1. Nurse Education Workforce Strategy – Gippsland Region Gippsland Oncology Nurses Group (GONG) Management of Central Venous Access Devices 1. INTRODUCTION

2. TUTORIAL Management of Central Venous Access Devices INTRODUCTION Acknowledgements CVAD Tutorials This Tutorial CVAD Description CVAD Types CVAD Choice CVAD IndicationsCVAD ChoiceCVAD Indications Key Principles of Care (1)Key Principles of Care Key Principles of Care (2)Key Principles of Care References (1-4)References GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETERHICKMAN CATHETER 3. PORTPORT 4. PICCPICC Acknowledgements This project is an initiative of : Nurse Education Workforce Strategy –Gippsland Content supplied by: Gippsland Oncology Nurses Group (GONG)- an initiative of Gippsland Region Integrated Cancer Services (GRICS) Special thanks: Anny Byrne (Gippsland Regional Integrated Cancer Services) Anne Maree Day (West Gippsland HealthCare Group) Dianne Fahy (Nurse Education Workforce Strategy) Anne Johnson (Latrobe Regional Hospital) Linda Langskaill (Central Gippsland Health Service) Melanie Regan (Gippsland Regional Integrated Cancer Services) See other sources and references at the end of this presentation. Further reading is encouraged to complement these tutorials.

3. TUTORIAL Management of Central Venous Access Devices INTRODUCTION Acknowledgements CVAD Tutorials This Tutorial CVAD Description CVAD Types CVAD Choice CVAD IndicationsCVAD ChoiceCVAD Indications Key Principles of Care (1)Key Principles of Care Key Principles of Care (2)Key Principles of Care References (1-4)References GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETERHICKMAN CATHETER 3. PORTPORT 4. PICCPICC CVAD Tutorials 1.Introduction to Central Venous Access Devices 2.Hickman CathetersHickman Catheters 3.Implantable PortsImplantable Ports 4.PICCsPICCs

4. TUTORIAL Management of Central Venous Access Devices INTRODUCTION Acknowledgements CVAD Tutorials This Tutorial CVAD Description CVAD Types CVAD Choice CVAD IndicationsCVAD ChoiceCVAD Indications Key Principles of Care (1)Key Principles of Care Key Principles of Care (2)Key Principles of Care References (1-4)References GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETERHICKMAN CATHETER 3. PORTPORT 4. PICCPICC Scope of this tutorial What is a Central Venous Access Device (CVAD)? Name three different types of CVADs Name 5 indications for CVADs What is a clean technique? When is it used? What is a sterile technique? When is it used? What is a pulsatile flushing technique and why is it used?

5. TUTORIAL Management of Central Venous Access Devices INTRODUCTION Acknowledgements CVAD Tutorials This Tutorial CVAD Description CVAD Types CVAD Choice CVAD IndicationsCVAD ChoiceCVAD Indications Key Principles of Care (1)Key Principles of Care Key Principles of Care (2)Key Principles of Care References (1-4)References GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETERHICKMAN CATHETER 3. PORTPORT 4. PICCPICC Central Venous Access Devices In Central Venous Access Devices (CVADs), the tip of the catheter resides in a central vessel in the chest that immediately connects with the right atrium. This is usually the Superior Vena Cava (SVC) Examples are Hickman Catheters, Central Venous Catheters, Implantable PORTS and Peripherally Inserted Central Catheters (PICCs)

6. TUTORIAL Management of Central Venous Access Devices INTRODUCTION Acknowledgements CVAD Tutorials This Tutorial CVAD Description CVAD Types CVAD Choice CVAD IndicationsCVAD ChoiceCVAD Indications Key Principles of Care (1)Key Principles of Care Key Principles of Care (2)Key Principles of Care References (1-4)References GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETERHICKMAN CATHETER 3. PORTPORT 4. PICCPICC Types of CVADs CVADs can be for short term (approximately 10 days to 6 weeks), intermediate term (2 weeks to 6 months) or long term (6 weeks to years) therapy. –Central Venous Catheter - for short term therapy, often used in the ICU setting –Hickman Catheter - for intermediate and long term therapies. Often used in the haematology setting –Implantable Ports - for long term therapies. Most often used in the chemotherapy setting –PICC - for intermediate and long term therapies, IV antibiotics, continuous chemotherapy

7. TUTORIAL Management of Central Venous Access Devices INTRODUCTION Acknowledgements CVAD Tutorials This Tutorial CVAD Description CVAD Types CVAD Choice CVAD IndicationsCVAD ChoiceCVAD Indications Key Principles of Care (1)Key Principles of Care Key Principles of Care (2)Key Principles of Care References (1-4)References GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETERHICKMAN CATHETER 3. PORTPORT 4. PICCPICC Choice of Venous Access Device Consider the following: Length of treatment Type of treatment Frequency of treatment Geographic location of the patient Age of patient Anatomical factors Social setting i.e. impact on body image, workforce issues Hickman Catheter

8. TUTORIAL Management of Central Venous Access Devices INTRODUCTION Acknowledgements CVAD Tutorials This Tutorial CVAD Description CVAD Types CVAD Choice CVAD IndicationsCVAD ChoiceCVAD Indications Key Principles of Care (1)Key Principles of Care Key Principles of Care (2)Key Principles of Care References (1-4)References GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETERHICKMAN CATHETER 3. PORTPORT 4. PICCPICC Indications for CVADs Difficult venous access Multiple infusions eg long term chemotherapy, antibiotics Continuous infusions of chemotherapy via a Continuous Ambulatory Delivery Device (CADD) pump Infusions of vesicant drugs, that may cause damage and/or pain if infused peripherally Bone marrow / stem cell transplants ICU setting Total Parenteral Nutrition infusion

9. TUTORIAL Management of Central Venous Access Devices INTRODUCTION Acknowledgements CVAD Tutorials This Tutorial CVAD Description CVAD Types CVAD Choice CVAD IndicationsCVAD ChoiceCVAD Indications Key Principles of Care (1)Key Principles of Care Key Principles of Care (2)Key Principles of Care References (1-4)References GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETERHICKMAN CATHETER 3. PORTPORT 4. PICCPICC Key Principles of Care (1) 1.Confirmation of placement – Always confirm placement before commencing treatment and ensure there is a written x-ray report confirming the placement of the device 2.Access - Always ensure a blood return before infusing any fluids or drugs 3.Syringe size – Only use syringes 10 mls or larger, smaller syringes increase the pressure in the catheter wall and increase the risk of rupture of the catheter 4.Pulsatile flushing - always use a pulsatile (stop/start) flushing technique, to create turbulence in the lumen of the catheter, remove debris and avoid blockage of the catheter

10. TUTORIAL Management of Central Venous Access Devices INTRODUCTION Acknowledgements CVAD Tutorials This Tutorial CVAD Description CVAD Types CVAD Choice CVAD IndicationsCVAD ChoiceCVAD Indications Key Principles of Care (1)Key Principles of Care Key Principles of Care (2)Key Principles of Care References (1-4)References GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETERHICKMAN CATHETER 3. PORTPORT 4. PICCPICC Key Principles of Care (2) 5.Aseptic technique – sterile tray and sterile gloves for accessing an open system (when cap/bung is removed) 6.Clean technique - Wash hands, clean gloves and clean bung with 3 alcohol swabs. Allow bung to air dry before proceeding to access a closed system (when cap/bung is in situ) 7.Heparin Lock (Heparinization) – weak versus strong –Strong Heparin Lock (1000u/s in 9ml Normal Saline - give 5ml ) –Weak Heparin Lock (50u/s in 5ml)

11. TUTORIAL Management of Central Venous Access Devices INTRODUCTION Acknowledgements CVAD Tutorials This Tutorial CVAD Description CVAD Types CVAD Choice CVAD IndicationsCVAD ChoiceCVAD Indications Key Principles of Care (1)Key Principles of Care Key Principles of Care (2)Key Principles of Care References (1-4)References GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETERHICKMAN CATHETER 3. PORTPORT 4. PICCPICC References (1/4) 1.Arrow International. (2000). Peripherally Inserted Central Catheters. Continuing Education Program. Arrow, Reading, PA, USA. 2.Brown, J.D., Moss, H.A. & Elliott, T.S.J. (1997). The potential for catheter microbial contamination from a needleless connector. Journal of Hospital Infection. 36, 181-189. 3.Cancer Nursing website. (2005). http://www.cancernursing.org http://www.cancernursing.org 4.Dougherty, L. (2000). Central Venous Access devices. Nursing Standard. 14(43):45-55. 5.Farley, K. (1998). Peripherally Inserted Central Catheters: Patient selection, insertion and maintenance. Johnson & Johnson Medical, USA. 6.Hadaway, L. Catheter related infections. Nursing 2002. 32(9), 46-48 More References

12. TUTORIAL Management of Central Venous Access Devices INTRODUCTION Acknowledgements CVAD Tutorials This Tutorial CVAD Description CVAD Types CVAD Choice CVAD IndicationsCVAD ChoiceCVAD Indications Key Principles of Care (1)Key Principles of Care Key Principles of Care (2)Key Principles of Care References (1-4)References GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETERHICKMAN CATHETER 3. PORTPORT 4. PICCPICC References (2/4) 7.ICU Medical. (2003). Extended Use Microbial Challenge and Disinfection Study of the CLC2000. ICU Medical. http://www.icumed.com/CLC2000.asp http://www.icumed.com/CLC2000.asp 8.Intravenous Nurses Society. (2005). Infusion nursing standards of practice. Journal of intravenous nursing. 23(6S). 9.Catheter Care. Best Practice Statement. www.joannabriggs.edu.au www.joannabriggs.edu.au 10.Latrobe Regional Hospital. (2004). Central Venous Catheter- PICC Management Policy & protocol. Latrobe Regional Hospital-Policies and Protocols, pp.1-4. 11.Lenhart, C. (2001). Preventing central venous access device occlusions with saline only flush by use of an adapter. Journal of Vascular Access Devices. Summer 2001. 12.Luptak, P. (2000). Prevention of PICC and midline occlusions with the CLC2000. Abbott Laboratories. More References

13. TUTORIAL Management of Central Venous Access Devices INTRODUCTION Acknowledgements CVAD Tutorials This Tutorial CVAD Description CVAD Types CVAD Choice CVAD IndicationsCVAD ChoiceCVAD Indications Key Principles of Care (1)Key Principles of Care Key Principles of Care (2)Key Principles of Care References (1-4)References GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETERHICKMAN CATHETER 3. PORTPORT 4. PICCPICC References (3/4) 13.Masoorli, S. & Angeles, T. (2002). Getting a line on central venous access devices. Nursing 2002. 32(4), 36-43. 14.NSW Cancer Institute. (2005). http://www.cancerinstitute.org.au http://www.cancerinstitute.org.au 15.Oncology Nursing Society. (1997). Access device guidelines: Recommendations for nursing practice and education. Pp. 2- 7, 40-46. Pittsburgh, PA, USA. 16.O’Grady, N., Alexander, M., Patchen-Dellinger, E., Gerberding, J., O’Heard, S., Maki, D., Masur, H., McCormick, R., Mermel, L., Pearson, M., Raad, I., Randolph, A. & Weinstein, R. (2002). Guidelines for the Prevention of Intravascular catheter Related Infections. Infection Control and Hospital Epidemiology. 23(12):759-769. More References

14. TUTORIAL Management of Central Venous Access Devices INTRODUCTION Acknowledgements CVAD Tutorials This Tutorial CVAD Description CVAD Types CVAD Choice CVAD IndicationsCVAD ChoiceCVAD Indications Key Principles of Care (1)Key Principles of Care Key Principles of Care (2)Key Principles of Care References (1-4)References GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETERHICKMAN CATHETER 3. PORTPORT 4. PICCPICC References (4/4) 17.Pearson, M., The hospital Infection Control Practices Advisory Committee. (1995). Guidelines for prevention of intravascular device-related infections. National Center for Infectious Diseases Centers for Disease Control and Prevention. 17:438-473. 18.Peter MacCallum Cancer Centre. (2005). Principles of care of central venous access devices. Peter MacCallum Cancer Centre Policies and Procedures 31.1, pp. 1-4. 19.Pratt, R., Pellowe, C., Harper, P., Loveday, H & Robinson, N. (2001). Preventing infections associated with central venous catheters. Nursing Times. 97(15):38-39. 20.Rummel, M., Donnelly, P. & Fortenbaugh, C. (2001). Clinical evaluation of a positive pressure device to prevent central venous catheter occlusion: results of a pilot study. Clinical Journal of Oncology Nursing. 5(6);261-265. 21.Welker, D. (2004). Troubleshooting Vascular Access Devices. Smiths Medical MD. Michigan, USA. End References

15. TUTORIAL Management of Central Venous Access Devices INTRODUCTION Acknowledgements CVAD Tutorials This Tutorial CVAD Description CVAD Types CVAD Choice CVAD IndicationsCVAD ChoiceCVAD Indications Key Principles of Care (1)Key Principles of Care Key Principles of Care (2)Key Principles of Care References (1-4)References GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETERHICKMAN CATHETER 3. PORTPORT 4. PICCPICC GONG Products www.gha.net.au/grics