Central Venous Catheters (CVC):
- All CVC should produce a free flowing brisk blood return upon aspiration without having the patient do shoulder/arm movements.
o It is not acceptable if patients have to do shoulder and/or arm movements in order to obtain blood return from a CVC.
o If this is the case, there maybe a problem with the CVC and/or tip.
- To aspirate and/or flush CVC, use a large syringe size (10mL) with the appropriate amount of flush solution. Smaller syringe size (3mL, 1mL) has a narrow diameter and exerts greater pressure (psi) causing potential damage to the catheter.
o There are prefilled syringes available with small amount of flush solution housed in a large barrel size syringe (10mL).
- There’s a problem if unable to get positive blood return from CVC, do not use the catheter and assess the cause.
- Apply a transparent semipermeable membrane dressing (TSM) and a securement (stabilization) device to CVC sites.
o TSM dressing allows visualization of site. The CVC dressing is not a securement device unless the product is designated as both dressing and securement.
o Securement device allow stabilization of catheter to prevent movement.
- When caring for a multilumen CVC, remember to change all caps, even on unused lumens.
- BP should not be taken in the arm where a PICC is placed. Pressure exerted may cause damage to vein lining resulting in complications.
Short Peripheral IV (PIV):
- On PIV sites, apply a transparent semipermeable membrane dressing (TSM) and a securement (stabilization) device.
- TSM dressing allows visualization of site. PIV site dressing is not a securement device unless product is designated as both dressing and securement.
- Securement device allow stabilization of catheter to prevent movement possibly reducing the incidence of phlebitis / infiltration.
- Blood samples from a peripheral IV should be obtained only at the time of insertion.
- Always include the number and location of insertion attempts in your documentation when starting a short peripheral IV.
- Infiltration-inadvertent administration of non vesicant medication/ or solution into the surrounding tissue.
- Use the infiltration scale from the Infusion Nursing Society’s infusion nursing standards of practice to grade the severity of infiltration.
- Extravasation-inadvertent administration of VESICANT medication or solution into the surrounding tissue.
- Use the extravasation scale from the Infusion Nursing Society’s infusion nursing standards of practice to grade the severity of extravasation.
- If extravasation occurs, manage patient according to organization’s policy/procedure.
- Any incidence of extravasation should be reported to the physician and a report filed according to your organizations’ policy/procedure.
- VESICANT is an agent capable of causing injury such as blistering, tissue sloughing/necrosis when it extravasates into surrounding tissue.
- If possible, avoid using a PIV access for a known vesicant agent.