Policy No: OP41 Version: 3.0 Name of Policy: Central Venous Access Device Policy (Central Line Policy) Effective From: 24/10/2013 Date Ratified 26/09/2013 Ratified Infection, Prevention and Control Committee Review Date 01/09/2015 Sponsor Director of Nursing, Midwifery and Quality Expiry Date 25/09/2016 Withdrawn Date This policy supersedes all previous issues. Version Control Version Release Author/Reviewer Ratified Date Changes by/Authorised (Please identify page no.) by 1.0 01/12/2006 L Swanson Trust Policy 01/12/2006 Forum 2.0 29/10/2009 J Thompson IPCN Infection, 31/07/2009 Prevention and Control Committee 3.0 24/10/2013 C Griffiths IPCN Infection, 26/09/2013 Prevention and Control Committee Central Venous Access Device Policy v3 2 Contents Section Page 1. Introduction ...................................................................................................................... 4 2. Policy scope ....................................................................................................................... 4 3. Aim of policy ..................................................................................................................... 4 4. Duties (Roles and responsibilities) ................................................................................... 4 5. Definitions ......................................................................................................................... 5 6. Central Venous Access Device Policy (Central Line Policy) ............................................... 6 6.1 Principles of Care ................................................................................................... 6 6.2 Setting .................................................................................................................... 6 6.3 Infection Prevention .............................................................................................. 6 6.4 Use of Ultrasound Guidance ................................................................................. 6 6.5 Choice of line ......................................................................................................... 7 6.6 Total Parenteral Nutrition ..................................................................................... 7 6.7 Critically ILL Patients ............................................................................................. 7 6.8 Poor Access ............................................................................................................ 7 6.9 Bionectors .............................................................................................................. 8 6.10 Lumens not in use ................................................................................................. 8 6.11 Flushing .................................................................................................................. 8 6.12 Documentation ..................................................................................................... 8 6.13 Types of CVADs ...................................................................................................... 8 6.14 Care of the insertion site ....................................................................................... 9 7. Training ............................................................................................................................. 9 8. Equality and diversity ........................................................................................................ 10 9. Monitoring compliance with the policy ............................................................................ 10 10. Consultation and review .................................................................................................. 11 11. Implementation of policy (including raising awareness) .................................................. 11 12. References......................................................................................................................... 11 13. Associated documentation (policies) ................................................................................ 11 Appendices Appendix 1 Types of Vascular Access Devices ............................................................................. 12 Appendix 2 The main veins used for Central Venous Access Device placement ........................ 13 Appendix 3 Procedure for Administering Medication via a CVC ................................................ 14 Appendix 4 Procedure for using a double lumen Haemofiltration Catheter .............................. 16 Appendix 5 Guidelines for Nursing staff on the Care and Management of Tunnelled Devices ... 17 Appendix 6 Guidelines for Nursing staff on the care and management of Hickman lines ........... 22 Appendix 7 Care Standard 25A Care of the patient with a Non Tunnelled ................................. 26 Central Venous Access Device Appendix 8 Care Standard 25B Care of the patient with a Tunnelled Central ............................ 27 Venous Access Device Appendix 9 Competency Based Assessment Document for a Registered ................................... 28 Practitioner to access Central Venous Access Devices Central Venous Access Device Policy v3 3 Central Venous Access Device Policy (Central Line Policy) 1 Introduction Central venous catheters (CVC) are inserted for many reasons including haemodynamic monitoring, intravenous delivery of blood products and drugs, haemodialysis, total parenteral nutrition, cardiac pacemaker placement and management of perioperative fluids. NICE have provided guidance on the methods used for placement of CVC. Their subsequent management has been mentioned in government documents such as Winning Ways and Saving Lives and is also been the subject of a review by EPIC. High impact Intervention No 1 – Central Venous Catheter Care bundle found at website ‐ http://www.clean‐safe‐care.nhs.uk/index.php?pid=4 should also be use as part of normal practice for any area using and caring for central lines. CVC’s are sited in a number of clinical areas within the Trust by clinicians from various specialties. This policy aims to aid all professionals in applying best practice within the setting of Gateshead Health NHS Foundation Trust. This policy has been compiled by a multidisciplinary group in consultation with the Clinical Directors of each Division. Paediatric practice is beyond the scope of this policy. Please refer to Consultant Paediatrician at RVI. 2 Policy scope This policy applies to all clinical staff employed in the trust. Clinical staff must comply with the relevant local policy and guidelines and must be used in conjunction with: IC 4 Hand Hygiene Policy IC 2 Personal Protection Clothing in Clinical Practice Policy IC 9 Waste Disposal and Recycling Policy OP 41 Central Venous Policy 3 Aim of policy This policy aims to aid all professionals in applying best practice for care of Central Access Devices within the setting of Gateshead Health Foundation Trust 4 Duties (Roles and responsibilities) The Chief Executive has responsibility for ensuring the Trust has robust and effective Infection and Prevention Control Policies. Central Venous Access Device Policy v3 4 Trust Board has a responsibility to ensure that the risk of infection to patients, staff and visitors is minimised to its lowest potential and therefore supports the full implementation of this policy. The Directors of Infection Prevention and Control have executive responsibility for Infection Prevention Control and oversee Infection and Prevention Control activity via the Infection and Prevention Control Committee. Consultant Microbiologist ‐ will give advice against this policy and follow up all positive blood cultures with clinical staff. Head of Infection Prevention and Control ‐ will give advice against this policy and Ensure that all staff have access to this policy via the Trust Intranet and ensure that it is updated every two years or in line with current national guidance. The Infection and Prevention Control Team – will give advice and support on management and policy interpretation. The Infection Prevention and Control Committee ‐ is responsible for the ratification of Trust wide infection prevention and control policies, procedures, and guidance, providing advice ad support on the implementation of policies and monitoring the progress of the annual infection control programme. Heads of Department ‐ Must ensure that appropriate training is available and that staff understand and comply with the Central Venous Access Device policy. Managers – will ensure that all staff are aware of and follow this policy and are aware of their own roles and responsibilities to ensure safe practice. All Trust staff ‐ have a responsibility to adhere to Trust policy and ensure that appropriate measures are taken to reduce risks associated with infection. All Trust staff have a responsibility to ensure they attend Central Line training, annual training in infection Prevention and Control and attend Central Line training updates thereafter. 5 Definitions Central Venous Catheter (CVC)/Central line – termed CVAD (Central venous Access Devices). Device is used instead of “line”. ART team – Acute Response Team IPCN – Infection Prevention and Control Nurse TPN – Total Parenteral Nutrition Central Venous Access Device Policy v3 5 6 Central Venous Access Device Policy (Central Line Policy) 6.1 Principles of care Regardless of the type of CVAD used, the principles of care for the device remain