CVAD Skills Rewritten PDF

Administering IV minibag med through locked CVAD: Pre Steps: Ensure mini-bag is room temp Check CVAD tip placement Gather supplies: alc wipes, 2 10ml syringes of NS, sterile cap, IV tubing, “change-date” label, medication Clamp tubing, spike bag, prime line, set up pump, put c...

Administering IV minibag med through locked CVAD: Pre Steps: Ensure mini-bag is room temp Check CVAD tip placement Gather supplies: alc wipes, 2 10ml syringes of NS, sterile cap, IV tubing, “change-date” label, medication Clamp tubing, spike bag, prime line, set up pump, put change-date sticker on line (24hr) Identify pt, evaluate CVAD site, scan meds Med admin: Remove cap, clean connector on CVAD Verify patency of line: attach 10 ml NS, unclamp (if needed), aspirate for blood return, flush 5-10 ml using push pause method Disconnect and rescrub Attach medication IV tubing to port Run pump at correct rate and volume Chart! Med complete: Clamp tubing, disconnect from CVAD, cap end of IV tubing with new cap Flush: Attach 10 ml NS, unclamp (if needed), flush 5-10 ml using push pause method Attach new cap to CVAD line Administering IVBP med through a CVAD with an infusing IV solution: Pre Steps: Verify appropriateness of meds and pt allergies Confirm placement of CVAD Obtain new secondary IV tubing and add change-date sticker (24hr) Spike bag, clamp tubing, prime line with backflush method, set up pump, put change-date sticker on line Identify pt, evaluate CVAD site, scan meds Med admin: Remove cap and clean highest port of primary tubing Attach tubing and backflash if not already done Set pump at correct rate and volume, begin infusion Chart! Med complete: Do NOT disconnect empty med bag or secondary tubing Check to ensure primary has resumed infusing Administering IV push med through an IV lock on a CVAD Pre-steps: Verify appropriateness of med, pt allergies, hold parameters Confirm placement of CVAD Gather supplies: alc wipes, 2 10ml syringes NS Scan med  Draw up med Identify pt, evaluate CVAD site Med admin: Remove cap on CVAD site, clean Verify patency of line: attach 10 ml NS, unclamp (if needed), aspirate for blood return, flush 5-10 ml using push pause method Remove syringe, clean again Attach med syringe and administer at ordered rate Remove when complete and clean Flush: flush w 10 ml NS with first 2-5ml being at SAME rate as med, remainder injected with push pause technique Lock lumen per policy Apply new cap Chart! Administering IV push med through CVAD with an infusing solution: Pre Steps: Verify appropriateness of med, pt allergies, hold parameters Confirm placement of CVAD Gather supplies: alc wipes, 2 10ml syringes NS Scan med Draw up med Identify pt, evaluate CVAD site {IF med IS compatible with solution infusing, you do NOT need NS flushed. If incompatibility exists, you WILL need flushes for before and after med admin} Med Admin: Remove cap and clean lowest port of IV tubing connected to CVAD Med compatible: admin at correct rate Med incompatible: ○ Use different lumen of CVAD if one is available ○ If different port NOT available: Stop infusion, clamp tubing, scrub and flush lowest port on IV tubing w/ 5-10ml Scrub again, administer med at proper rate Flush: flush w 10 ml NS with first 2-5ml being at SAME rate as med, remainder injected with push pause technique Restart infusion pump and resume infusion Important Notes: 1. Assess and flush unused ports on CVAS every shift- ideally within 2 hr of start 2. If unable to aspirate blood or flush a port, do NOT use it. Notify PCN of inability, chart. 3. CVAD tip location must be verified before using 4. Implanted ports should be Heparin locked 5. Can use same line for 24 hr if med compatible  CVAD Insertion Site Dressing Change: Supplies: Sterile CVAD dressing tray: mask, sterile gloves, chlorhexidine, tape, 2x2 dressing, skin protectant, transparent dressing Biopatch Sign indicating sterile procedure in progress Long sterile applicators (Q-tips) Pre-steps: Gather supplies Place sterile procedure sign on door Explain procedure, ask about allergies If pt has a cough, they need to mask. Anyone in room needs to mask Procedure: Hand hygiene, open kit, put on mask, put on NONsterile gloves, remove old dressing Inspect site Remove gloves and discard w old dressing Hand hygiene Open biopatch and Q Tips and drop into kit Put on STERILE gloves Clean area with chlorhexidine If there is drainage, put 2x2 over site, if no drainage use biopatch Apply skin protector Apply transparent dressing Secure tubing with tape Remove gloves and mask Hand hygiene Fill out label w dressing change date and initial Document Dressing Change Notes: Dressing with gauze changed Q48hr Transparent dressings should be changed 5-7 days  Removing centrally inserted (subclavian or jugular) CVAD: Supplies: Suture removal kit Chlorhexidine sponge Vaseline gauze 4x4 and 2x2 Transparent dressing Nonsterile gloves Pre steps: Verify order Gather supplies Ensure pt has functional IV unless no IV access is needed Check CVAD hub for catheter size and length: do NOT proceed if catheter is larger than 8 french Assess for signs of intravascular thrombus: edema of upper extremities, face, neck, dizziness Assess pt coagulation labs and recent use of anticoagulants. Caution is counts are low Explain procedure, assess pt ability to lay flat and perform valsalva Procedure: Turn off infusion if needed, clamp Hand hygiene, put on nonsterile gloves Open suture removal kit and remove tweezers Maintaining sterility, assemble 4x4/2x2/vaseline gauze Place pt in trendelenburg position ○ If not tolerated, want HOB at least less than 30 degrees Remove dressing and inspect insertion site Discard dressing and gloves Hand hygiene and new nonsterile gloves Remove sutures Cleanse area w chlorhexidine Carefully place gauzes onto site Have pt valsalva, remove catheter Apply direct pressure for 5 min, 10 if on anticoagulants Monitor for signs of air embolism: respiratory distress, chest pain, decreased LOC, tachycardia, hypoxia, hypotension) ○ If suspected: call for help, ensure site is occluded, place pt in left side trendelenburg, and place high flow O2 Inspect catheter for length, deficits, jagged edges, etc. After 5-10 minutes, have pt valsalva and check for bleeding Once bleeding stopped, remove 4x4 Apply transparent dressing over 2x2 and vaseline gauze Label dressing After procedure: Pt needs to remain flat for 30 min  Assess pt every 15 min for next hour Educate pt to leave dressing for 24 hr Document! Removal Notes: Staff nurses only responsible for removal of percutaneously placed CVADS (subclavian and jugular) ONLY allowed to remove 8 french or smaller