Infusion Therapy – Groshong Catheter Maintenance SECTION: 25.18 Strength of Evidence Level: 3 __RN__LPN/LVN__HHA

PURPOSE: PROCEDURE: To maintain a patent line for continuous or intermittent 1. Adhere to Standard Precautions. drug, fluid infusion or blood withdrawal. 2. Explain procedure and purpose to patient/caregiver. 3. Assemble equipment on a clean surface close to the CONSIDERATIONS: patient. 1. The Groshong catheter has a patented, three- 4. Place patient in comfortable position making sure position, pressure-sensitive valve that does not that site is accessible. require the use of heparin or clamping. 5. Ensure adequate lighting. 2. Clamping may damage the catheter. 6. Clean top of normal saline vial with alcohol 3. Never use acetone or acetone-based products on or applicator, using friction. Allow to air dry. Withdraw around catheter. Acetone erodes silicone or silastic 5-20 mL of normal saline. tubing. 7. Clean injection port with alcohol applicator, using 4. Keep all sharp objects (e.g., pins, scissors) away friction. Allow to air dry. from the catheter. 8. Flush catheter using normal saline (Heparin if 5. If leaking or breaking of the catheter occurs, cover indicated) per physician’s orders. the broken part with a sterile gauze pad. DO NOT 9. Loop the catheter and secure with tape. clamp. (See Infusion Therapy- Central Venous 10. Discard soiled supplies in appropriate containers. Catheter: Temporary Repair of Breakage.) 6. Always flush catheter with 20 mL normal saline after AFTER CARE: blood withdrawal. 1. Document in patient's record: 7. If blood is noted in catheter, flush with 20 mL normal a. Date, time, procedure and observations. saline. b. Appearance of central venous access site. 8. If unable to flush the catheter, call physician for c. Amount of normal saline flush. further orders. d. Patient's response to procedure. 9. Heavy straining or lifting may cause back flow of e. Instructions given to patient/caregiver. blood into the catheter. FLUSHING AND CHANGING INJECTION PORT OF 10. Heparin may be used as a flush in Groshong GROSHONG CATHETER catheter per physicians' orders. It will not hurt the The injection port must be changed at least every 7 days catheter. when not in use, twice a week when in use and PRN 11. Per Joint Commission recommendations, all tubes when they become loose or leakage is noted. Following and catheters should be labeled to prevent the a blood draw, the injection port must be changed. possibility of tubing misconnections. Staff should emphasize to all patients the importance of EQUIPMENT: contacting a clinical staff member for assistance when there is an identified need to disconnect or Gloves reconnect devices. Alcohol applicator (wipe/swab/disk/ampule) FLUSHING GROSHONG CATHETER WITHOUT 10-20 mL syringe with needle or needle less adaptor CHANGING INJECTION PORT Normal saline The Groshong catheter requires flushing with 5-10 mL normal saline every 7 days. Flush with 20 mL of normal Tape saline after infusion of blood, when blood is observed in Puncture-proof container the catheter, and after drawing a blood sample. If Impervious trash bag withdrawing blood after infusion of TPN, flush the catheter with 20 mL of normal saline before obtaining PROCEDURE: blood sample. 1. Adhere to Standard Precautions. 2. Explain procedure and purpose to patient/caregiver. EQUIPMENT: 3. Assemble equipment on a clean surface close to the Gloves patient. Alcohol applicator (wipe/swab/disk/ampule) 4. Place patient in comfortable position making sure that site is accessible. 10-20 mL syringe with needle or needle less adaptor 5. Ensure adequate lighting. Normal saline 6. Prepare syringe with normal saline. Remove air Tape from syringe. 7. Open protective package of injection port. Puncture-proof container 8. Insert needle or needle less adaptor straight into Impervious trash bag center of new injection port. 9. Slowly inject flush to fill dead space of injection port and then remove needle or needle less adaptor. Infusion Therapy – Groshong Catheter Maintenance SECTION: 25.18 Strength of Evidence Level: 3 __RN__LPN/LVN__HHA

10. Clean old intermittent injection port and catheter at 7. Open protective package of injection port and pre-fill junction with alcohol applicator, using friction. Allow dead space with normal saline. (See Flushing and to air dry. Changing Injection Port of Groshong Catheter) 11. Wrap new alcohol wipe around connection and hold 8. Clean old intermittent injection port and catheter at in place until you disconnect the injection port. junction with applicator, using friction. Allow to air 12. Ask patient to hold breath or wait until patient is dry. exhaling before removing old injection port. 9. Wrap new alcohol wipe around connection and hold 13. Remove old intermittent injection port. in place until you disconnect the injection port. 14. Remove protective cover from new intermittent 10. Disconnect injection port from catheter. Attach 10 injection port. mL normal saline filled syringe and flush line (if TPN 15. Attach new pre-filled intermittent injection port, infusing use 20 mL of normal saline). Using same twisting firmly to secure. connected syringe pull back 5 mL of blood for 16. With new injection port in place, flush catheter discard. briskly with 5 mL normal saline. 11. Discard blood-filled syringe in puncture-proof 17. Before syringe is completely empty apply pressure container. on plunger while removing the needle or syringe 12. Attach new 20 mL syringe directly to catheter and from the injection port (positive pressure). withdraw appropriate amount of blood for 18. Tape connection (optional). specimens. 19. Loop the catheter and secure. 13. Disconnect blood sample syringe from catheter. 20. Discard soiled supplies in appropriate containers. Attach needle no larger than 20-gauge to blood sample syringe. Attach 20 mL normal saline-filled AFTER CARE: syringe directly to catheter and flush catheter 1. Document in patient's record: briskly. Attach new pre-filled injection port. a. Date, time, procedure and observations. 14. Fill blood specimen tubes. b. Appearance of central venous access site. 15. Loop the catheter and secure. c. Amount of normal saline flush. 16. Discard soiled supplies in appropriate containers. d. Patient's response to procedure. DRESSING CHANGE e. Instructions given to patient/caregiver. (See infusion Therapy- Central Venous Catheter: BLOOD WITHDRAWAL FROM GROSHONG Gauze Dressing Change or Central Venous Catheter: CATHETER Transparent Permeable Adhesive Dressing.) MEDICATION ADMINISTRATION EQUIPMENT: Medication can be administered via the Groshong Gloves catheter either continuously or intermittently. (Review Alcohol applicator (wipe/swab/disk/ampule) Administration of Intravenous Therapy in the Home.) If a pump is used, refer to manufacturer's guidelines for 20 mL syringe for lab sample and flush (2) specific instructions. 10 mL syringe for discard Flush the Groshong catheter with 5-10 mL normal saline Appropriate lab tubes prior to medication administration, between medications if more than one is administered and at the end of the 20-gauge needle, 1-inch (2) administration. Normal saline Injection port AFTER CARE: Tape 1. Document in patient's record: Puncture-proof container a. Date, time, procedure and observations. b. Appearance of central venous access site. Impervious trash bag c. Blood samples drawn, identity and location of laboratory where specimens taken. PROCEDURE: d. Amount of normal saline flush. 1. Adhere to Standard Precautions. e. Patient's response to procedure. 2. Explain procedure and purpose to patient/caregiver. f. Instructions given to patient/caregiver. 3. Assemble equipment on a clean surface close to the patient. REFERENCE: 4. Place patient in comfortable position making sure Centers for Disease Control and Prevention (CDC), that site is accessible. Guidelines for the Prevention of Intravascular Catheter- 5. Ensure adequate lighting. Related Infections. 6. Prepare two syringes, one with 10 mL normal saline and one with 20 mL normal saline.