Mid-line Vascular Access Device Policy (Adults) and Procedures/Guideline

Transcription

1 Mid-line Vascular Access Device Policy (Adults) and Procedures/Guideline October 2016

2 Document Profile Type i.e. Strategy, Policy, Procedure, Guideline, Protocol Title Category i.e. organisational, clinical, finance Policy and Procedures/Guideline Mid-line Vascular Access Device Policy (Adults) and Procedures/Guideline Clinical Version 1.0 Author Approval Route Approved by Carol Rowley-Blackwell Operational Governance Group CEO Julie Gafoor Date approved 03/10/16 Review date 03/10/19

3 Contents List 1. Introduction 1 2. Policy 2 3. Procedures 3 4. Development and Consultation Process 4 5. Dissemination and Implementation Plan 4 6. Reference Documents 5 Appendices

4 1. INTRODUCTION 1.1 Rationale Mid-line Vascular Access Devices (s) are small catheters which are threaded through a peripheral vein (cephalic/basilic) with the terminal tip in the axiliary vein (Vygon 2015). They provide a long term alternative when central access is not required or there is no clinical benefit to central access (Mermel et al 1995 in Vygon 2015) and are ideal for the purpose of administering medications, fluid and/or blood products (McCallum & Higgins 2012). This form of peripheral access device has an indwelling time of up to 4 weeks (Vygon 2015). Intravenous (I.V.) therapy has become a vital component in patient care and it is estimated that annually the majority of patients admitted to a UK hospital will receive an I.V. device during their stay (Peterson 2002 in Vygon 2015). It is also becoming increasingly more common in the community. Historically, the insertion practice of Peripheral Venous Access Devices (PVAD) has varied significantly, dependent upon the specialty and experience of the practitioner involved in the care. Variation in the standard of care constitutes a clinical risk and increases the chance of patients suffering complications related to PVAD insertion such as healthcare associated infections (HAIs). Intravenous cannula related infections are associated with increased morbidity and mortality, prolonged hospitalisation and increased costs (Morris & Tay 2008). The aim of this policy is to support the standardisation of practice throughout Family Nursing & Homecare (FNHC) and to reduce the risk of related infections. 1.2 Scope This policy applies to all staff involved in the insertion and ongoing care and maintenance of s in adult patients. This includes Nurses who have the support of FNHC and their respective managers in the undertaking of this practice. It identifies both the insertion procedure for s and the ongoing care management principles that must be adhered to within FNHC. 1.3 Roles and Responsibilities It is the duty of all those who insert and manage s to understand the risks associated with such devices and be responsible for updating their knowledge and maintaining the highest standard of practice. 1.4 Principles The practice of insertion is a multi-disciplinary skill and responsibility. Consent to care will be sought in accordance with local policy and professional practice standards. Adherence to best practice in infection prevention and control will underpin clinical practice to reduce the risk of healthcare associated infections. A risk-based approach will be used to promote patient safety in all aspects of practice regarding s. The title practitioner, used throughout this document, refers to all those staff undertaking insertion and care of a midline vascular access device. 1

5 2. POLICY Practitioners undertaking the insertion and care of s must have received training in device insertion, formal education in the principles of device management and have been deemed competent in these skills. N.B. this may have been have been achieved in a bespoke midline training session (see appendix 1). These clinical skills must then be used in conjunction with this policy and the Royal Marsden Manual (2015) procedural guidelines and Collaborative Intravenous Nursing Service (2013) guidelines for insertion and management to ensure adherence to best practice principles. The insertion of a peripheral venous access device is regarded as a minor surgical procedure (Phillips et al 2011) and therefore the utmost care and adherence to strict infection prevention and control (IPAC) procedures is paramount. Thorough hand decontamination is the single most effective method in reducing HAIs and must be practiced prior to the insertion or manipulation of a. Skin preparation prior to insertion has been shown to be most effective utilising 2% chlorhexidine in 70% isopropyl alcohol (Chloraprep) (Scales 2009). It is therefore stipulated that Chloraprep must be used prior to insertion. This policy is limited to adult insertion and therefore the recommended use of Chloraprep is for this client group only. The Frepp applicator (1.5ml) which is used prior to arterial line insertion is suitable for this procedure. Chloraprep must be used as per the manufacturer s recommendations i.e. be applied in the correct method according to the product type used and allowed to dry for 30 seconds prior to skin puncture. Post insertion the line should be secured using steri-strips or a Griplock securing device and covered with a clear view dressing such as the IVAC At times patients discharged from the hospital with a in situ may have it secured with sutures but this is not standard procedure. s should be checked on a daily basis. If there are no signs of phlebitis and the line is patent the line can remain in place for up to 4 weeks (Vygon 2015). However if the line is required for longer, following discussion with clinical lead, it may be possible to extend the dwell time if there are no problems with phlebitis or patency. Daily consideration as to whether the line is required is essential. If a practitioner is unsure as to whether a should be removed it should be discussed with their clinical team lead. Flushing of the should take place pre and post administration of all intravenous therapy with 0.9% Sodium Chloride as documented in section 3. The Griplock securing device and clear view dressing should be changed weekly. This must be performed using an aseptic non touch technique (ANTT) whilst observing standard precautions. The site should be cleaned with Chloraprep and allowed to air dry prior to the new dressing and securing device being applied Whenever accessing the, the non-return, needle-free connector must be decontaminated using Alcoholic 2%/Chlorahexidine Clinell wipes. These must be used in accordance with the manufacturer s instructions ensuring that the sterilised bung is allowed to dry for 30 seconds following application. 2

6 3. PROCEDURES PROCEDURES FOR INSERTION, CARE, AND MAINTENANCE OF THE Adherence to the clinical guidelines set out in the Royal Marsden Manual (2015) guidelines will be adopted by all practitioners undertaking the procedure of midline access device insertion. Please follow link below for insertion procedure: For care and maintenance of the device in situ, follow care bundle in appendix 2 For flushing of the device please follow link below: DOCUMENTATION PROCEDURE All aspects of care from insertion and daily/weekly care to removal should be documented using the Family Nursing & Home Care Midline Care Bundle (appendix 3). Part 1 of the care bundle must be fully completed following the insertion of the : Affix a patient Addressograph to the care bundle or complete the patient s demographic details Complete the clinical area details and practitioner identifier details Complete Part 1 and sign each metric. Part 2 must be completed on a daily basis this section is on the back of the care bundle. All aspects of day 7 should also be completed as per the bundle Part 3 must be completed on removal If a patient is discharged from hospital or any other in-patient setting with a mid-line in situ, the care bundle, if used within that setting, should follow the patient and be kept in the patient s nursing records. If however there is no care bundle in place, the information should be obtained from the referrer and entered onto part 1 of the FNHC care bundle document indicating that this insertion was undertaken by a different care provider. Part 2 should then commence on the appropriate post-insertion day with a single line scored through the days when care was not provided by FNHC. The Mid-line venous access device care bundle must be filed in the patient s nursing notes in line with the Cochrane report [Webster et al 2013] which discusses patient documentation. 3

7 4. DEVELOPMENT & CONSULTATION Discussion with Out of Hospital Operational lead and benchmarked against best practice in the UK a. CONSULTATION SCHEDULE Name Title Consultation Date Clare Stewart Out of Hospital Operational Lead April 2016 Louise Hamilton Deputy Sister RRRT March 2016 Tia Hall Operational Lead DN April 2016 Julia Foley Sister - Team Lead DN April 2016 Anne-Marie Wilkie Sister -Team Lead DN April 2016 Jim Wilkinson Charge Nurse Team lead DN April 2016 Elspeth Snowie Clinical effectiveness Lead April 2016 Judy Foglia Quality and Governance Lead April DISSEMINATION AND IMPLEMENTATION PLAN Action Responsible Person Planned timeline to all staff Policy to be placed on FNHC Central Files Staff to sign up to documents if relevant Information Governance Officer Information Governance Officer Operational Leads Within 2 weeks following ratification Within 2 weeks following ratification Within 2 weeks following ratification 4

8 6. REFERENCE DOCUMENTS McCallum, L & Higgins, D. (2012) Care of peripheral venous cannula sites, Nursing Times, Vol 108 [34/35] pp12-15 Mermel, LA et al (1995) in presentation from Vygon.co.uk to FNHC, An assessment of IV access devices to avoid the unintentional consequences of IV Therapy (2015) Morris, W.& Tay, MH. (2008) Strategies for preventing peripheral intravenous cannulation infection. British Journal of Nursing [IV Therapy Supplement], Vol 17 [9] Peterson (2002) in presentation from Vygon.co.uk to FNHC An assessment of IV access devices to avoid the unintentional consequences of IV Therapy (2015) Phillips S. Collins, M. and Doherty, L. (2011) Essential Skills for Nurses Venepuncture and Cannulation: Wiley-Blackwell The Royal Marsden, (2015) The Royal Marsden Hospital Manual of Clinical Nursing Procedures 9 th Edition, Intranet Version (Online 2015) Scales, K. (2009) Correct use of Chlorohexidine in Intravenous Practice. Nursing Standard, Vol 24 [8], pp41-46 Vygon.co.uk [2015] An assessment of IV access devices to avoid the unintentional consequences of IV Therapy. Power-point presentation to FNHC May (2015) Webster, J. Osbourn, S. Rickard, CM, New, K. (2013) Clinically indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database of Systematic Reviews, Issue 4. 5

9 Appendix 1 Vygon Presentation 2015 Vygon 2015 presentation click on PPT below, then press escape when finished Leaderflex Midline An assessment of IV access devices to avoid the unintentional consequences of IV Therapy

10 Appendix 2 Mid-Line Care Bundle Please complete or affix addressograph Surname Forename Mid-Line care bundle Address Name/Designation. Date of birth Signature. Date/Time. URN No Team. Mid-line vascular access device () care bundle - adults Part 1 MID-LINE INSERTION Tick Signature Hands decontaminated 2% Chlorhexidine / 70% Isopropyl alcohol 1.5ml used for skin prep (ChloraPrep) Aseptic technique practiced Device secured and clear view dressing applied Line fushed with 0.9% Sodium chloride to ensure patency Draw on the diagram were the insertion point is and where the Mid-line ends Document points below Length of catheter Guage of catheter Brand of catheter Catheter Lot Number Local anaesthetic used YES / NO Number of insertion attempts Insertion complications? Tick Signature Part 2 on back of sheet V.I.P. Score (Visual infusion phlebitis score) Score No sign of phlebitis I.V.Site appears healthy 0 OBSERVE CANNULA One of the following is evident: Possible first sign of phlebitis Slight pain near the i.v. site 1 OBSERVE CANNULA or slight redness near the i.v. site Two of the following are evident: Early stage of phlebitis Pain near i.v. site Erythema Swelling 2 RESITE CANNULA All of the following are evident: Medium stage of phlebitis Pain along path of cannula Erythema 3 RESITE CANNULA + CONSIDER TREATMENT Induration All of the following are evident: Advanced stage of phlebitis or start of Pain along path of cannula Erythema 4 thrombophlebitis Induration Palpable venous cord RESITE CANNULA + CONSIDER TREATMENT All of the following are evident & extensive Advanced stage of thromboplebitis Pain along path of cannula Erythema 5 INITIATE TREATMENT + RESITE CANNULA Induration Palpable venous cord Pyrexia Part 3 Removal - Remove if V.I.P. score 2 or above or is no longer needed Date: Removed by:

11 Appendix 2 Mid-Line Care Bundle Part 2 Oservations of - Daily checks Ensure hand hygeine prior to accessing device. Clean hub for at least 15 seconds with Clinel wipe Date Day 1: Required? Dressing Insertion VIP End VIP Flush Action Signature 24 hour post insertion dressing check - change if not clean and intact Date Day 2: Required? Dressing Insertion VIP End VIP Flush Action Signature Date Day 3: Required? Dressing Insertion VIP End VIP Flush Action Signature Date Day 4: Required? Dressing Insertion VIP End VIP Flush Action Signature Date Day 5: Required? Dressing Insertion VIP End VIP Flush Action Signature Date Day 6: Required? Dressing Insertion VIP End VIP Flush Action Signature Day 7 Date: Required? Dressing Insertion VIP End VIP Flush Action Signature Change Griplock securing device if used On changing cleanse insertion site with CloraPrep and allow to dry Change Clear View dressing Change needle free access device (connector bung) Date Day 8: Required? Dressing Insertion VIP End VIP Flush Action Signature Date Day 9: Required? Dressing Insertion VIP End VIP Flush Action Signature Date Day 10: Required? Dressing Insertion VIP End VIP Flush Action Signature Date Day 11: Required? Dressing Insertion VIP End VIP Flush Action Signature Date Day 12: Required? Dressing Insertion VIP End VIP Flush Action Signature Date Day 13: Required? Dressing Insertion VIP End VIP Flush Action Signature Day 14 Date Day 14: Required? Dressing Insertion VIP End VIP Flush Action Signature Change Griplock securing device if used On changing, cleanse insertion site with ChloraPrep and allow to dry Change Clear View dressing Change needle free access device (connector bung) Ensure Griplock device / Clear View dressing / needle free access device changed every 7 days