Policy
When should the blood vial(s) be labeled to ensure proper specimen handling?
What is at the time of collection.
Blood bank tubes should be labeled and cosigned on the tube, not on label sheet.
Dressings are regularly changed every 7 days for all CVAD types, but there are four other reasons a dressing may need to be changed before then.
What is if the dressing is loose, soiled, or wet OR if a gauze dressing is used, it must be changed after 48 hours.
Late access orders are required when a port was last accessed over...
What is 6 weeks ago.
Per policy, each lumen of a PICC is to be locked with what after use?
What is 10ml normal saline.
Hickmann's are a ____ catheter.
What is tunneled catheter.
Hemodialysis catheters are accessed and maintained by...
What is Dialysis Unit RN staff ONLY.
Dressings can be changed by RNs outside of dialysis following the CVAD dressing change procedure.
Insertion site, sutures, and catheter are cleansed using 2% chlorhexidine preparation and are scrubbed for ___ and allowed ___ to dry.
What is scrubbed for 30 seconds and allowed 30 seconds to dry.
(Alternately, alcohol or betadine can be used to clean the site using the same technique if patient has an allergy to chlorhexidine.)
Port needles must be __ prior to insertion.
What is primed/flushed.
After a lumen is used for blood draw, __ ml is used to flush the line to ensure good patency for future use.
What is 20 ml.
For standard Hickmann lumen locking, ___ concentration of heparin is used.
What is 10 units/ml - 3ml syringe (blue).
For blood culture sampling, the needleless connection is changed ___ to collection.
What is PRIOR to collection.
Prior to accessed, catheter hubs or injections ports are cleansed by scrubbing and maintaining contact with a chlorhexidine or alcohol preparation for what amount of time? (Scrub time and dry time?)
What is 15 second scrub and 15 second dry for alcohol and 15 second scrub and 30 second dry for chlorhexidine.
___ dose heparin should be ordered and administered before removal of an access needle and/or for periodic access and flushing of an implanted port.
What is 100unit/ml - 3ml syringe (yellow).
PICC's are a ___ catheter.
What is non-tunneled catheter.
If a Hickmann is being used for photopheresis or other forms of apheresis, each lumen should be locked with...
What is high dose heparin 5000units/ml - 1 ml vial.
Heparin must be administer with a 10 ml syringe containing the exact volume of lumen (typically 0.8 ml or 0.9 ml per lumen). If port volume > 1 ml, use 1 ml heparin 5,000 units/ml + 0.9% NS to equal volume of port lumen.
Late access orders are required when a PICC or hickmann was last accessed over...
What is over 7 days ago.
If the line is flushing but blood return is sluggish or absent, what steps can be taken before pharmacologic intervention?
What is positioning, extra flushes, deep breathing/coughing, ensuring needle is in the correct position (for ports).
When a port is de-accessed it can be dressed with a __ gauze.
What is nonsterile.
Advise patient can be removed after 1 hour.
What defines a power PICC?
What is a device capable of withstanding high-pressure injections.
If no sutures are present securing a hickmann at insertion site, ___ is used.
What is a statlock.
Dressing changes of any kind must be completed wearing ___ gloves?
What is sterile gloves.
How is a power port identified?
What is with X-ray imaging - view the image and look for "C T" on the port.
Access with a power needle ONLY if a patient requires dye for a ct scan. Power needles are located in the clinician office.
A new port may be accessed within 24 hours of implantation with ___.
What is an order from a privileged provider.
If the site appears infected what steps should be taken?
What is notify the medical team to come and assess the site. RN should prepare to culture(swab) site if drainage present.
If the CVAD is being used frequently or locked with high concentration heparin, an attempt to ___ heparin should be done prior to flushing.
What is attempt to withdraw/ aspirate heparin.
This is imperative so as not to bolus patient with a therapeutic dose of heparin.