FW: Management of CVC/PICC lines and dressings

[Claire Rickard]

Dear Rachel

I recommend the Infusion Therapy Standards of Practice 2016 (currently being updated)-they are evidence-based (levels of evidence provided after the practice criteria).
They are comprehensive and excellent!!
https://www.ins1.org/

Question one:
I am quoting in brief
“standard 34.1 use a Luer locking mechanism to ensure a secure junction when attaching needleless connectors to a vascular access device (VAD) hub or access site.
Practice criteria a. The need for a needleless connector placed between the VAD hub and the administration set used for continuous fluid infusion is unknown. The primary purpose of needleless connectors is to protect health care personnel by eliminating needles and subsequent needlestick injuries when attaching administration sets and/or syringes to the VAT hub or injection site for intermittent infusion 1-3. (Regulatory).

1. Avoid use of a needleless connector for rapid flow rates of crystalloid solutions and red blood cells as their presence can greatly reduce flow rates (4) (IV)

Question 2.
There are two practice standards, one to do with dressings, and one to do with stabilisation products.
Dressings:
41.2 site care, including skin antisepsis and dressing changes, are performed at established intervals and immediately if the dressing integrity becomes damp, loosened, or visibly soiled, or if moisture, drainage, or blood are present under the dressing.
41.5 labelled the dressing with the date performed or date to be changed based on organisational policies and procedures
H. Perform dressing changes on central venous access devices and midline catheters at a frequency based on the type of dressing.
1. Change transparent semipermeable membrane dressings (TSM) at least every 5 to 7 days and because dressings at least every two days; research has not supported the superiority of a TSM dressing versus a gauze dressing; note that a gauze dressing underneath a TSM dressing is considered a gauze dressing and changed at least every two days. (3-5, 16) (II).

I. assess the integrity of the ESD with each dressing change and change the ESD according to the manufacturer’s directions for use. Remove adhesive ESDs during the dressing change to allow for appropriate skin anti-sepsis and apply a new ESD. An ESD designed to remain in place for the life of the VAD (e.g., sutures, subcutaneous ESD) may need to be removed and replaced if appropriate stabilisation is no longer being achieved (3, 22, 23, 27) (IV)

Hope this helps, happy to discuss further.
Claire Rickard PhD RN
School of Nursing and Midwifery
Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland
Griffith University

Hi Brains Trust,

I posted a couple of questions on Monday about local practices relating to managing CVCs and PICCs.

At this stage I have not had any replies.

I would be really grateful if my questions could be reposted and if anyone would be kind enough to consider and reply that would be most welcomed.

Many thanks
Rachel

……………………………………………………………………………..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South

*: 03 6166 7882/ 6166 8658

Level 4, H Block
48 Liverpool Street
Hobart, 7000

Hi all,

We are currently commencing a process of reviewing all of our protocols relating to central access devices. As part of this we are reviewing the use of needleless access devices used in conjunction with these items.

Could you consider the following questions and share your organisations approach/es

1. If you have an infusion running on a central venous access device (CVC and/or PICC), do you use a needleless connection between the line and the lumen?
* If so, why?
* If not, why?
2. What frequency of dressing change do you adopt in relation to CVCs and PICC for inpatients?
* Are there differences between CVCs and PICCs

i. If yes, what are these differences and why?

* If weekly, why did you choose this?
* If more frequent than weekly, why did you choose this?

Any sources of information that you would recommend that we consider would be welcomed.

Many thanks
Rachel
……………………………………………………………………………..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South

*: 03 6166 7882/ 6166 8658

Level 4, H Block
48 Liverpool Street
Hobart, 7000

________________________________

CONFIDENTIALITY NOTICE AND DISCLAIMER
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MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

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MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

Replies to this message will be directed back to the list. To create a new message send an email to acipclist@acipc.org.au

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[Thomson, Rachel EA (THS)]

Thanks for this advice Claire. We have accessed these, so I am pleased that you think they are an important resource.

Thanks also to others who have replied – this is much appreciated!

Kind regards
Rachel

……………………………………………………………………………..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South

*: 03 6166 7882/ 6166 8658

Level 4, H Block
48 Liverpool Street
Hobart, 7000

Dear Rachel

I recommend the Infusion Therapy Standards of Practice 2016 (currently being updated)-they are evidence-based (levels of evidence provided after the practice criteria).
They are comprehensive and excellent!!
https://www.ins1.org/

Question one:
I am quoting in brief
“standard 34.1 use a Luer locking mechanism to ensure a secure junction when attaching needleless connectors to a vascular access device (VAD) hub or access site.
Practice criteria a. The need for a needleless connector placed between the VAD hub and the administration set used for continuous fluid infusion is unknown. The primary purpose of needleless connectors is to protect health care personnel by eliminating needles and subsequent needlestick injuries when attaching administration sets and/or syringes to the VAT hub or injection site for intermittent infusion 1-3. (Regulatory).

1. Avoid use of a needleless connector for rapid flow rates of crystalloid solutions and red blood cells as their presence can greatly reduce flow rates (4) (IV)

Question 2.
There are two practice standards, one to do with dressings, and one to do with stabilisation products.
Dressings:
41.2 site care, including skin antisepsis and dressing changes, are performed at established intervals and immediately if the dressing integrity becomes damp, loosened, or visibly soiled, or if moisture, drainage, or blood are present under the dressing.
41.5 labelled the dressing with the date performed or date to be changed based on organisational policies and procedures
H. Perform dressing changes on central venous access devices and midline catheters at a frequency based on the type of dressing.
1. Change transparent semipermeable membrane dressings (TSM) at least every 5 to 7 days and because dressings at least every two days; research has not supported the superiority of a TSM dressing versus a gauze dressing; note that a gauze dressing underneath a TSM dressing is considered a gauze dressing and changed at least every two days. (3-5, 16) (II).

I. assess the integrity of the ESD with each dressing change and change the ESD according to the manufacturer’s directions for use. Remove adhesive ESDs during the dressing change to allow for appropriate skin anti-sepsis and apply a new ESD. An ESD designed to remain in place for the life of the VAD (e.g., sutures, subcutaneous ESD) may need to be removed and replaced if appropriate stabilisation is no longer being achieved (3, 22, 23, 27) (IV)

Hope this helps, happy to discuss further.
Claire Rickard PhD RN
School of Nursing and Midwifery
Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland
Griffith University

Hi Brains Trust,

I posted a couple of questions on Monday about local practices relating to managing CVCs and PICCs.

At this stage I have not had any replies.

I would be really grateful if my questions could be reposted and if anyone would be kind enough to consider and reply that would be most welcomed.

Many thanks
Rachel

……………………………………………………………………………..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South

*: 03 6166 7882/ 6166 8658

Level 4, H Block
48 Liverpool Street
Hobart, 7000

Hi all,

We are currently commencing a process of reviewing all of our protocols relating to central access devices. As part of this we are reviewing the use of needleless access devices used in conjunction with these items.

Could you consider the following questions and share your organisations approach/es

1. If you have an infusion running on a central venous access device (CVC and/or PICC), do you use a needleless connection between the line and the lumen?
* If so, why?
* If not, why?
2. What frequency of dressing change do you adopt in relation to CVCs and PICC for inpatients?
* Are there differences between CVCs and PICCs

i. If yes, what are these differences and why?

* If weekly, why did you choose this?
* If more frequent than weekly, why did you choose this?

Any sources of information that you would recommend that we consider would be welcomed.

Many thanks
Rachel
……………………………………………………………………………..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South

*: 03 6166 7882/ 6166 8658

Level 4, H Block
48 Liverpool Street
Hobart, 7000

________________________________

CONFIDENTIALITY NOTICE AND DISCLAIMER
The information in this transmission may be confidential and/or protected by legal professional privilege, and is intended only for the person or persons to whom it is addressed. If you are not such a person, you are warned that any disclosure, copying or dissemination of the information is unauthorised. If you have received the transmission in error, please immediately contact this office by telephone, fax or email, to inform us of the error and to enable arrangements to be made for the destruction of the transmission, or its return at our cost. No liability is accepted for any unauthorised use of the information contained in this transmission.
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

Replies to this message will be directed back to the list. To create a new message send an email to acipclist@acipc.org.au

To send a message to the list administrator send an email to admin@acipc.org.au

You can unsubscribe manually from this list by sending ‘signoff acipclist’ (without the quotes) to listserv@aicalist.org.au
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

Replies to this message will be directed back to the list. To create a new message send an email to acipclist@acipc.org.au

To send a message to the list administrator send an email to admin@acipc.org.au

You can unsubscribe manually from this list by sending ‘signoff acipclist’ (without the quotes) to listserv@aicalist.org.au

________________________________

CONFIDENTIALITY NOTICE AND DISCLAIMER
The information in this transmission may be confidential and/or protected by legal professional privilege, and is intended only for the person or persons to whom it is addressed. If you are not such a person, you are warned that any disclosure, copying or dissemination of the information is unauthorised. If you have received the transmission in error, please immediately contact this office by telephone, fax or email, to inform us of the error and to enable arrangements to be made for the destruction of the transmission, or its return at our cost. No liability is accepted for any unauthorised use of the information contained in this transmission.

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

Replies to this message will be directed back to the list. To create a new message send an email to acipclist@acipc.org.au

To send a message to the list administrator send an email to admin@acipc.org.au

You can unsubscribe manually from this list by sending ‘signoff acipclist’ (without the quotes) to listserv@aicalist.org.au

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