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1 If viewing a printed copy of this policy, please note it could be expired. Got to to view current policies. Department Policy Code: D: PC-5575 Entity: Fairview Pharmacy Services Department: Fairview Home Infusion Manual: Policy and Procedure Manual Category: Home Infusion Subject: Peripheral Venous Access Purpose: Fairview Home Infusion qualified staff who is responsible for maintenance of peripheral venous access systems will follow established policies and procedures to provide safe and appropriate patient care. Policy: A peripheral-short catheter shall be placed for therapeutic or diagnostic indications and will be inserted with an aseptic, no-touch technique. FHI RN will make two attempts; if unsuccessful the RN will offer a second RN to attempt placement unless the patient agrees to have the first RN make additional attempts. Definitions: No-touch technique: the intended VAD insertion site is not palpated after skin cleansing, unless sterile gloves are worn. Procedure: I. Equipment A. Gloves, nonsterile B. Short peripheral catheter C. IV start kit D. Local anesthetic as indicated/ ordered E. Needleless connector and any add-on devices F. Preservative-free 0.9% sodium chloride prefilled syringe(s) and/ or primed administration set G. Sharps container H. Waste receptacle I. Vein visualization device and disposable covers if using Page 1 of 6

2 II. J. Alcohol pads Patient Education and Site Assessment/ Selection A. Obtain and review prescriber s order. B. Verify patient s identity using two (2) independent identifiers. C. Provide patient with information on site assessment/ selection, catheter insertion procedure including specific device benefits, management, and potential complications. D. Obtain patient s verbal consent. E. Place patient in a recumbent position, as needed. F. Perform hand hygiene. G. Gather supplies. H. Assess for an appropriate venipuncture site. 1. Avoid using lower-extremity veins in adults 2. Initiate the site selection process in non-dominant arm I. Use the following principles to guide vein selection: 1. Assess appropriate veins on both dorsal and ventral surfaces of the hand and forearm 2. Avoid the following: a. Areas of flexion b. Areas of pain upon palpation c. Bruised, phlebitic, infiltrated, sclerosed, corded veins d. Areas near valves e. Areas where there are planned procedures f. Areas of lymphedema g. Extremities affected by stroke or injury h. For patient with chronic kidney disease, avoid forearm and upper arm veins 3. Assess veins by applying tourniquet a. Palpate extremity distal to tourniquet to assess vein condition and inspect skin integrity b. Palpate intended venipuncture site to differentiate arteries from veins Page 2 of 6

3 c. If unable to palpate vein instruct the patient to open and close fist several times; position extremity lower than heart for several minutes; lightly stroke vein downward; apply heat to extremity for about minutes to promote vein relaxation and dilation. 4. Select the most distal site for catheter placement. Select sites that are proximal to any previous cannulation sites. J. If vein visualization device is used to determine site: 1. Turn off any overhead fluorescent lights as these may interfere with transillumination. 2. Perform hand hygiene. 3. Place device inside the disposable plastic cover. Wipe the area of the cover coming in contact with the patient with 70% isopropyl alcohol or other medically-accepted disinfectant. Check the cover to make sure it is intact. 4. Visually locate the region of the skin you wish to examine for veins, and use the device to locate a site. Apply gentle pressure to the device to ensure it is in contact with the skin 5. If device to be used during insertion of catheter. Device must be placed on a clean surface and cleaned with 70% isopropyl alcohol again prior to use. K. Prepare insertion site. 1. If visibly soiled, cleanse with antiseptic soap and water L. Perform hand hygiene if not previously done and don gloves. M. Select an antiseptic solution to disinfect insertion site; allow site to dry completely. Recommended solutions include: 2. Chlorhexidine gluconate (preferred): apply using a back-and-forth motion for at least 30 seconds 3. Alcohol and Povidone-iodine (3 of each): apply using swab-sticks in a concentric circle beginning at the catheter insertion site, then moving outward; it must remain on the skin for at least 2 minutes or longer to Page 3 of 6

4 completely dry for adequate antisepsis III. Device Placement and Therapy Initiation A. Apply tourniquet above intended venipuncture site. B. When not using a vein visualization device; stabilize vein below intended venipuncture site with non-dominant hand. C. To access a vein while viewing with the vein visualization device, place the properly-covered and cleansed device over the vein. Rotate the device so the opening in the circle of the LEDs faces away from the heart. Apply gentle pressure on the device to sequester the vein. Pull back slightly on the device to stretch the skin and provide traction. Insert the needle in the normal way per protocol listed below. Discard the disposable plastic cover after each patient use. D. Insert the catheter according to manufacturer s directions for use. E. Release tourniquet. F. Remove stylet. 1. Activate engineered safety mechanism. 2. Discard stylet in sharps container. IV. Post-Catheter Placement A. Attach appropriate add-on devices primed with preservative-free 0.9% sodium chloride (USP) and flush catheter, or attach primed administration set. 1. Observe the site for signs of swelling, or patient complaints of discomfort or pain, removing VAD if present B. Stabilize VAD with tape; avoid placing tape over or near the insertion site. C. Dress venipuncture access site with a sterile transparent dressing. D. Secure connection junctions. E. Discard expended equipment in appropriate receptacles. F. Remove gloves and perform hand hygiene. Page 4 of 6

5 G. Label dressing: 1. Date and time of insertion 2. Gauge and length of VAD 3. Initials of inserter H. Initiate prescribed therapy as indicated. I. Document procedure in patient s permanent medical record. V. Site Rotation VI. A. The peripheral catheter should be routinely changed every 96 hours and on a PRN basis. Exception: If venous access is difficult, the catheter may be left in place longer than 96 hours with prescriber orders if site is healthy and patent. Removal of a Peripheral Venous Catheter A. Equipment 1. Gauze pad 2. Non-sterile gloves 3. Band-Aid or tape B. Discontinuing a Peripheral Venous Catheter 1. Explain procedure to patient/caregiver. 2. Clean workspace; gather equipment and perform hand hygiene. 3. Don gloves. 4. Place patient in sitting or recumbent position as needed. 5. Remove dressing and tape from insertion site. 6. Assess site for redness, swelling, pain, palpable cord, or streak formation. 7. Remove catheter with a continuous motion and apply pressure at the site with gauze. 8. Apply pressure to site with gauze until hemostasis is achieved, minimum of 30 seconds. 9. Apply bandage when bleeding has stopped from the venipuncture site. 10. Inspect the catheter to be intact. 11. Discard used supplies Page 5 of 6

6 12. Remove gloves and perform hand hygiene. 13. Instruct patient to monitor site until healed and to report any concerns to their healthcare provider. 14. Document procedure in patient s permanent medical record. External Ref: INS Policies and Procedures for Infusion Nursing; 4 th Edition, 2011 Internal Ref: Joint Commission applicable standards Source: FHI Clinical Managers; Compliance Department Approved by: Director of Operations, Medical Director Date Effective: 01/01/1990 Date Revised: 06/01/1991, 03/08/1995, 02/29/1996, 03/19/1999, 3/28/2001, 10/30/2001, 1/1/2002, 5/2008, 5/2011, 11/2014 Date Reviewed: 11/2014 Page 6 of 6