s Full Name: Date of Birth: NHS Number 1. The fully implanted port system Sitimplant is not regularly used in the community and nursing staff may be unfamiliar with the recommended care of this system Potential delay in treatment action required (Y/N) 1a. At the earliest opportunity, discuss procedure with Medicines Management Team and Line Manager 1b. Ensure a well planned discharge and visit referring health care provider, if unfamiliar with procedure 1c. Ensure the referring clinician has given clear instructions on the procedure required. For example: if community nurses are requested to administer a locking solution of heparinised saline for a venous port, to be used in an adult patient when the port is not in daily use: The manufacturer recommends the following: Initial flushing with 5ml sodium chloride 0.9% Then a heparin lock of 3ml to 5ml heparinised saline 500 units per ml. Frequency of administration at least every four weeks Ensure the correct volume of sodium chloride 0.9% flush and the correct strength of heparinised saline, volume and frequency has been prescribed by the referring clinician and is written on a Medicines Administration Chart To ensure control measures are in place to maintain patient safety all nurses must follow Wirral Community NHS Trust policies, procedures and standing operating procedures relating to care and maintenance of Implanted Ports Page 1 of 5
s Full Name: Date of Birth: NHS Number 2. The strength of heparinised saline 500 units per ml, the manufacturer advises for locking the Sitimplant when it is not being accessed daily (for Adults), is not commercially available To prepare a solution of 500 units per ml of heparinised saline a dilution is required. There is a risk of medication error, leading to bleeding and other adverse effects. action 2a. To prepare Heparinised Saline 500 units per ml To prepare the lock as per manufacturer s instructions dilute 1.5ml of 1000 units/1ml of Heparin with 1.5 ml 0.9% Sodium Chloride, to give 3ml of Heparinised Saline (500units in 1ml) 2b. Two members of staff must check medication when mixing heparinised saline and carrying out this procedure, both being registered nurses. required Y/N 3. Medication error when flushing or administering medicines via Sitimplant Port Water should never be used for flushing as it damages red blood cells Adverse reaction Bleeding Medication error Admission to hospital 3a. Two members of staff must check medication when carrying out this procedure; both being registered nurses 3b. Ensure the correct flushes have been prescribed on Medicines Administration Chart. 3c. Community nurses to follow the standard operating procedure (SOP) for the safe administration of medicines 3d. Community nurses to follow SOP for administration of heparin flushes via central Intravenous access devices 3e. Community nurses to follow Procedure for Flushing Totally Implanted Ports To ensure control measures are in place to maintain patient safety all nurses must follow Wirral Community NHS Trust policies, procedures and standing operating procedures relating to care and maintenance of Implanted Ports Page 2 of 5
s Full Name: Date of Birth: NHS Number 4. Medication administered via intravenous route 5. Local site infection or systemic blood stream infection Potential for anaphylaxis Bacteraemia Septicaemia 6 Catheter damage Catheter breakage Leakage of fluid action required Y / NY 4a.Community nurses must follow the procedure for managing an anaphylactic emergency in the community 5a Nurses to be aware of the signs and symptoms of local infection at skin site and systemic blood stream infections 5b. Community nurses must follow aseptic non-touch technique when caring for implanted ports 5c. to be educated how to inspect site daily to observe for signs of infection 5d. Nurse to complete Intravenous access phlebitis checklist each Visit 6a. Use 10ml luer lock syringe and never force the solution into the catheter, if forced may cause damage to the catheter 6b. Always follow manufacturer s instructions for the care and maintenance of the Ports (If available) or request from discharging hospital or health care provider 6c. Educate patient on the signs and symptoms of infection to observe for and when to report 6d. Refer to trouble shooting section procedure for flushing totally implanted Intravenous Access Device Ports 6e. Refer patient back to hospital or referring ward 6f. Report concerns regarding medical products to Medicines and Healthcare Products Regulatory Agency To ensure control measures are in place to maintain patient safety all nurses must follow Wirral Community NHS Trust policies, procedures and standing operating procedures relating to care and maintenance of Implanted Ports Page 3 of 5
s Full Name: Date of Birth: NHS Number 7. Use of sharps Potential for needle stick injury staff action required Y / N Follow procedure for the sharps safety and management of contamination injuries policy. Any needle stick injuries complete incident form and ensure a copy is forwarded to occupational health. To ensure control measures are in place to maintain patient safety all nurses must follow Wirral Community NHS Trust policies, procedures and standing operating procedures relating to care and maintenance of Implanted Ports Page 4 of 5
Location/Activity: Generic Risk Assessment for Sitimplant Ports in Adults Only s Full Name: Date of Birth: NHS Number Location/Activity: Assessment date: Review date: Assessor Name: Signature: Designation: Ref Further Action Implemented Short Term Medium Term Long Term 1 Review risk assessment on a three monthly basis Responsible Person Team Leader/Senior practitioner Revised Risk rating L x C = R Are further assessments required if so list. Page 5 of 5