Vascular Access Procedures PDF

## Disinfection of Durable Medical Equipment / Ultrasound Probe * Disinfection of ultrasound probes for vascular access * Refer to manufacturers IFU for recommended level of disinfection * Clean transducer prior to disinfection * Ensure the disinfectant is approved by the manufacturer...

## Disinfection of Durable Medical Equipment / Ultrasound Probe * Disinfection of ultrasound probes for vascular access * Refer to manufacturers IFU for recommended level of disinfection * Clean transducer prior to disinfection * Ensure the disinfectant is approved by the manufacturer prior to use. Some disinfectants can degrade and damage the sensitive probe transducer over time. * AVA's position on transducer disinfection aligns with the intersocietal position statement. Only low or intermediate level disinfection methods are recommended for percutaneous procedures ## Device Insertion * Routine insertion environment * Surgical suite or interventional radiology suite * Tunneled CVADS * Implanted ports * Pulmonary Artery Catheter (may be bedside in critical care settings) * Bedside placement (acute care settings, outpatient facilities, home, long-term care, sub-acute care facilities except when otherwise indicated below) * Peripheral IV * Midlines * Non-tunneled CVADS (Including PICCs, dialysis, and apheresis catheters) * Tunneled CVADS * Aquapheresis Catheter * Arterial Catheter (Acute care only) * Intraosseous device (Pre-hospital emergencies or Acute care only) * Maximal sterile barrier (MSB) required for a CVAD insertion and recommended for peripheral midline insertion * Aseptic Technique: Specific practice steps that are designed to minimize the risk of transmission of pathogens to a patient. * No Touch Technique: A specific type of aseptic technique where key areas of items to be used for an infusion cannot be touched prior to insertion (ie, the IV cannula, the syringe tip, the needleless tip of IV tubing); once a site has been treated with antiseptic it can only be touched by the clinician if wearing sterile gloves. ## Pediatric Considerations * **Sedation** * Patients (routinely pediatrics) on inpatient units may have Vascular Access Devices (VADs) inserted in a procedure room to avoid violation of the "safe haven" of the patient room. * **Procedural Sedation** * Risks, benefits, and alternatives must be explained to the patient and or family and consent obtained. * Peripheral IV access is required for administration. * Sedation may be mild, moderate, or deep (requiring anesthesia consultation). * Topical, Transdermal anesthetics/analgesics, and vibration therapy. * Some type of pain control, anesthetic or analgesic should be offered to all patients regardless of age prior to insertion of any VAD. * Follow mamufacturer's instructions for use for optimal application. * Apply to the planned insertion site or indwelling port prior to access with non-coring needle. * Allow for adequate time for medication to reach therapeutic effect * Anxiolytic medications and techniques. * Used for relaxation in an anxious patient. * Anesthesia services may be required for optimal comfort and safety. * Distraction (Music, guided imagery, virtual reality, augmented reality, video, and meditation) is proven effective as an adjunct to or replacement for medication. * Moderate sedation or general anesthesia may be required. * Ensure patients are warm and as comfortable as possible. * Injury to caregiver prevention. * Complimentary therapies. ## Proper Hand Hygiene (5 moments of Hand Hygiene) prior to patient contact * Time-out: Verbally confirm the patient's name, date of birth, and/or medical record number, device, and site for all CVAD insertion procedures. * If insertion site and surrounding area are hairy, clip hair using single use surgical clippers (do not use razor). * Clipping of hair should be performed as close to the time of the procedure as possible in order to reduce the risk for microbial growth in breaks in the skin. * Skin antisepsis on planned insertion site. * An adequate amount of chlorhexidine should be applied using friction on clean skin for at least 30 seconds and allowed to dry completely. ## Dressing and Securement * Insert selected venous access device following institution/organization policies and procedures and manufacturer's instructions for use. * Manufactured securement devices are recommended for catheter securement*. * Stabilizes external portion of the catheter. * Prevents catheter migration and loss of catheter tip position. * May be an Engineered Securement Device (ESD) which includes subcutaneous anchoring device. * Adhesive ESDs must be replaced according to manufacturer's instructions for use (typically every 7 days). * Apply sterile, occlusive dressing material to vascular access site. * Consider use of antimicrobial dressing for all CVADS as CLABSI prevention strategy". * Transparent, semipermeable dressing should be changed every 5 to 7 days*. * Gauze (if used) occlusive dressing should be changed every 2 days*. ## For Antiseptic Effect to Occur * Must be allowed to have contact with the skin for two minutes or more to release free iodine. * Once applied, lodophors have residual effect for approximately two hours; if iodine comes into contact with organic matter, such as blood, it is neutralized and no longer effective, tincture of iodine solution contains 1% to 2% iodine in an alcohol base. ## Pediatric Considerations * Percutaneous absorption of iodine has been noted in neonates, with hypothyroidism induction in newborns; lodophor solutions are usually not used in neonatal and infant populations. * Remove povidone iodine with sterile saline wipes after the antiseptic has dried to minimize the risk of skin irritation and dryness. ## Alcohol * 70% isopropyl alcohol is used extensively in skin antisepsis. * Exerts antimicrobial effect by denaturing the cell proteins and dissolving the cell lipids. * Effective against gram positive, gram-negative bacteria, fungi and viruses. * Lacks residual antimicrobial property once the alcohol evaporates. * Irritates and dries the skin. * Volatile or flammable nature untill completely dry. ## Adhesive remover * Removes sticky residue from tape or dressings. * Allows easy removal of transparent dressings, butterfly closures and stabilization devices during dressing changes. * Decreases skin trauma and tears. * Do not use directly on insertion site. * Certain adhesives and dressings are designed to be removed with isopropyl alcohol or normal saline. Check manufacturer's instructions for use for dressing materials or engineered securement devices. ## Skin protectant * Available as a spray, swab, or application pad. * Liquid barrier film, applied to skin around, but not directly on insertion site, where the transparent dressing and any stabilization device will be applied. * Protects skin integrity especially in patients with thin, fragile skin. * Enables dressing to adhere to skin, particularly helpful in diaphoretic patients. * Single use, sterile packaging. * Allow to dry completely before applying stabilization devices or sutures and transparent dressings.