Central Venous Lines



University of Colorado Hospital Policy and Procedure

Central Venous Lines

Related Policies and Procedures:

Administration of Blood Components

Aseptic Technique in Invasive and Operative Procedures

Consent for Medical Care and Procedures

Insertion of the Peripherally Inserted Central Catheter (PICC)

Midline Catheter

Lines, Peripheral Venous

Restoration of Patency to an Indwelling Adult Catheter Using Alteplase (t-PA).

Approved By:  Professional Practice Policy and Procedure Committee

Effective: 10/96

Revised: 3/11

Description:     This policy and procedure describes the guidelines for the physician and registered nurse in the care, maintenance, and removal of central vascular access devices and implanted vascular access devices.

Definitions:

CVAD: central vascular access device

Intermittent: Stopping and starting an infusion that is disconnected and reconnected at intervals.

PICC: peripherally inserted central catheter

Midline: a long-dwell (2-8 weeks) PERIPHERAL vascular access device. Longer periods for dwell time should be based on the nurse’s professional judgment. It is deemed a PERIPHERAL vascular access device because it is 3 to 8 inches in length inserted into the veins of the antecubital fossa with the catheter tip residing at or below the axillary line.

*Midline catheters placed by the University of Colorado Hospital PICC Registered Nurse in Interventional Radiology will appear to be a PICC line but will be labeled as a MIDLINE on the external/visible PICC tubing for clarity of which type of catheter it is.

TSM: transparent semi permeable membrane

VAD: vascular access device

Examples of externally placed percutaneous CVADs: Cook catheters, PICCs, Subclavian Catheters, Internal Jugular Catheters, Femoral Venous Catheters, and Single Lumen Large Bore Introducers or Sheaths (i.e., Cordis, Arrow).

Examples of TUNNELED CVADs: Hickman, Broviac, Groshong, Pheresis Catheter

Accountability: The registered nurse is responsible for the maintenance of CVADs and implantable VAD ports. The placement of CVADs and implanted ports is a medical act performed by physicians; PICCs may be placed by a PICC certified registered nurse. All CVADs are placed using sterile technique and maximum barrier precautions (gown, gloves, and mask).

Table of Contents:

I. Patient Consent Page 2

II. Placement Verification Page 2

III. Patient Assessment Page 2

IV. CVAD Site Care and Maintenance Page 3

V. Blood Drawing Page 3

VI. Accessing, Flushing, and Maintaining CVADs Page 4

VII. Central Line Cap change Page 6

VIII. Implanted Port Care and Maintenance Page 7

IX. Discontinuing CVADs Page 9

X. Documentation Page 11

XI. Vascular Access Device Guide (location) Page 11

References Page 11-12

Policy and Procedure:

I. Patient Consent

A. Physicians or other approved personnel must obtain informed consent to be placed in the patient’s chart prior to central line insertion. The physician or physician designee will insert the central line access using maximum sterile barrier protection.

II. Placement Verification

A. An x-ray or fluoroscopic evaluation must be obtained immediately after insertion and a physician must verify placement. If the ordering healthcare provider requests that the radiologist confirm the central line placement film, then the radiology request must be marked, "Immediate read, page with results" and the request must indicate the name and pager number of the healthcare provider; otherwise, the ordering provider will review the radiology report. After the radiology report is read, a physician must indicate that the central line is ready for use by writing an order stating such in the patient’s chart.

No fluids should be infused or administered into a CVAD until catheter tip location is confirmed.

III. Patient Assessment

Intravenous access sites and infusion devices shall be monitored at established intervals to identify complications and ensure that infusion devices are working properly.

A. Equipment Inspection: Once a shift.

Inspect and monitor the following access equipment:

• Catheter (for migration), connections, fluids being infused, pump function including flow rate.

B. Site Inspection: Every four hours while fluids are infusing. More frequent assessment is warranted when vesicants are infusing or when particular patient circumstances increase the risk of extravasation or leakage.

1. Question patient regarding pain and/or discomfort at access site.

2. Wash hands and don gloves.

3. Palpate the CVAD access site for tenderness daily through the intact dressing.

4. If the site is covered with a TSM dressing, inspect site through dressing. Do not remove TSM dressing unless dressing change is required.

5. If the site is covered with gauze, remove gauze dressing to inspect site.

6. Inspect site for signs of intravenous-related infections and/or complications:

a. Discoloration, disruption of sensation, edema, localized swelling, exudates, increase in skin and basal temperatures, indurations with palpable cord.

7. Notify the physician if the patient reports pain or tenderness at access site or if there is other evidence of impending complication development.

IV. CVAD Site Care and Maintenance

CVAD TSM dressings should be changed every 7 days or when dressing is loose, damp, or soiled, utilizing aseptic technique. Gauze used in conjunction with a TSM dressing should be changed every 48 hours or immediately if the integrity of the dressing is compromised.

A. Gather equipment:

1. Central line dressing kit (available from Central Supply)

2. Catheter securement device (i.e., Stat Lock®) if applicable

3. Central line cap

4. Biopatch®

B. Procedure:

1. Wash hands and assemble equipment

2. Don mask, sterile gloves and other PPE equipment.

3. Remove old dressing, biopatch® and catheter securement device (if applicable).

4. Inspect access site. Notify physician of signs of swelling, redness, tenderness or drainage.

5. Discard old dressing and used gloves. Don sterile gloves.

6. Disinfect insertion site with Chloraprep® (chlorhexidine gluconate 2% with Isopropyl Alcohol 70%) using a back and forth scrubbing motion for 30 seconds, completely wet the site. Allow the prepped area to dry completely for approximately 30-60 seconds.. Do not blot or wipe the solution away.

7. When patient has chlorhexidine and povidone-iodine sensitivity, use an alcohol friction rub and allow to "air dry" Do not blow or blot dry.

8. Apply biopatch® to insertion site.

9. Place the TSM dressing over the insertion site.

10. If gauze is used in conjunction with a TSM dressing, the dressing should be considered a gauze dressing and changed every 48 hours. Seal gauze dressing edges with tape

11. Use the appropriate catheter securement device or tape. Pay particular attention to not placing tension on the line when securing.

12. Date and initial the dressing.

13. Clean suture lines for tunneled catheters with Chloraprep®.

14. Patient may shower if dressing is protected by taped plastic wrap.

15. For routine care, patients with central lines including PICCs, should receive daily baths with 4:1 body cleanser and the skin surrounding the central line should be cleansed with a CHG wipe. The wipes should be used up to the border of the dressing; do not wipe the surface of the dressing with the wipe, as this may disrupt the integrity of the dressing. Never use CHG wipes above the jawline, on the face or ears. CHG wipes should not be used over broken, irritated skin or wounds. If the patient can shower, CHG wipes should not be used either one hour prior to or one hour after showering, due to risk of irritation.. Dispose of CHG in trash, never flush.

V. Blood Drawing

A. Obtain and review physician’s order for blood specimen collection.

B. Verify patient’s identity.

C. Use aseptic technique and utilize standard precautions and needle-safe products at all times when accessing lines. Wash hands and don gloves.

D. TPN line is not recommended to be used for any type of access. If the TPN line must be accessed, flush with 20 ml normal saline prior to blood withdrawal.

E. Vacutainer devices are not recommended for use with the Groshong catheter or Groshong PICC.

F. Do not draw PT/PTT from CVAD that has heparin infusing.

G. Hold administration of all infusions into the CVAD prior to obtaining blood samples. Clamp all lumens not being used for blood withdrawal.

H. If blood does not flow into blood tube or syringe:

1. Change patient position, cough, move arm above head, or hold a deep breath.

2. Replace blood tube with a new one.

3. Attempt to flush catheter with saline and attempt to withdraw blood again. If not successful, notify physician and patient may be eligible for t-PA use. (See policy "Restoration of Patency to an Adult Indwelling Catheter Using [t-PA]".)

4. Draw blood specimen peripherally.

I. General Supplies:

1. Antiseptic solutions-alcohol wipes, chlorhexidine swabs

2. Flush Solutions- 0.9% sodium chloride, heparin flush if ordered

3. Blood collection tubes and labels

4. Vacutainer/Syringes-appropriate number of 10-ml syringes

5. Gloves

J. Syringe Method:

1. Clamp Catheter.

2. Disinfect catheter hub with alcohol wipe for 15 seconds.

3. Flush with 5 ml normal saline then withdraw 5 ml of blood. Reclamp catheter. Remove and discard syringe.

4. Attach second 10-ml syringe to catheter hub. Unclamp Catheter. Withdraw blood into syringe or syringes, depending on amount of blood needed. Reclamp catheter and remove syringe.

5. Transfer blood to appropriate tubes using appropriate needleless system. Cleanse catheter hub with alcohol and flush per policy. (See Section VI, Flushing CVAD’s).

K. Vacutainer Method:

1. Clamp Catheter. Attach needleless connector to vacutainer barrel holder.

2. Disinfect injection cap with alcohol for 15 seconds.

3. Remove cover and insert vacutainer connector into injection cap. Unclamp catheter. Advance blood tube inside vacutainer to activate blood flow. Hold tube in place until blood flow ceases and consider this the waste.

4. Clamp catheter. Discard the tube. Insert another blood tube, unclamp catheter, and draw specimens as ordered. After all samples are collected, clamp catheter. Remove vacutainer.

5. Flush catheter per policy. (See Section VI, Flushing CVAD’s)

6. Change injection cap, if needed.

L. If drawing blood cultures from CVAD: refer to the Blood Cultures Policy.

VI. Accessing, Flushing, and Maintaining CVADs

A. Single lumen large bore catheters or sheaths (i.e., Cordis, Arrow) are to be managed only in the Adult Special Care Areas (SICU, MICU, Burn Unit, IMCU, GCRC and PACU). This type of catheter must be removed before a patient transfers to a unit other than those listed above.

B. Utilize needleless devices when accessing catheters.

C. Flushing

1. Avoid using syringes less than 10 ml to prevent excess pressure against the catheter. Flush heparin-locked VADs with saline before and after administering drugs to avoid drug incompatibilities and precipitation.

2. Utilize the pre-printed Adult Central Venous Access Flushing protocol order form with any CVAD.

3. If CVAD is being flushed with heparin and concern arises about the patient receiving an excessive amount of heparin, this issue should be discussed with the patient's physician. The physician should write an order for any practice that differs from the recommended flush.

4. If resistance is met while flushing the catheter, do not force. Attempt to aspirate after removing central line cap. If able to aspirate, flush with 10 ml normal saline prior to flushing with appropriate flush. If unsuccessful, notify physician immediately for possible use of a fibrinolytic agent approved by University of Colorado Hospital for this purpose. (See policy "Restoration of Patency to an Adult Indwelling Catheter Using Alteplase (Cathflo)”).

5. If the patient's CVAD requires four flushes per day, a keep vein open (KVO) IV infusion should be considered to decrease manipulation of CVAD. This may also decrease risk of infection. Prior to the initiation of therapy, a KVO order shall contain a specific rate. A physician order is needed for a specific KVO rate.

D. Labeling

1. Day of change labels should be attached to all IV tubing and solutions, indicating the day and time they are to be changed.

2. All intravenous tubing’s connected to CVADs should be labeled at the luer-lok connection and on the electronic infusion device if one is used.

E. Tubing Changes: This list is a guideline and not an inclusive list: please continue to refer to the medication specific literature for guidance with specific tubings and filters.

1. All tubing connected to CVADs should have luer-lock design connections.

2. Primary and secondary continuous administration sets shall be changed every 72 96 hours and all IV sets should be changed immediately upon suspected contamination or when the integrity of the product or system has been compromised.

a. The continuous primary administration set change should coincide with initiation of a new container of solution. The secondary "piggyback" set change should coincide with the primary administration set change and with the initiation of new IV fluid bags. (See Lines, Peripheral Venous for secondary infusions)

b. Change of add-on devices such as, but not limited to, extension sets, filters, stopcocks, and needleless devices should coincide with the changing of the administration set.

3. Primary and secondary intermittent administration sets (i.e., those used for intermittent infusions) shall be changed every 24 hours and immediately upon suspected contamination or when the integrity of the product or system has been compromised.

a. Change of add-on devices such as, but not limited to, extension sets, filters, stopcocks, and needleless devices should coincide with the changing of the administration set.

4. Exceptions:

a. Neutropenic patients: replace tubing every 48 hours.

b. Lipid emulsions and/or TPN: replace tubing every 24 hours.

c. Blood or blood products: replace tubing according to policy "Administration of Blood Components."

d. Outpatient setting: replace IV tubing daily.

5. IV solutions:

a. Pre-mixed by the manufacturer can hang for 72 hours (48 hours for neutropenic patients), but IV solutions mixed at UCH may hang for only 24 hours. IV solutions pre-mixed by the manufacturer are maintained in a plastic outer cover until opened by unit personnel.

b. If a pharmacist or nurse has mixed or added any additives to an IV solution, the sterility of the IV infusion is uncertain; thus, it is recommended that the solution be changed every 24 hours. Exceptions: When lipid emulsions are given alone (without parenteral nutrition fluids), the infusion must be completed within 12 hours of hanging the emulsions.

6. Procedure for tubing change:

a. Gather equipment:

• IV solution, per MD order

• IV tubing

• Day of change labels

• Pen

b. Close clamp on new administration tubing, connect IV tubing to IV solution, squeeze drip chamber to fill to manufacturer’s mark, and slowly open clamp to prime entire length of tubing to remove all air. (For primary administration sets, invert and tap white check valve to remove all air bubbles while tubing is being primed.)

c. Clamp off IV flow.

d. Attach day of change labels to new tubing and IV bag, indicating the date and time changed and RN initials. Do not mark directly on IV bag, in-line drip chamber (i.e., Buretrol), or tubing.

e. Remove tape at connection site.

f. Remove tubing at connection site and replace with new tubing.

7. Open IV flow and set appropriate rate.

VII. Central line cap change

All CVADs should have a central line cap attached to the end of catheter hubs. Change central line caps once a week or with dressing changes or if there are signs of precipitate present. If the CVAD has more than one lumen, the other device(s) should also be replaced at the same time. Assessment of the integrity of the cap should be done before and immediately following each use. If it is compromised or there is residual blood it should be changed.

A. Gather equipment:

1. central line cap(s)

2. Alcohol wipes

3. Appropriate flush

4. 10 ml syringe(s)

5. Gloves

B. Change central line cap

1. Wash hands and don gloves.

2. Prepare syringe with appropriate flush.

3. Clamp catheter with in-line clamp provided. DO NOT USE HEMOSTAT. There is no need to clamp Groshong catheters.

4. Using aseptic technique, clean hub of catheter with alcohol wipe for 15-30 seconds using friction, remove old cap and attach new device.

5. Unclamp catheter and flush with appropriate flush solution.

6. Remove syringe and then re-clamp catheter (unless solution[s] infusing). To decrease reflux of blood it is recommended to clamp before disconnecting.

VIII. Implanted Port Care and Maintenance

A. Assessment

1. Observe suture line and surrounding skin of unaccessed implanted port for any signs of swelling, redness, drainage, or increased temperature. DO NOT ACCESS AN IMPLANTED PORT IF A PORT POCKET INFECTION IS SUSPECTED.

2. As with other VADs, accessed implanted ports should be assessed at least every four hours. More frequent assessment is warranted when vesicants are infusing or when particular patient circumstances increase the risk of dislodgment and/or extravasation.

B. Accessing port

An RN may access and perform routine site care and maintenance of an implanted port after the physician order is obtained.

1. Gather equipment:

a. Central line dressing kit

b. 90-degree angle noncoring needle (19, 20, or 22 gauge; 0.75", 1", or 1.5" length) with extension set that includes Y-site and in-line clamp. Select smallest gauge needle that can deliver prescribed therapy. Ideally, the length of the needle should approximate the distance from the skin surface to the bottom of the portal chamber, so that when placed, the needle tip touches the bottom of the port and rests flush against the skin for stabilization. The most commonly used needle is 19-20 gauge, 1 inch size.

c. Central line cap

d. 3 -10 ml preservative-free 0.9% sodium chloride (USP) prefilled syringe

e. 5 ml Heparin flush (100units/ml) if not starting continuous infusion after access.

f. Tape

g. Alcohol wipes

2. Wash hands and explain procedure to patient.

3. Position patient in comfortable position, usually semi-fowler or supine; palpate port site and locate septum.

4. Open 90-degree noncoring needle set package and central line cap, leaving set in original sterile package box.

5. Open central line dressing kit and don mask and first set of sterile gloves

6. Disinfect skin area over port using ChloraPrep® applicator using a back and forth scrubbing motion for 30 seconds over the port site. Prep at least a 2 inch circumference on all sides of the port.

a. Allow the chlorhexidine solution to "air dry." Note: When patient has chlorhexidine sensitivity, use alcohol/povidone-iodine combination and allow to "air dry." Do not blow or blot dry.

7. Using same set of sterile gloves, prepare noncoring needle by attaching the positive pressure device to the distal end of the needle infusion set touching only the distal 2” of the set. Attach the prefilled NS syringe and flush the device to clear tubing and needle of air, protecting needle and base of set from contamination. Maintain aseptic technique and leave the device in original sterile package

8. Remove and discard gloves and don new sterile gloves.

9. Relocate port septum by palpation and stabilize it with non-dominant hand by applying light pressure with your thumb and first two fingers, stretching the skin so that it’s taught over the septum.

10. Grasp the primed noncoring needle with your other hand, hold it perpendicular to the septum, and insert it at the point between the fingers and thumb of your other hand.

11. Advance the needle until you feel the bottom of the reservoir.

12. Aspirate for brisk blood return to verify needle position and confirm patency; flush with attached 10 ml NS syringe e and close clamp while flushing.

a. If unable to aspirate blood, do not flush.

b. Discard used equipment and gather all new equipment to repeat above steps. Re-access and attempt to aspirate blood from port.

13. If unable to obtain blood return, contact physician for instructions

14. The second port of a double implanted port should be accessed, if necessary, at this time using all the above procedures.

15. If necessary, sterile gauze may be placed under device to prevent rocking and does not constitute a gauze dressing if insertion site is visible. Cover needle (and gauze) and 2-3 cm of extension set tubing with TSM dressing. Label dressing with length and gauge of needle along with date and R.N.’s initials.

16. Securely tape additional extension set tubing to skin.

17. Vigorously flush port with 20 ml normal saline to clear port of all blood residues.

18. Change noncoring needle and dressing every seven days.

19. Initiate prescribed therapy.

20. If port is to be used for intermittent therapy, flush with 5 ml heparin (100 units/ml), if appropriate.

C. Suture line care for newly implanted port

1. Gather equipment:

a. Chloraprep®

b. Telfa bandage

c. Tape

2. Wash hands and explain procedure to patient.

3. Remove Telfa or suture line gauze dressing the day after port placement.

4. Observe suture line and surrounding skin for any signs of swelling, redness, drainage, or increased temperature.

5. Cleanse site PRN with Chloraprep®.

6. Secure sterile Telfa bandage over site with tape if drainage is evident.

D. Needle removal from implanted port

1. Gather equipment:

a. 2 -10 ml preservative-free 0.9% NS prefilled syringes

b. 5 ml heparin flush (100 units/ml)

c. Alcohol wipes

d. Band-Aid

e. 2x2 gauze

f. Sterile and nonsterile gloves

2. Wash hands and explain procedure to patient. Apply nonsterile gloves.

3. Flush port with 20 ml normal saline, then follow with 3 5 ml heparin flush (100 units/ml) using intermittent positive pressure and closing clamp while flushing.

4. Remove dressing and discard old dressing and gloves

5. Don sterile gloves.

6. With nondominant hand, stabilize port between fingers and with fingers of dominant hand grasp needle set and remove needle according to manufacturer's recommendations so that needle retracts safely into set as it withdraws from port.

7. Apply pressure over needle site with 2x2 gauze until any bleeding stops.

8. Apply Band-Aid to site if desired.

9. Dispose of needle set into sharps container and discard gloves.

E. Patient and family education

1. Teach and/or reinforce to patient and family that unaccessed implanted ports should be flushed every month by an RN qualified to care for implanted ports.

2. Teach and/or reinforce to patient and family the risks of implanted port infections and that patient should immediately report any discomfort, pain, increased warmth, redness, swelling, exudate, or other changes in unaccessed implanted port to their RN or MD.

Teach and/or reinforce to patient and family about risks of dislodgement and extravasation and that they have a responsibility to immediately report to the RN any discomfort, pain, swelling, fluid leakage, or possible or actual needle dislodgment during infusion.

IX. Discontinuing CVADs

A. A physician's order is required before a CVAD may be discontinued/removed. A physician may discontinue a CVAD or implanted port. An appropriately trained RN may discontinue PICCs and noncuffed/ non tunneled catheters.

B. CDC definition of Catheter-Associated BSI (Blood Stream Infection) is defined by the following :

1. A vascular access device that terminates at or close to the heart or one of the great vessels. An umbilical artery or vein catheter is considered a central line.

2. BSI (Blood Stream Infection) is considered to be associated with a central line if the line was in use during the 48-hour period before development of the BSI. CDC definition for Catheter Related Blood Stream Infection (CRBSI) is bacteria/fungemia in a patient with an intravascular catheter with at least one positive blood culture obtained from a peripheral vein, clinical manifestations of infections (i.e., fever, chills, and/or hypotension), and no apparent source for the blood stream infection (BSI) except the catheter. Please refer to for further CDC definition/clarification. Crucial judgment is necessary to determine need for removal of line.

C. Registered nurses will be permitted to discontinue femoral lines following instruction and verified competency. A written physician's order must be present to discontinue femoral lines.

1. Registered nurses may not discontinue catheters in patients with bleeding disorders, or when catheter placement is uncertain. Discuss with MD the need to hold the anticoagulant and consider checking labs prior to removal.

D. Procedure:

1. Gather equipment:

• Sterile and nonsterile gloves

• Sterile 2x2’s

• Chloraprep®

• Tape

• Antibiotic ointment

• Optional:  1 suture removal kit (for culture)

1 sterile culture container (for culture)

2. Wash hands and explain procedure to patient.

3. Positioning:

a. CVAD’s: Place patient in supine flat position unless this position is contraindicated.

b. PICC’s: Patient may be in upright/sitting position. Place arm at 90° angle to patient’s body if removing a PICC.

c. Femoral Lines: Place patient in a supine flat position at less than 35-degree angle.

4. D/C IV solution, disconnect tubing, don nonsterile gloves, and remove CVAD dressing and securement device (if applicable). Discard dressing and gloves.

5. Inspect the site, noting redness, swelling, or exudate.

6. Don sterile gloves and any appropriate PPE.

7. Disinfect catheter skin junction site with Chloraprep®

8. Cut securing sutures (if present), taking care not to cut IV line.

9. Slowly withdraw the catheter from the vein using short gentle strokes. Do not stretch. As you remove the last 5-10 cm have the patient hold their breath (Valsalva maneuver) then remove line.

10. Immediately place pressure on the insertion site with a dry gauze to prevent bleeding and air from entering.

11. If resistance or complication occurs, discontinue removal and notify physician immediately. The catheter could be kinked or knotted so forceful removal could fracture the catheter and cause possible embolization.

a. Resistance in a PICC can be caused by smooth muscle vein spasms. Instruct the patient to relax and take deep breaths. After a few minutes, then try again.

b. Venous thrombosis can also cause resistance. An ultrasound can be ordered to assist with this diagnosis.

12. Assess integrity of removed line.

13. Digital pressure should be applied until hemostasis is achieved (approximately 5 minutes), then antibiotic ointment and a sterile occlusive dressing should be applied to the access site upon catheter removal. Application of ointment may occlude the skin tract and prevent air embolism.

a. Femoral lines: Have patient on bed rest for 30-60 minutes or as ordered. Reassess site every 15 minutes x 4 or as ordered, then at least once a shift thereafter. Change dressing every 24 hours until site is healed.

b. Secure the dressing with tape or a tegaderm dressing. Instruct the patient to keep the dressing in place for at least 24 hours or until the site is closed. Change the dressing and assess the site every 24 hours until this occurs.

E. Obtaining culture:

1. Determine from physician prior to removal if tip is to be cultured

a. Supplies: sterile specimen cup and sterile suture removal set.

b. The culture should be obtained from either the tip or a subcutaneous portion of the catheter (per physician order).

c. Apply pressure to the site with hand and hold catheter with the other hand. The assisting individual will cut approximately 5 cm allowing the tip or subcutaneous portion to fall into the sterile culture container.

X. Documentation: Assessment, care and patient/ family education on the use of the CVAD site should be documented on the nursing flow sheet in Care Manager under the NIC: VAD maintenance and includes the following:

A. Site care

B. Tubing change/ Cap change

C. Flushing

1. Document the administration of appropriate flushes on the Medical Administration Record (MAR)/ Admin RX.

2. Document IV bag/solution changes on the IV medication MAR/ Admin RX and on the nursing flow sheet under intake/output

D. Discontinuing CVAD’s:

E. Discharge education

XI. VASCULAR ACCESS DEVICE GUIDE is located on the UCH Vascular Access Resources Web site.

References:

1. Becton Dickinson Medical (2007). BD Q-Syte Luer Access Split Septum: Points of Practice. Retrieved electronically April 20, 2008 (LOE VI).

2. Camp-Sorrell, D. (Ed.). (2004). Access device guidelines: Recommendations for nursing practice and education. Pittsburgh: Oncology Nursing Press. LOE VI

3. Devine, D. & Brackett, H. (2008). Vascular access devices. Oncology nursing secrets: Questions and answers about caring for patients with cancer (3rd ed., pp. 130-146). St.Louis: Mosby Elsevier. LOE VI

4. Goodman, M. (2005). Chemotherapy: principles of administration. In: C. H. Yarbro, M. H. Frogge, M. Goodman, & S. Groenwald (Eds.), Cancer Nursing: Principles and practice (6th ed., pp. 385-442). Boston: Jones and Bartlett. LOE VI

5. Gorski, L. (2008) Speaking of Standards……..Standard 45: Implanted Ports and Pumps. Journal of Infusion Nursing , 31(1): 20-1 (LOE V)

6. Hadaway, L.C. (2008) Central Venous Access Devices. Nursing 2008, 38(6), 34-41. (LOE VI)

7. Infusion Nurses Society. (2006) Infusion equipment. Journal of Infusion Nursing, 29(1S), S35. LOE VI.

8. Infusion Nurses Society. (2006) Infusion nursing standards of practice. Journal of Infusion Nursing, 29 (1S), 51-52. LOE VI

9. Infusion Nurses Society. (2006). Policies and Procedures for Infusion Nursing (3rd Ed.). Infusion Nurses Society. LOE VI

10. Medi-Flex, Inc. (2004). Using Chloraprep antiseptic skin prep. LOE VI

11. Najeme, E. (2006). Central venous catheter related infections: which dressing is more effective in preventing infection? Bone Marrow Transplantation, 37 Supplement 1: S 292. LOE VI

12. O’Grady, N.P., Alexander, M., Dellinger, E.P., et al. (2002). Guidelines for the Prevention of Intravascular Catheter-Related Infections. Centers for Disease Control and Prevention. MMWR, August 9, / 51(RR10); 1-36. LOE V

13. O’Horo J.C., Silva G.L.M, Munoz-Price L.S., et al. (2012). The efficacy of daily bathing

with chlorhexidine for reducing healthcare-associated bloodstream infections: A meta-analysis. Infection Control and Hospital Epidemiology 33(3); 257-267 LOE I

14. Powers J, Peed J, Burns L, et al. (2012) Chlorhexidine bathing and microbial contamination in patients’ bath basins. AJCC 21(5); 339-342 LOE IV

15. Rosenthal, K. (2006). I.V. Rounds. What you need to know about ports, Nursing 36(1), 20-1 (LOE VI)

16. Zitella, L., (2003). Central Venous Catheter Site Care for Blood and Marrow Transplant Recipients. Clinical Journal of Oncology Nursing, 7,289-298. LOE VI

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