Accessing (Needle Insertion ) a Totally Implanted Venous Access Device (Portacath) in Children and Young People Procedure

Transcription

1 Accessing (Needle Insertion ) a Totally Implanted Venous Access Device (Portacath) in Children and Young People Procedure Children s Services Final March Introduction / Scope To provide a step-by-step procedure for accessing (Needle Insertion ) a Totally Implanted Venous Access Device (Portacath) with the aim to provide safe and effective care and prevent micro-organism contamination of the implanted device and line. This procedure applies to all Health Professionals who administer care to children and young people with Central Lines at UHL. 2. The main body of the Guideline / Procedure This procedure should be used in conjunction with the UHL consent policy to ensure the child receives safe care and children and families are able to understand the reasons for care to facilitate co-operation and the UHL Intravenous Medication Policy and UHL Venous Access Policy Locking Central Lines using Heparinised Sodium Chloride 2:1 When using Needled Portacaths after each use you must lock with 4ml Heparinised Sodium Chloride 100units/ml. Before removing the needle you must also flush with 10mls Sodium Chloride 0.9% before locking with 4ml Heparinised Sodium Chloride 100units/ml Other Care 2:2 Some children have a double implanted device in which the dual septum allows efficient multiple-infusion procedures and treatment, but as both septum work independently of each other both port septum need to be accessed and flushed separately. However with double implanted devices the mixing of medication running concurrently does not occur until they exit the catheter. 2:3 You must only use syringes of 10mls or greater as smaller size syringes may cause the line to rupture due to excess pressure. If the medication you need to give can only be measured in a smaller syringe, the line must be flushed first with a 10ml syringe to ensure patency. 2:4 All babies, children and young people with a central line should be commenced on daily Stellisept wash and nasal Mucopiricin TDS whilst they are in-patients. Equipment 1/ A selection of 10ml and 20ml Luer-Lock Sterile Syringes 2/ Blue Needles for drawing up flush 3/ Chlorhexidine 2% and Alcohol 70% swab (pad) (Chloraprep) 0.6-3ml size of swab depending on size and age of child 4/ Clean gloves* & apron 5/ Sterile Gloves and sterile Needlefree (Bionector) Hub as implementing a closed system Page 1 of 5

2 6/ Prescription Chart 7/ Heparinised Sodium Chloride 100units/ml (Portacaths) and Sodium Chloride 0.9% (or other compatible flush). 8/ Bonded triple lumen, double anti-reflux device (Squid) if planning to give more than one Medication down the lumen You must use non-bonded if you are giving TPN through Portacath 9/ Metal Trolley 10/ Polo Skin Fixes or Mepore tape 11/ Sterile transparent semi-permeable dressing (IV 3000 hand 9cm x 12cm ported or nonported) 12/ Dressing Pack 13/ Ametop Local Anaesthetic Cream and Dressing 14/ Gripper Port Needle or Safety Port Needle *All clean gloves referred to in this guideline are non- sterile gloves from a dedicated box kept for the sole use of IV and CVL administration. No Action 1 Approach the child or young person and family in a friendly and open manner Depending on the age and development of the child or young person, explain the procedure to them and their parents or carers and obtain their verbal consent. (You may need to involve a play specialist in the explanation to gain a suitable level of understanding) 2 Reassure child and parent throughout procedure 3 Depending on the age and preferences of the child or young person, consider applying local anaesthetic cream (Ametop ) to the Port Site(s) Ethyl Chloride spray can be used at the time of inserting the needle, however this is extremely cold and can cause undue distress in younger children (Local Anaesthetic cream/spray must be prescribed by a Medical Practitioner and checked by two Registered Nurses or given via Children s Hospital PGD) 4 Before starting the procedure you must clean your hands, put on a plastic apron and gloves from a dedicated box you only need to wash rather than use alcohol hand rub on your hands if you have been in contact with bodily fluids or an infected patient 5 Clean the top. Legs and bottom of the metal trolley with Chlorclean. You do not need to use any additional solutions if you allow the trolley to air dry but if you dry the trolley with paper towels you must also disinfect using 70% Industrial Methylated Spirits your trolley now provides an clean surface. Remove gloves and apron, decontaminate hands 6 Gathering the equipment you need check the packages are intact and the equipment is in date, place on the bottom of the trolley if you are accessing a double septum port you must collect equipment to access both septum at this point. 7 Two qualified practitioners, one of whom is competent in giving IVI medication on central lines must check and administer intravenous flush together. The nurse inserting the needle must be assessed and competent in this procedure. 8 Collect the prescription chart and both practitioners must check child s name, DOB, Hospital number and allergies are completed, that the prescription is legible Both nurses must independently check the correct flush and dose has been prescribed against the child s weight Page 2 of 5

3 9 Put on plastic apron, decontaminate hands then open aseptic field using the tips of fingers and corners only, carefully open sterile gloves and other equipment onto aseptic field 10 Place clinical waste bag below level of sterile field 11 Take the prepared trolley to the child s bedside, re-explain the procedure to the child and family and gain consent Decontaminate hands using the alcohol hand rub. Both practitioners must check the child s details both verbally and from their identity band against the prescription chart, at this stage the independent checker must sign the chart ensuring that they clean their hands before leaving the bed space, they do not have to wait until the flush has been fully administered 12 Position the child comfortably, using pillows or their parents for support 13 Remove the local anaesthetic cream from Port Site(s) and using visual inspection and palpation over the port locate the septum(s) and edges noting the angle and position. 14 Wash hands with liquid soap and water if you have been in contact with bodily fluids otherwise decontaminate hands with alcohol hand rub and apply sterile gloves 15 A pair of sterile gloves must be worn when accessing (Needle Insertion) and administering flush to a port when system is being set-up. Once needle is in situ If accessing port to give medication an aseptic non-touch technique can be used 16 Assemble equipment attaching needles to the syringes and loosen sheaths, arrange in an orderly manner in aseptic field so syringe tips (key parts) remain sterile once needles have been removed 17 Check and draw up flush(s) and Heparinised Sodium Chloride and check with independent practitioner. label syringes - Use a green/blue needle for plastic bottles and rubber topped vials - Use an blue needle or filter needle for glass vials As using Sterile Gloves, you may use a, sterile gauze swab, a Chlorhexidine 2% and Alcohol 70% wipe or a second practitioner to hold the flush 18 Prime the Port Needle(s) and integrated line with Sodium Chloride 0.9%, close the clamp(s) and leave the syringe(s) attached to the end. If leaving the Port Needle(s) in situ you must attach a Needlefree Hub to the end of the integrated line before flushing. Place the primed line(s) back onto the aseptic field. 19 Using the Chlorhexidine 2% and Alcohol 70% skin preparation swab (pad), clean the area over the port the sponge must be gently pressed against the patient s skin in order to apply the antiseptic solution and a back and forth action of the sponge should be used for 30 seconds. If you are accessing a double septum port you must clean both septum at this point. Using the edges of the sterile dressing towel from the dressing pack, place this under the port site(s) ensuring that the child understands they must not touch the towel. 20 Taking care not to contaminate the port septum (especially is accessing a double septum), locate the edges of the device (first septum) and hold firmly using the thumb and first finger of the non-dominant hand in a C position. Pick up the primed Port Needle and syringe using the dominant hand, either hold the syringe in the palm or place onto the aseptic field below the port site, ensuring you do not contaminate the needle. 21 Using a firm smooth movement push the Port Needle through the skin in the centre of the port septum, until the needle hits the back of the portal chamber. 22 Undo the clamp and slowly flush the needled port using positive pressure until 2-3 mls of Sodium Chloride 0.9%has been instilled. Page 3 of 5

4 Pull back gently until flashback is seen in the line and then continue to administer the remainder of the flush into the line checking for signs of leakage, pain or swelling around the wound site. (Note that not all Ports bleed back, however if you cannot get the portacath to bleed back you must seek help) 23 Using positive pressure, clamp line and remove empty syringe and discard. Taking care not to contaminate the end of the line (key part). If using line to administer Medication or Infusion attach and commence at this point. If Port is not being used immediately or just being flushed routinely, lock the line using 4 mls Heparinised Sodium Chloride (100 iu/ml) This should be given using a push-pause turbulent flow technique and a positive pressure lock with the last 0.5 ml (ensuring the line is firmly clamped). Wipe the needlefree hub using the Chlorhexidine 2% and Alcohol 70% wipe. 24 If accessing a double septum port you must repeat stages using exactly the same method for the second port septum before continuing with the stages below. 25 If the Port Needle is being used for blood sampling or routine flushing only, you must leave the contoured grip in place for ease of removal. To remove Gripper Needle once the flush is complete relocate the edges of the port and hold firmly using the thumb and first finger of the non-dominant hand in a C position taking care not to knock the Gripper Needle 26 Using the dominant hand, pull the Gripper Needle out of the port using a firm single movement hold the needle using either the side of the contoured grip or the cushion needle platform protector- the port should be held firmly to prevent movement caused by the force of the needle being pulled away. Cover the wound with a sterile dressing if required 27 If the Gripper Port Needle is staying in place for continuing treatment, you must remove the contoured grip and using an aseptic no touch technique apply a sterile transparent semipermeable dressing (IV 3000). If accessing a double septum port you will require two separate dressings. The dressing should cover the needle and port and approximately one inch of the integrated line which should be positioned comfortably ensuring the access hub is not covered. 28 Remove the apron and gloves, ensure the child is comfortable and then the primary practitioner must document on the prescription sheet that the Sodium Chloride 0.9% Flush and Heparinised Sodium Chloride have been administered, Decontaminate hands before leaving the bedside 29 Dispose of all sharps, syringes into a sharps container and other equipment into an orange bag and decontaminate the tray/trolley before putting it away 30 Document procedure in child s notes 3. Further information / References Rowley S (1992) Aseptic Non-Touch Technique: a safe and efficient handling technique for IV therapy & other clinical procedures Training Pack University College Hospitals London. Department of Health (2007) Saving lives: reducing infection, delivering clean and safe care using High Impact Interventions (HII): HII no 1 Central Venous Catheter Care Bundle Pratt, R.J., Pellowe, C.M., Wilson, J.A., Loveday, H.P., Harper, P.J., Jones, S.R.L.J., McDougall, C., and Wilcox., M.H (2007) epic2: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England Journal of Hospital Infection 65(S) S1-S64 Page 4 of 5 x

5 4. Legal Liability Guideline Statement Guidelines issued and approved by the Trust are considered to represent best practice. Staff may only exceptionally depart from any relevant Trust guidelines providing always that such departure is confined to the specific needs of individual circumstances. In healthcare delivery such departure shall only be undertaken where, in the judgement of the responsible healthcare professional it is fully appropriate and justifiable - such decision to be fully recorded in the patient s notes Page 5 of 5