Care and Maintenance to Reduce Vascular Access Complications

Nursing Best Practice GuidelinePrior to changing any add-on component and before accessing the system, the nurse must disinfectexternal surfaces of the catheter hub and connection ports with an appropriate solution (Recommendation 3.0)to prevent the migration of microorganisms (DH, 2001b). Tape should not be used as a method of junctionsecurement (INS, 2000; RCN, 2003) because it can cause the migration of micro-organisms.Electronic Infusion DevicesWhile not a true add-on device, the electronic infusion device, an adjunct for the administration ofprescribed infusates is not intended to alleviate the nurse’s responsibility for monitoring the prescribedrate of infusion. The device should have anti-free flow protection and have a lock-out feature to preventtampering. The nurse will have working knowledge of the devices, including how to operate andtroubleshoot alerts and alarms of the infusion pump. Organizational policies should outline criteria forpump use, and should include routine preventive maintenance programs which adhere to manufacturerguidelines (INS, 2000; RCN, 2003).Peripheral Short Catheters Site RotationDespite the focus on CVAD in this guideline, complications related to peripheral IV sites requireconsideration. In order to prevent complications associated with prolonged dwell time much of theliterature supports removing and rotating peripheral IV sites at least every 72 hours or immediately ifcontamination is suspected (CINA, 1999; CDC, 2002; INS, 2000; RCN, 2003). In fact, studies of short peripheralcatheters indicate that the incidence of thrombophlebitis and bacterial colonization of catheters increaseswhen they are left in place greater than 72 hours (CDC, 2002). While some settings may advocate changingsites every 96 hours, there are insufficient RCT available to support this claim. As a result, the developmentpanel recommends 72 hour site rotation as best practice at this time.DocumentationRecommendation 12.0Nurses will document the condition of the vascular access device including:■ The insertion process;■ Site assessment; and■ Functionality. Level IIIDiscussion of EvidenceDocumentation in the client’s health record is an integral part of safe and effective nursing practice (CNO,2004g). Clear, comprehensive and accurate documentation is a record of the judgment and critical thinkingused in professional practice and provides an account of nursing’s unique contribution to health care (CNO,2004g, 2004k).For the purposes of this guideline, the documentation will include recording in the client’s health record allinformation reflective of the equipment and supplies being used. Initial VAD insertion documentationshould include, but not be limited to, the following:■■■Insertion;Site assessment; andFunctionality.37