PREPHERALLY INSERTED VENOUS CATHETERS (MIDLINE CATHETERS)

Transcription

1 CVC MID REV12/2016 PREPHERALLY INSERTED VENOUS CATHETERS (MIDLINE CATHETERS) Instructins fr use Intended use: Sterile single use device indicated t be placed peripherally in the upper arm veins fr use in attaining access t the venus system fr specific purpse : Infusin f: - All intravenus fluids that are apprpriate fr shrt peripheral IV infusin - Infusates that are Less than 10% Dextrse - Infusates that are Less than 5% Prtein - Infusates that are between ph 5 and 9 have an smlarity less than 500 mosm Frequent bld sampling Warning Since upper arm veins run deeper than veins used fr insertin and likely targets fr shrt peripheral IV ca theters, cmplicatins frm the infusin may nt be recgnized until a severe reactin has ccurred. There fre, certain medicatins that are likely t be damaging t the vein generally shuld nt be infused thrugh Midline catheters. These medicatins include vancmycin, nafcillin, Primaxin, Phenergan (prmethazine), and Dilantin (phe nytin) as well as any agent that is hypersmlar (> 500 mosm) r very acidic f basic Warning: Fr single use nly. D nt re-use, reprcess r re-sterilize. D nt use catheter r accessries if any sign f prduct damage is visible. Warning: Reprcessing r re-sterilizatin may damage the catheter and affect its integrity which may, when re-used, lead t severe deteriratin in health and safety f patients. Warning: The catheter des nt have any metallic cmpnents and can be expsed t varius envirnmental cnditins including thermal ignitin surce (during MRI) as lng as n metal cmpnent is attached t it. Warning: The catheters shuld nt be placed in patient fr mre than 4 weeks. Warning: The insertin technique has a significant influence n the cmplicatins and utcme f the patient. Insertin must be perfrmed by a cmpetent and experienced catheter insertin team. Inexperienced 1

2 persnnel shuld nt be permitted t perfrm the insertin except under the direct supervisin f an experienced physician r surgen Hw supplied: The device is sterilized by Ethylene Oxide. Cntents are sterile and nn pyrgenic in unpened and undamaged package. D nt use catheter if sterile package has been damaged r has been pened. Strage: Stre at rm temperature. D nt expse t rganic slvents, inizing radiatin r ultravilet lights, Rtate inventry s that catheters are used prir t expiratin date n package label. Cntraindicatins: The catheter shuld nt be placed in patient with bleeding disrders When the presence f anther device related infectin, bacteraemia r septicemia is knwn r suspected. If severe chrnic bstructive lung disease exists Previus episdes f venus thrmbsis r vascular surgical prcedure at the prspective placement site have ccurred. Lcal tissue factrs which may prevents prper devices stabilizatin and/r access. Histry f mastectmy at the insertin site. Device descriptin Peripherally Inserted venus catheters (Midline catheters) are Radipaque and made frm plyurethane. The catheter tube can be single, dual r multilumen. Midline catheters are lnger than peripheral IV catheters and shrter than peripherally inserted central catheters (PICC) which extend int the vena cava. This device prvides an alt ernative t shrt peripheral IVs fr certain treatments. Catheters are supplied with tw kits type fr direct puncture fllwing Seldinger technique (using ver needle peel away) r its mdified technique (using ver dilatr peel away). Which vein t cannulate? Cephalic, Basilic r the median Cubital veins. Basilic is the preferred insertin site fr peripherally inserted venus catheters. Placement abve anticubital fssa is recmmended. Warning: Placement at r belw anticubital fssa may result in phlebitis Figure 1 Insertin instructins Precautin: Ultrasund culd be used in the placement f catheters. D nt use abslute alchl r acetne based prduct n the catheter. 2% chlrhexidine r Idine based slutin is recmmended as antiseptic slutin. It is nt recmmended t use antimicrbial intments n catheters as it may cause its degradati Catheter Warnings and Precautins Warning: D nt apply excessive frce in placing r remving catheter. Failure t d s can result in catheter breakage. If placement r withdrawal cannt be easily accmplished, an x-ray shuld be btained and further cnsultatin requested. Warning: D nt secure, staple, and fr suture directly t utside diameter f catheter bdy r extensin lines t minimize the risk f cutting r damaging the catheter r impeding catheter flw. Secure nly at indicated stabilizatin lcatins. Warning: D nt cut catheter t alter catheter length unless prcedure requires it. Warning: D nt use scissrs t remve dressing t minimize the risk f cutting catheter.. Precautin: Check ingredients f prep sprays and swabs befre using. Sme disinfectants used at catheter insertin site cntain slvents which can attack the catheter material. Alchl and acetne can weaken the structure f plyurethane materials. These agents may als weaken the adhesive bnd between catheter stabilizatin device and skin. Take care when instilling drugs cntaining high cncentratin f alchl. 2

3 Allw insertin site t dry cmpletely prir t applying dressing. D nt use syringes smaller than 10 ml t minimize the risk f pressure induced damage t catheter. D nt exert excessive frce while remving the catheter t minimize the risk f catheter breakage. Cntinuusly mnitr catheters fr: desired flw rate security f dressing adherence f stabilizatin device t skin and cnnectin t catheter crrect catheter psitin; use centimeter markings t identify if catheter psitin has changed secure cnnectins Identify insertin vein: - Apply turniquet abve anticipated insertin vein. - Identify apprpriate vein fr insertin and access vein suitability. - Temprarily release the turniquet. Preparing fr insertin Precautin: Clinicians shuld use sterile techniques and dress in prtective clthing. 1. Drape puncture site. 2. Perfrm a lcal anesthetic as needed. Catheter Insertin Instructins Mdified Seldinger - Using ver dilatr peel away sheath. 1. Reapply turniquet and replace sterile glves. 2. Lcate vein fr insertin and use image guidance if available. 3. Insert intrducer needle int vein and check fr pulsatile flw. Pulsatile flw is usually an indicatr f inadvertent arterial puncture. The clr f bld bserved is nt always a reliable indicatr f venus access. 4. Insert sft tip f guide wire thrugh intrducer needle int vein. Advance guide wire t desired depth. Warning: D nt insert stiff end f guidewire int vessel as this may result in vessel damage. Warning: D nt cut guide wire t alter length. Warning: D nt withdraw guidewire against needle bevel t minimize the risk f pssible severing r damaging f guidewire. Warning: If any resistance is felt then the needle shuld be pulled ut with the wire still inside and the prcedure repeated. This reduces the risk f entangling f the guide wire r its end being cut ff by the needle tip 5. Hld guidewire in place while remving intrducer needle and maintain firm grip n gaidewire at all times. 6. Enlarge puncture site if necessary by using scalpel psitined away frm the guidewire t enlarge the puncture site. 7. Thread tapered tip f peel-away sheath dilatr assembly ver guidewire. Advance assembly with slight twisting mtin t a depth sufficient t enter vessel. Dilatr may be partially withdrawn t Further facilitate advancement f sheath int the vessel. A slight twisting mtin f the peel-away might help sheath advancement. D nt withdraw tissue dilatr until the sheath is well within the vessel t minimize the risk f damage t sheath tip. Sufficient guide wire length must remain expsed at huh end f sheath t maintain the firm grip n guide wire 8. Hld the sheath in place, withdraw guide wire and dilatr as ne unit. Warning: D nt leave the dilatr in plate t minimize the risk f pssible vessel wall perfratin. 3

4 Warning: D nt apply undue frce n guidewire t minimize the risk f pssible breakage. 9. Insert Catheter thrugh peel-away sheath. Warning: D nt apply excessive frce in placing r remving catheter. Failure t d s can result in catheter breakage. Warning: If placement r withdrawal cannt he easily accmplished, an X-ray shuld be btained and further cnsultatin requested. 10. IF resistance is met while advancing catheter. retract and/r gently flush while advancing. 11. Befre reaching pre- established insertin length, withdraw peel-away sheath ver catheter until free frm vcnipuncture site. 12. Grasp tabs f peel-away sheath and pull apart away frm catheter until sheath splits dwn entire length. 13. Advance catheter t final psitin. Catheter clamp must nt t be clamped until either guidewire is remved. 14. Verify Catheter tip placement by checking catheter placement with syringe and aspirating thrugh distal lumen until free flw f venus bld is bserved. The clr f bld is nt always a reliable indicatr f venus access. 15. Flush lumen(s) t cmpletely clear bld frm catheter. Use catheter clamps, if prvided, t cclude lumen(s). If catheter is equipped with female luer valve fllw the fllwing instructins 16. Cleanse insertin site per hspital prtcl. 17. Ensure insertin site is dry befre applying dressing. D nt rutinely apply prphylactic tpical antimicrbial r antiseptic intment r cream t the insertin site f peripheral venus catheters because f the ptential risk t prmte fungal infectins and antimicrbial resistance. 18. Secure catheter in place by suture fixatin r using adhesives. Fixatin with hub fixatin adhesive The hub is suitable t wrk with many cmmercial hub fixatin adhesives ( Statlk, Griplk, unifix lk, ) 19. Assess placement f catheter tip in cmpliance with hspital prtcl. Direct puncture - Using ver needle peel away sheath. 1. Reapply turniquet and replace sterile glves. 2. Lcate vein fr insertin and use image guidance if available. 3. Insert the ver needle peelaway sheath int vein and be sure that the flw is nt pulsatile. Pulsatile flw is usually an indicatr f inadvertent arterial puncture. 4. Hld the sheath in place, withdraw its needle. 5. Cntinue with step (9.) mentined abve. Catheter Care and Maintenance Dressing Replace dressing accrding t rganizatinal plicies, prcedures, and practice guidelines. Change immediately if the integrity becmes cmprmised e.g. dressing becmes damp, siled, lsened, r n lnger cclusive. Transparent semipermeable membrane dressing shuld be changed every week. Gauze and tape shuld be changed every 2 days 4

5 Label dressing with type, size, and length f catheter; date and time. Maintain Catheter Patency: Maintaining venus catheter patency shuld dne in accrdance with hspital plicies, prcedures, and practice guidelines. The persnnel wh care fr patients with venus catheters must be knwledgeable abut effective management t prlng catheters dwell time and prevent injury. Slutin and frequency f flushing a venus access catheter shuld be established in hspital plicy. Catheter patency is established and maintained by flushing intermittently via syringe with heparinized saline r 0.9% sdium chlride. Cntinuus drip is preferred. Assess patient fr heparin sensitivity. Heparin-induced thrmbcytpenia has been reprted with the use f heparin flushing slutins. The vlume f flush slutin shuld be equal t at least twice the priming catheter. When using any venus catheter fr intermittent infusin therapy, prper flushing using a psitivepressure flushing technique will help prevent cclusin. All valves, if used, need are t be prperly swapped with an apprpriate antiseptic befre being accessed. Catheter Remval Prcedure - Catheter shall be remved immediately upn patient assessment fr: - suspected cntaminatin - unreslved cmplicatin - discntinuatin f therapy - Place patient in supine psitin t minimize the risk f ptential air emblism. - Remve dressing and securements. - Remve catheter by slwly pulling it parallel t skin. If resistance is met, catheter shuld nt be frcibly remved and the physician shuld be ntified. D nt exert excessive frce while remving the catheter; t minimize the risk f catheter breakage. - Upn remval f catheter, measure and inspect t ensure entire catheter length has been remved - Apply direct pressure at site until hemstasis is achieved. - Dress insertin site with sterile cclusive dressing Cmplicatins Table 3. Ptential cmplicatins. Early Arterial puncture- Bleeding Injury t surrunding nerves Air emblism Late Venus thrmbsis r phlebitis Infectin Causes f Early Catheter Dysfunctin Kinks Drug precipitatin (sme antibdy lcks r IV IgG) Lss f catheter integrity by infectin Methds that shuld be used t treat a dysfunctinal r nn-functinal catheter include: Use f thrmblytics, as per hspital prtcl. All catheter-related infectins, except fr catheter exit-site infectins, shuld be addressed by initiating parenteral treatment with an antibitic(s) apprpriate fr the rganism(s) suspected. Definitive antibitic therapy shuld be based n the rganism(s) islated. 5

6 Catheters shuld be exchanged as sn as pssible and within 72 hurs f initiating antibitic therapy in mst instances, and such exchange des nt require a negative bld culture result befre the exchange. Fllw-up cultures are needed 1 week after cessatin f antibitic therapy. Catheter dispsal Used Catheter shuld be dispsed in sanitary cntainer r accrding t hspital prtcl t prevent pssible cntaminatin and crss infectin. Descriptin f marking system: The catheter tube is reversely marked fr effective length in numerical number every 1 centimeters and dt every ne 10 centimeter. Hwever the first 5 cm is nt marked. The marking start and ascend frm catheter hub. Example fr 60 cm lng: Catheter Kits range Midline catheters range Fr. Size Length Single lumen Duble lumen 2 10 MLSLC MLSLC MLSLC MLSLC MLSLC MLSLC MLSLC MLSLC MLSLC MLSLC MLDLC MLSLC MLDLC MLDLC MLDLC MLSLC MLSLC MLDLC MLSLC MLDLC

7 Catheter kit fr Seldinger technique (using IV cath cannula) Fr. Size Length cm Single lumen duble lumen Pressure resistant single lumen 3 10 MLSLC-0310-K PRMLSLC-0310-K 3 12 MLSLC-0312-K PRMLSLC-0312-K 3 20 MLSLC-0320-K PRMLSLC-0320-K 3 25 MLSLC-0325-K PRMLSLC-0325-K 4 10 MLSLC-0410-K PRMLSLC-0410-K 4 12 MLSLC-0412-K PRMLSLC-0412-K Pressure resistant duble lumen 4 20 MLSLC-0420-K MLDLC-0420-K PRMLSLC-0420-K PRMLDLC-0420-K 4 25 MLSLC-0425-K MLDLC-0425-K PRMLSLC-0425-K PRMLDLC-0425-K MLDLC K PRMLDLC K MLDLC K PRMLDLC K 5 12 MLSLC-0512-K PRMLSLC K 5 20 MLSLC-0520-K MLDLC-0520-K PRMLSLC-0520-K PRMLDLC-0520-K 5 25 MLSLC-0525-K MLDLC-0525-K PRMLSLC-0525-K PRMLDLC-0525-K Catheter kit fr Seldinger technique (using ver needle peel away intrducer) Fr. Size Length cm Single lumen duble lumen Pressure resistant single lumen 2 10 MLSLC-0210-KON 2 12 MLSLC-0212-KON 2 20 MLSLC-0220-KON 3 10 MLSLC-0310-KON PRMLSLC-0310-KON 3 12 MLSLC-0312-KON PRMLSLC-0312-KON 3 20 MLSLC-0320-KON PRMLSLC-0320-KON 3 25 MLSLC-0325-KON PRMLSLC-0325-KON 4 10 MLSLC-0410-KON PRMLSLC-0410-KON 4 12 MLSLC-0412-KON PRMLSLC-0412-KON Pressure resistant duble lumen 4 20 MLSLC-0420-KON MLDLC-0420-KON PRMLSLC-0420-KON PRMLDLC-0420-KON 4 25 MLSLC-0425-KON MLDLC-0425-KON PRMLSLC-0425-KON PRMLDLC-0425-KON MLDLC KON PRMLDLC KON MLDLC KON PRMLDLC KON 5 12 MLSLC-0512-KON PRMLSLC KON 5 20 MLSLC-0520-KON MLDLC-0520-KON PRMLSLC-0520-KON PRMLDLC-0520-KON 5 25 MLSLC-0525-KON MLDLC-0525-KON PRMLSLC-0525-KON PRMLDLC-0525-KON 7

8 Catheter kit fr Mdified Seldinger technique (using Over Dilatr peel away intrducer) Fr. Size Length cm Single lumen duble lumen Pressure resistant single lumen 3 10 MLSLC-0310-KOD PRMLSLC-0310-KOD 3 12 MLSLC-0312-KOD PRMLSLC-0312-KOD 3 20 MLSLC-0320-KOD PRMLSLC-0320-KOD 3 25 MLSLC-0325-KOD PRMLSLC-0325-KOD 4 10 MLSLC-0410-KOD PRMLSLC-0410-KOD 4 12 MLSLC-0412-KOD PRMLSLC-0412-KOD Pressure resistant duble lumen 4 20 MLSLC-0420-KOD MLDLC-0420-KOD PRMLSLC-0420-KOD PRMLDLC-0420-KOD 4 25 MLSLC-0425-KOD MLDLC-0425-KOD PRMLSLC-0425-KOD PRMLDLC-0425-KOD MLDLC KOD PRMLDLC KOD MLDLC KOD PRMLDLC KOD 5 12 MLSLC-0512-KOD PRMLSLC KOD 5 20 MLSLC-0520-KOD MLDLC-0520-KOD PRMLSLC-0520-KOD PRMLDLC-0520-KOD 5 25 MLSLC-0525-KOD MLDLC-0525-KOD PRMLSLC-0525-KOD PRMLDLC-0525-KOD The catheter kit fr Mdified Seldinger technique has the fllwing accessries Intrducer needle. Straight end Nitinl guide wires. Shrt ver dilatr peel away sheath intrducer. Mini scalpel. - Syringe. The catheter kit fr Seldinger technique (direct puncture) has the fllwing accessries Tuhy burst adaptr T-cnnectr with sidearm valve cnnectr Straight end Nitinl cre wires with stainless steel tip r gld cated tip. Over the needle peel away sheath intrducer. Mini scalpel. - Syringe 8