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Vascular Access Device (VAD) Management

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Vascular Access Device (VAD) Management Vascular Access Device (VAD) Management Page 1 of 21 Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure, and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient's care. TABLE OF CONTENTS Definitions………………………………....…………………………....………………………………………….. Page 3 CVAD Post-Insertion Dressing Care………….………………………………………………………………….. Page 4 VAD Maintenance Care………….………………………………………………………………………………... Pages 5-8 Dressing Care …………………………………………………………………………………………………. Page 5 Flush Management …………………………………………………………………………………………. Page 6 Needleless Connector Management………………………………………………………………………….. Page 7 Tubing Management………………....…………….……………………………...………………………….. Page 8 Implanted Venous Ports: Access and Management……….…………………………………………………….. Page 9 VAD Complications………………………………………………………………………….…………………….. Pages 10-13 Skin Impairment…….………………………………………………………………………………………… Page 10 Site Complication/Infection…………………………………………………………………………………… Page 11 Phlebitis …………………………....…………….……………………………...……………………………... Page 12 CVAD Device-Related …………………………....…………….……………………………...……………… Page 13 CVAD = central venous access device PICC = peripherally inserted central catheter CICC = centrally inserted central catheter Department of Clinical Effectiveness V4 Approved by The Executive Committee of the Medical Staff on 04/30/2019 Vascular Access Device (VAD) Management Page 2 of 21 Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure, and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient's care. TABLE OF CONTENTS - continued APPENDIX A: CLABSI Bundle……………….....…………………………………………….………................ Page 14 APPENDIX B: Flush Panel .……………………………………………………………………………………… Page 15 APPENDIX C: Venous Access Procedure Orders……………………………………………………………….. Page 15 APPENDIX D: Pediatric Routine Catheter Flush……………………………………………………………….. Page 16 APPENDIX E: Skin Prep Allergy Recommendations..………………………………………………………….. Page 16 APPENDIX F: Alternative Adhesive Dressing Recommendations……………………………………………... Page 17 APPENDIX G: Infusion Nurses Society Phlebitis Scale ..…………………………………………….………..... Page 18 Suggested Readings …………...……………………………………………………………...…………………..... Pages 19-20 Development Credits ……………...………………………………………………………………...……………… Page 21 CLABSI = central line-associated blood stream infection Department of Clinical Effectiveness V4 Approved by The Executive Committee of the Medical Staff on 04/30/2019 Vascular Access Device (VAD) Management Page 3 of 21 Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure, and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient's care. DEFINITIONS Acute Care Procedure Team: A team comprised of specialized Advanced Practice Providers (APP) that are trained in placement, management, and removal of central venous access devices. Apheresis catheter: A large bore CVAD that is typically greater than 10 French or more in size that is used for apheresis procedures as well as other infusions as indicated. Central Venous Access Device (CVAD): Includes peripherally inserted central catheter (PICC) and all centrally inserted catheters including non-tunneled, tunneled, or implanted catheter with the catheter tip ending in the vena cava, such as a subclavian, femoral, and internal jugular. Centrally Inserted Central Catheter (CICC) [also known as central venous catheter (CVC)]: Includes tunneled or non-tunneled central venous catheters. Infusion Therapy Team (ITT): A team comprised of registered nurses who are skilled and educated in the management and care of central and peripheral venous access devices. Implanted venous port: A surgically placed central venous catheter that is attached to a reservoir located under the skin. Non-Tunneled Centrally Inserted Catheter (Non-Tunneled CICC): A catheter inserted by direct venous puncture through the skin in the subclavian, jugular or femoral areas without tunneling. Peripherally Inserted Central Catheter (PICC): A central venous catheter inserted into an upper extremity vein that is threaded within the superior vena cava. Tunneled Centrally Inserted Catheter (Tunneled CICC): A catheter that is tunneled under the skin before entering the venous system which can either be cuffed or non-cuffed. Cuffed indicates that the catheter has a small cuff promoting tissue growth for catheter adherence. Vascular Access Device (VAD): Any device utilized for venous access regardless of location. These include peripheral intravenous catheter (PIV), peripherally inserted central catheter (PICC), centrally inserted central catheter (CICC), and implanted venous port. Vascular Access Team (VAT): A team that is comprised of the Acute Care Procedure Team and the Infusion Therapy Team engaged in the planning and management of patients requiring vascular access. Department of Clinical Effectiveness V4 Approved by The Executive Committee of the Medical Staff on 04/30/2019 Vascular Access Device (VAD) Management Page 4 of 21 Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure, and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient's care. CVAD POST INSERTION DRESSING CARE1 MANAGEMENT 2 Yes Dressing change should occur 7 days post insertion or if clinically indicated Is a sterile Post-CICC/ transparent dressing PICC with CHG impregnated insertion disc used? 3,4 No To ensure gauze dressing is removed , initiate dressing change within 2 days post-insertion or as clinically indicated1 For post-procedure Apply sterile transparent Dressing and needle must be changed after 7 days or patient education, dressing with CHG if clinically indicated2,5 refer to patient Yes 6 impregnated disc education materials Post-implanted Is port accessed venous with needle in port insertion place? Steri-Strips™ or surgical glue should not physically Yes be removed during the first two weeks post-surgery No Is site open to air? If a sterile transparent or non-transparent dressing is No present, remove after 2 days and leave open to air 1 See Appendix A for Central Line-Associated Blood Stream Infection (CLABSI) Bundles 2 Immediate dressing change is required when dressing is soiled, damp, reinforced, or no longer intact. Refer to CVAD Maintenance Dressing Change on Page 5. 3 Best practice indicates that gauze should only be used when clinically appropriate; sterile transparent dressing with CHG impregnated disc is recommended post-insertion 4 If unable to determine if gauze is present, initiate CVAD Dressing Care: Maintenance Dressing Change within 2 days post-insertion or as clinically indicated 5 Needle change is only required if port has been accessed greater than 7 days 6 Central Line (CVC/PICC) Patient Checklist (https://www.mdanderson.org/patient-education/Infusion-Therapy/Central-Line-(CVC-PICC)-Patient-Checklist-Infusion-Therapy_docx_pe.pdf) Department of Clinical Effectiveness V4 Approved by The Executive Committee of the Medical Staff on 04/30/2019 Vascular Access Device (VAD) Management Page 5 of 21 Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure, and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient's care. VAD MAINTENANCE CARE: DRESSING CARE1 DRESSING TYPE AT PRESENTATION MANAGEMENT Transparent chlorhexidine gluconate (CHG) impregnated dressing or transparent dressing with CHG impregnated disc2 4 5 ● Change dressing using institutional standard dressing change process at least every 7 days or as clinically indicated ● If skin or site related complications are noted, refer to Pages 10-11 for management Note: Non-transparent dressing with ● For patients with CHG allergy, follow CHG allergy standard of care dressing deviation protocol: CHG impregnated disc3 Patient presents ○ First line: alternative bordered transparent dressing with equivalent skin prep; change every 7 days or as clinically for dressing indicated change ○ Second line: non-transparent dressing with equivalent skin prep; change every 2 days or as clinically indicated Transparent dressing without CHG impregnated disc Gauze dressing (i.e., any non-transparent 5 4 ● Change dressing using institutional standard dressing
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