Vascular access in practice: best practice update

Transcription

1 Vascular access in practice: best practice update Nicola York Clinical Nurse Manager Vascular Access Oxford University Hospitals NHS Foundation Trust June 2016

2 Objectives Patient assessment Best practice for care and maintenance Insertion of PICC s using new technology

3 Patient examination and assessment Underlying diagnosis, relevant past medical history Contraindications for placing intravascular devices Intended duration of drug therapy Previous problems with venepuncture Patient preference

4 Insertion of vascular access devices: Best practice Specialist vascular access teams using evidence based care, adhering to relevant guidelines and competencies Use a catheter with the minimum number of ports or lumens appropriate for management of the patient. (Power, silicone, valve, non valved) Maximum sterile barrier precautions during insertion. (Mermel 2007, Young 2006) Chlorhexidine for skin antisepsis The use of catheter insertion checklist /bundles Ultrasound for internal jugular, femoral and upper arm placement The use of tip confirmation technology Documentation of procedure

5 Catheter Related Bloodstream infection (CRBSI) Intravascular devices can result in bloodstream infection. These are associated with the insertion and maintenance of intravascular devices and are potentially among the most dangerous complications associated with health care. Epic 3 (2014) Hadaway, L. Flushing vascular access catheters: risks for infection transmission. Infect Control Resource. 2007; 4: 1 8

6 Best practice for care and maintenance of intravascular devices Education of health care practitioners use of competency framework The use of VIP score ANTT using 2% chlorhexidine in 70% isopropyl alcohol must be used when accessing any intravascular device and the disinfectant must be allowed to dry before and after accessing the intravascular device.

7 Bionector TKO

8 Best practice for care and maintenance of intravascular devices The use of needle-free infusion systems and connection devices have been widely introduced to reduce the incidence of sharp injuries and minimise the risk of transmission of blood borne pathogens to healthcare workers, they must be disinfected prior to use. The use of catheter securement devices i.e. Statlock or SecurAcath Weekly dressing changes with semipermeable dressing Chlorhexidine sponges or chlorhexidine gel pad dressings

9 Best practice for care and maintenance of intravascular devices? Use of antibiotic/ anticoagulation locks Correct management of complications Patient education, information leaflet, passport care of line/risks/symptoms to recognise Remove intravascular device as soon as treatment finished

10 PICC Tip confirmation technology Is indicated for use as an alternative to chest x-ray and fluoroscopy for PICC tip placement confirmation in adult patients

11 Conclusion: The Key Points Education of healthcare practitioners and patients Expert operator for insertion Following guidelines e.g. NICE, RCN Standards for IV Therapy Remaining up to date with new technology and innovations

12 References Aseptic Non Touch Technique (2010) ANTT Theoretical Framework for Clinical Practice. epic3: (2014) National Evidence-Based Guidelines for Preventing Healthcare- associated Infections in NHS Hospitals in England. H.P. Loveday et.al,journal of Hospital Infection 86S1 S1 S70. Hadaway L (2007) Flushing vascular access catheters :risks for infection transmission. Infect resource 4, 1-8 Mermel L (2007)Prevention of central venous catheter related infections: what works other than impregnated or coated catheters?j Hosp Infect 65 2:30-3 Young E (2006) translating evidence in to practice to prevent central venous catheter associated bloodstream infections : a systems based intervention. Am J Infect Control 34(8)503-6