ATI Skills Modules Checklist for Central Venous Access Devices

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1 For faculty use only Educator s name Score Date ATI Skills Modules Checklist for Central Venous Access Devices Student s name Date Verify order Patient record Assess for procedure need Identify, gather, and prepare equipment and supplies accessing the site (clean gloves, sterile gloves, mask, noncoring [Huber] needle, extension tubing with clamp, injection or access cap, 10-mL syringe filled with preservative-free 0.9% sodium chloride solution, heparin, preservative-free flush solution in 10-mL syringe, transparent dressing, sterile gauze dressing, antiseptic, sterile field, sterile tape) obtaining a blood sample (clean gloves, 10-mL syringes filled with preservative-free 0.9% sodium chloride solution, heparin, flush solution in a 10-mL syringe, antiseptic, biohazard container, blood tubes, needleless connector, and barrel holder for evacuated collection tube system) initiating an infusion (10-mL syringes filled with 0.9% sodium chloride solution, heparin, flush solution in 10-mL syringes, prepared and labeled 10-mL medication syringe(s), alcohol preps, infusion pump, primed infusion tubing, infusion fluid, clean gloves) discontinuing an infusion (clean gloves, sterile cap, antiseptic, flush solution in 10-mL syringe) deaccessing the site (clean gloves, sterile dressing, alcohol preps, paper tape, 10-mL syringe filled with preservative-free 0.9% sodium chloride solution, heparin, preservative-free flush solution in a 10-mL syringe) Tunneled catheter initiating an infusion (10-mL syringes filled with 0.9% sodium chloride solution, heparin, flush solution in 10-mL syringes, 10-mL medication syringe(s), alcohol preps, infusion pump, primed infusion tubing, infusion fluid, clean gloves)

2 Identify, gather, and prepare equipment and supplies (continued) Peripherally inserted central catheter obtaining a blood sample (clean gloves, two 10-mL syringes filled with 0.9% sodium chloride solution, heparin, flush solution in a 10-mL syringe, antiseptic, biohazard container, two empty 10-mL syringes, access/injection cap) Peripherally inserted central catheter dressing change (clean gloves, central line dressing-change kit, sterile gloves, mask, antiseptic, transparent dressing, gauze dressing, tape, catheter-stabilizing device or butterfly closures, skin prep) Apply principles of aseptic practice Hand hygiene Personal protective equipment Disposal of waste Communicate effectively Privacy Patient identification Patient teaching Provide for a safe environment Body mechanics Equipment placement Patient safety

3 Demonstrate procedural steps accessing the site Apply topical anesthetic. Palpate and inspect skin over and around port. Open outer wrap of supplies. Don mask and prepare supplies using surgical asepsis. Don sterile gloves. Prime and prepare access cap, extension tubing, and noncoring needle with prefilled saline syringe. Keep syringe attached to access cap and place on sterile field. Cleanse site with antiseptic and allow it to dry. Immobilize device with nondominant hand. With dominant hand, insert primed needle into port at 90-degree angle. Push firmly through skin until needle hits back of port. Pull back slightly on syringe plunger to check for brisk blood return. Flush with sterile normal saline from syringe attached to injection cap and extension tubing. Cover device with sterile transparent dressing. Use positive-pressure flushing technique to remove syringe. If deaccessing port, heparinize line before removing noncoring needle. Label site. obtaining a blood sample Temporarily turn off any infusing solutions. Disconnect IV tubing from access port. Clean access port and injection cap with antiseptic, then allow it to dry. Connect saline-filled syringe to appropriate lumen. Withdraw blood until it reaches syringe but does not enter into syringe. Flush line with normal saline in 10-mL or larger syringe using minimal pressure. Prepare supplies. Using same syringe, aspirate and withdraw blood to discard. Attach syringe to extension tubing. Withdraw blood sample by pulling back on plunger. Remove syringe from extension tubing or holder.

4 Demonstrate procedural steps obtaining a blood sample (continued) Attach blood transfer device to syringe. Fill blood tubes. Advance tube inside holder. Flush line using pulsatile flush method. Clamp tubing and remove syringe, maintaining positive pressure while withdrawing syringe. Connect new access cap (if appropriate). Connect IV tubing to extension tube. Label specimen, place in biohazard bag, and send to laboratory. initiating an infusion Perform rights of medication administration. For bolus administration, attach 10-mL medication syringe to access port and deliver bolus at recommended rate. Wipe access port with alcohol pad and allow it to dry. Attach prefilled saline syringe to access port. Open clamp and aspirate for blood flash or blood return. Flush line with required amount of fluid in 10-mL or larger syringe using pulsatile flush method. Maintain positive pressure when withdrawing syringe. For continuous or intermittent infusion, connect IV tubing to access port. Swab port with alcohol pad, allow it to dry, and attach IV tubing and administer infusion. discontinuing an infusion Discontinue IV infusion by turning off pump. Clamp extension tubing. Disconnect IV tubing from access port. Place sterile cap on end of IV tubing. Clean access port and injection cap with antiseptic and allow it to dry. Flush line with normal saline. Clamp tubing. With positive pressure, withdraw syringe.

5 Demonstrate procedural steps deaccessing the site Don clean gloves and palpate and inspect skin over and around port. Prepare supplies. Open clamp on extension tubing. Cleanse access cap with antiseptic. Attach prefilled 10-mL saline syringe to access cap. Aspirate for blood flash. Withdraw blood until it reaches syringe but does not enter into syringe. Flush line with normal saline, using pulsatile flush method. If port requires heparinization, attach labeled heparin syringe to access cap of clamped extension tubing, and flush line. Loosen and then remove all dressings stabilizing and covering noncoring Huber needle. Use thumb and index finger of nondominant hand to stabilize device. Use dominant hand to remove Huber needle with upward pull to engage needle s safety feature. Apply pressure with sterile gauze if bleeding. Tunneled catheter initiating an infusion Identify port for administering fluid and medication. Wipe access port with alcohol pad and allow it to dry. Attach prefilled saline syringe to access port. Open clamp and aspirate for blood flash or blood return. Flush line with required amount of fluid using 10-mL or larger syringe and minimal pressure. Maintain positive pressure when withdrawing syringe. Use SAS or SASH method. Swab port with alcohol pad, allow it to dry, and attach IV tubing to access port and administer infusion. For bolus administration, swab access port with alcohol pad. Attach 10-mL medication syringe to access port and deliver bolus at recommended rate. Flush line with saline when infusion is completed or immediately following bolus administration. Use pulsatile flush method. With positive pressure, withdraw syringe. If using SASH method, attach heparin syringe and administer.

6 Demonstrate procedural steps Tunneled catheter initiating an infusion (continued) Clamp line before removing syringe. Peripherally inserted central catheter obtaining a blood sample Raise height of bed and lower head of bed. Don clean gloves and temporarily turn off any infusing solutions. Clamp all lumens not used for drawing blood. Inspect and palpate around insertion site for swelling or tenderness. Using friction, clean access port and injection cap with antiseptic, then allow it to dry. Connect saline-filled syringe to appropriate lumen. Aspirate for blood flash. Withdraw blood until it reaches syringe but does not enter into syringe. Flush line with normal saline in 10-mL or larger syringe and use pulsatile flush method with minimal pressure. Clamp tubing if appropriate and, using same syringe, aspirate and withdraw blood to discard. Attach syringe to extension tubing and unclamp line if appropriate. Withdraw blood sample by pulling back on plunger. Discard specimen in a biohazard container. Place a new, sterile injection hub onto access cap. Flush catheter using pulsatile flush method. Clamp tubing if appropriate and remove syringe. Fill blood tubes. Resume infusions. Peripherally inserted central catheter dressing change Ask patient to turn his head away from insertion site. Raise height of bed and lower head of bed. Don clean gloves and mask. Inspect and palpate site around dressing for swelling or tenderness. With clean gloves, remove dressing by pulling it toward catheter s insertion site. When removing transparent dressing, grasp opposite sides, pull outward, and stretch it away from insertion site. Assess site and examine catheter and hub.

7 Demonstrate procedural steps Peripherally inserted central catheter dressing change (continued) Remove any catheter-securing device and antimicrobial patch. Measure external portion of catheter. Compare this measurement to previous length to detect migration. Remove gloves. Discard dressing and gloves. Perform hand hygiene. Open dressing kit. Don sterile gloves. Cleanse insertion site. Cleanse skin under central line and line. Allow area to air-dry. Apply skin prep. Apply catheter-securing device or wound closure strips. Apply antimicrobial patch. Apply transparent dressing. Coil external portion of catheter and tape it in place. Leave catheter s end cap exposed.

8 Documentation Document per facility policy General assessment: Site condition and appearance Body temperature Clear labels on all lines Determination of external catheter length when appropriate Fluid and/or medication infusing at prescribed rate Any indicators of infection (erythema, warmth, swelling, tenderness, discharge) Replacing dressing: Assessment of insertion site External catheter length Status of insertion site Condition of previous dressing Site care performed Adherence to sterile technique Type of dressing applied Site labeled with date, time, s Patency of tubing (if evaluated) Drawing blood: If applicable, length of time infusion stopped prior to blood sampling Laboratory tests to be performed Amount of blood used for sampling Appropriate labeling of specimen collected Lumen used for blood sampling Patency of catheter and ability to flush and draw blood Method used (syringe versus evacuated collection tube system) Follow-up care (cap replacement, heparin flush, infusion restarted)

9 Documentation Document per facility policy Accessing implanted port: Assessment findings for surrounding tissue Location of insertion site (where port is located) Gauge of Huber needle used to access port Reason for access Difficulty accessing port and interventions used Type of dressing applied after access Flush (normal saline or heparin) Infusion therapy initiated Deaccessing implanted port: Location of insertion site (where port is located) Assessment findings for surrounding tissue Heparinization (include volume/concentration) Dressing applied Administering IV fluid, medications, or parenteral nutrition: Assessment findings prior to administering medication (blood pressure before IV beta blocker, pain rating before IV analgesic) Patency of line Troubleshooting techniques implemented for resistance or difficulty with flushing Type of fluid or medication administered Which fluids and medications are infusing through each pathway Evaluation findings after administering medication (blood pressure after administering IV beta blocker, pain rating after IV analgesic) Flush solution used after medication administration (normal saline, heparin) Patient education: Type of central venous access device and purpose Activity restrictions when applicable Hand hygiene When to seek medical care

10 Documentation Document per facility policy Patient education (continued): Principles of sterile technique Site care Flushing Troubleshooting techniques Emergency measures for clamping catheter if it breaks

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