Vascular Access Devices & Infusion Therapy Specialist Practice Network 12 May 2016
Meet the VAD&IT SPN Committee Chair - Nicole Gavin (Qld) Deputy Chair - Kerrie Curtis (Vic) Treasurer position vacant
VAD Guideline Leads Pre-insertion & insertion *Vessel preservation - Tricia Kleidon (Qld) Device selection & insertion - Fiona Gillianders (NSW) Patient education vacant Competency & Documentation Nurse education & competency Leisa Brown (Qld) Legal issues & documentation - vacant Maintenance & Failure (mechanical & infective) *Dressings & securement - Sarah Northfield (Qld) Skin prep & integrity Sara Hurren (Qld) Occlusion & thrombosis - Fiona Fuller (Qld) Flushing & blood taking Renee McMullen (Qld) Infection - Peter Haywood (Vic) *ANTT & NC Julie Flynn (Qld) Surveillance of complications Emily Larsen (Qld)
Vessel preservation How frequently should peripheral venous catheters be replaced? How can nurses ensure the correct placement of peripheral venous catheters for chemotherapy administration? How many attempts should a clinician have before escalating peripheral venous catheters insertion?
Dressings & securement How often should dressings be changed on central venous access devices? Which dressings and securement devices are best for my patient with a central venous access device? Which dressings and securement devices are best for my patient with a peripheral venous catheter? What is the ideal dressing to minimise the risk of central venous access device-site infection? What are the factors that minimise the risk of central venous access device-site infections when changing dressings?
Which are the best dressing and securement devices are best for my patient with a central venous access device? Patient(s) Cancer patients with a CVAD (general) Cancer patients with a PICC Cancer patients with a tunnelled cuffed CVAD Intervention(s) & Control(s) Outcomes(s) Infection Mechanical CVAD dwell time Dressing integrity Skin integrity Site preparation 2% CHG versus povidone iodine versus ETOH Dressings Gauze & tape versus transparent dressings Stitching versus stat lock versus glue Transparent dressing & stat lock versus integrated dressing Transparent dressing versus transparent dressing & biopatch versus CHG dressing CHG versus AMD (PHMB) versus silver patches Frequency Daily versus weekly
Aseptic non touch technique & needless connectors How long do I need to scrub the hub for? How often should needleless connectors (and other extension tubing) be changed? What is the evidence supporting changing needleless catheter caps/bungs frequently? (I.e. post blood administration/blood tests/administration set change)
Which needless connector should I use? How long should I scrub the hub for? Patient(s) Cancer patients with a vascular access device (peripheral or central) Intervention(s) & Control(s) Neutral versus positive versus negative displacement values ETOH versus CHG for NC decontamination 5 second versus 15 second versus 30 second hub scrub Manual hub scrub versus passive decontamination Outcomes(s) Infection Mechanical CVAD dwell time
Additional reviewers Mellisa Arneil (Qld) Ray Chan (Qld) Dan Fitzgerald CIRCS (Qld) Helen Westman (nee Blackburn)
Cancer Wiki Guidelines
Rise and rise in the number of Cochrane Systematic reviews
Pre-insertion 1. 1. Comparison of routes for achieving parenteral access with a focus on the management of patients with Ebola virus disease 2. 2. Ultrasound guidance versus anatomical landmarks for subclavian or femoral vein catheterisation 3. 3. Catheter impregnated, coating or bonding for reducing central venous catheter-related infections in adults
Complications & management Occlusion & thrombosis 4a. Heparin versus 0.9% sodium chloride intermittent flushing for prevention of occlusion in central venous catheters in adults 4b. Heparin versus 0.9% sodium chloride intermittent flushing for prevention of occlusion in long term central venous catheters in infants and child 5. Interventions for restoring patency of occluded central venous catheter lumens
Complications & management Dressings 6a. Devices & dressings to secure peripheral venous catheters 6b. Dressings and securement devices for central venous catheters
Complications & management Phlebitis 7. Aloe vera for prevention and treatment of infusion phlebitis
Complications & management Routine replacement 8. Clinically-indicated replacement versus routine replacement of peripheral venous catheters
Complications & management Device removal 9. 9. Early removal versus expectant management of central venous catheters in neonates with bloodstream infection
Complications & management Adherence to guidelines 10. 10. Interventions to improve professional adherence to guidelines for prevention for device-related infections