[Kerrie Curtis]

Hi

It is recommended and routine practice to check and document Central Venous Access Device (CVAD) patency before use. This is especially important when infusing any solutions that are considered irritant, vesicant, pH9 or osmolarity of >900mmols. Erroneous catheter tip locations, reduced patency and other complications such as catheter damage can also be assessed when checking blood return and then pulsatile flushing with sodium chloride before use. The exception is with <3F catheters where the size of the lumen is so small, blood withdraws are generally not recommended or possible.

Reference:
Infusion Nursing Society. (2016). Infusion Therapy Standards of Practice. Journal of Infusion Nursing, 39(1S), S1-S159.

10. Documentation in the Medical Record
A. 10. Results of VAD functionality assessment including patency, absence of signs and symptoms of complications, lack of resistance when flushing,
and presence of a blood return upon aspiration. 8,16 (V)

40. Flushing and Locking
D. Assess VAD functionality by using a 10-mL syringe or a syringe specifically designed to generate lower injection pressure (ie, 10-mL-diameter syringe barrel), taking note of any resistance.
1. During the initial flush, slowly aspirate the VAD for blood return that is the color and consistency of whole blood, which is an important component of assessing catheter function prior to administration of medications and solutions (refer to Standard 48, Central Vascular Access Device [CVAD] Occlusion ; Standard 53, Central Vascular Access Device [CVAD] Malposition ).

41. Vascular Access Device (VAD) Assessment, Care and Dressing Changes
B. Assess VAD function by flushing and aspirating for a blood return prior to each intermittent VAD use (eg, intermittent medication) and as clinically indicated with continuous infusions (eg, occlusion alarms). Recognize the risk of contamination with each manipulation of the infusion system (refer to
Standard 36, Add-on Devices ; Standard 40, Flushing and Locking ).

46. Infiltration and Extravasation
B. Assess all VADs for patency and the absence of signs and symptoms of infiltration and extravasation prior to each intermittent infusion and on a regular basis for continuous infusions. Assessment includes observation, palpation, flushing to identify resistance, aspiration for a blood return, and listening to the patient's report of pain. Frequency of VAD site assessment depends upon the specific patient population and characteristics of the infusion therapy (refer to Standard 40, Flushing and Locking ; Standard 41, Vascular Access Device [VAD] Assessment, Care, and Dressing Changes).

Happy to answer any questions. Thanks
Kind regards

Kerrie

KERRIE CURTIS
Project Manager: The Lines Project
A PICS, Royal Children's Hospital and Monash Children's Hospital Collaboration.

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Hi Both,

I am far from an expert in this area, but wouldn’t one expect that blood, if it stagnates for a while, will coagulate, and one wouldn’t want to push the blood clot back into the patient?

Best regards, Matthias.

—
Matthias Maiwald, MD, FRCPA
Senior Consultant in Microbiology
Head of Service, Microbiology
Adj. Assoc. Prof., Natl. Univ. Singapore
Department of Pathology and Laboratory Medicine
KK Women’s and Children’s Hospital
100 Bukit Timah Road
Singapore 229899
Tel. +65 6394 8725 (Office)
Tel. +65 6394 1389 (Laboratory)
Fax +65 6394 1387

Hi Sonja

I can’t say that I am an expert in this area, but in our PICC policy it states this:

If the PICC has not been accessed for 7 days access the PICC with an empty 10ml syringe. Remove 5mls of blood and discard. Then flush with Normal saline 10mls.

Not sure exactly why that is in there, as our PICC policy is based on The Queensland Health PICC guidelines (https://www.health.qld.gov.au/__data/assets/pdf_file/0028/444493/icare-pcvc-guideline.pdf) and I cannot see this statement in there.

Not sure if this helps or not!

Cheers
Michael

Michael Wishart, CICP-E
Infection Control Coordinator

A 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
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Hello,

We are reviewing our central line management policies and we trying to find evidence related to the routine practice for aspiration of blood prior to accessing the central line (especially PICC).
Our ICU team states that this is routinely performed within oncology groups.

I would be grateful for some specialist information.

Kind Regards
Sonja

Sonja Wegert | Infection Control Practitioner (ICP)
Infection Prevention and Control Unit | Central Australia Health Service
Northern Territory Government
Alice Springs Hospital, Gap Rd, Alice Springs
GPO Box 2234, Suburb, NT Postcode
p … 08 89517977
e … sonja.wegert@nt.gov.au http://www.nt.gov.au/health

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[Kerrie Curtis]

Dear Daniela

Great question! Julie Flynn, a colleague with AVATAR (Alliance for Vascular Access and Teaching, Queensland) and RBH&W Hospital is doing her PhD on the disinfection of needleless connectors. She recently published a letter to the editor on exactly this in the American Journal of Infection Prevention, 2018. Please find attached.

Thanks
Kind regards

Kerrie

KERRIE CURTIS
Project Manager: The Lines Project
A PICS, Royal Children’s Hospital and Monash Children’s Hospital Collaboration.

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Dear colleagues,

I am interested to know if Australian hospitals are routinely using wipes containing chlorhexidine 2% with alcohol 70% to disinfect vascular access hubs (i.e. to ‘scrub the hub’). In particular, is this practised on general wards when accessing a PIVC?

Many thanks,
Daniela

Daniela Karanfilovska
Clinical Nurse Consultant
Infection Prevention & Healthcare Epidemiology

t 03 90762819 m 0427 703 769
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