reading) purposes. CVADs are increasingly used within acute and community settings to deliver substances into large central veins and in direct continuity with the right atrium. Insertion is commonly sited to deliver substances into the superior vena cava (SVC) or less frequently, the inferior vena cava (IVC) or the right atrium. The internal tip of the catheter lies within a large central vein. There are various different types of CVAD but common to all is the concept that the tip of the catheter should float freely within the bloodstream in a large vein and parallel to the vein wall. Blood flow around the catheter is maximised, and physical and chemical damage to the internal walls of the vein are minimised as a result (Royal Marsden Manual of Clinical Procedures, 2015) CVADs are used mainly for: Fluid resuscitation where high volumes of fluids are infused. (Large volumes of blood products however, should be given through a blood warming device to prevent cardiac arrhythmias and hypothermia) Short term administration of intravenous medications when peripheral access is not obtainable or appropriate e.g.
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