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Implanted Port Competency
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Implanted Port Competency

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This is a checklist with the criteria the learners needed to demonstrate to verify competency in accessing, using, and de accessing central venous access devices with implanted ports.

This is a checklist with the criteria the learners needed to demonstrate to verify competency in accessing, using, and de accessing central venous access devices with implanted ports.

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    Implanted Port Competency Implanted Port Competency Document Transcript

    • Fairview Southdale Hospital Nursing Competency Validation 1 Implanted (Port) Central Venous Access Devices (CVADs): Accessing, Deaccessing, Drawing Blood, and Administering Fluid Chest and Arm Placement Name: __________________________ Unit: ______________ Trainer: _________________________ Date: ______________ Criteria for competency was MET NOT MET. Action Plan: _________________________________________________________________________ ____________________________________________________________________________________ Signature Date Competency Criteria YES NO Before Procedure 1. Verifies the order for labs, meds, or fluids. 2. Identifies the type of catheter to access (implanted vs. external), number of lumens, and type of catheter tip (open-end vs. valve). 3. Ensures that VENOUS ADDESS DEVICE PROTOCOL is in patient medical record and verifies appropriate flush. 4. Checks for allergies. YES NO Setup for Procedure 1. Correctly identifies patient. Introduces self and explains procedure to patient. 2. Gathers appropriate equipment on a clean dry surface. Sterile field supplies for accessing the implanted port: Sterile Central Line Kit; 30 ml. vial sterile NS; (2) empty 10 ml. syringes in sterile wrapper; Gripper Plus. Supplies for drawing blood via vacutainer (PREFERRED METHOD): (3-4) pre-filled 10 ml. syringes of sterile NS and needless connectors; vacutainer barrel, female adapter and connector; blood tubes for lab; labels; biohazard bag. Supplies for drawing blood via syringe: (3-4) pre-filled 10 ml. syringes of sterile NS and needless connectors; adequate number 10 ml. syringes to draw to fill blood tubes; vacutainer barrel and female adapter; blood tubes for lab; label; biohazard bag. Supplies for deaccessing valved catheter: non sterile gloves; alcohol wipes; (2-3) pre-filled 10 ml. syringes of sterile NS, sterile gauze; bandaid. Supplies for deaccessing open-end catheter: non-sterile gloves; alcohol wipes; (1-2) pre- filled 10 ml. syringes of sterile NS; pre-filled syringe of heparinized flush solution (as prescribed in Venous Access Device Protocol); sterile gauze; bandaid. Supplies to flush dormant valved catheter with Gripper Plus: non sterile gloves; alcohol wipes; (2-3) pre-filled 10 ml. syringes of sterile NS Developed by FSH VAT: October, 2004 C
    • Fairview Southdale Hospital Nursing Competency Validation 2 Implanted (Port) Central Venous Access Devices (CVADs): Accessing, Deaccessing, Drawing Blood, and Administering Fluid Supplies to flush dormant open-end catheter with Gripper Plus: non-sterile gloves; alcohol wipes; (1) pre-filled 10 ml. syringe of sterile NS; pre-filled syringe of heparinized flush solution (as prescribed in Venous Access Device Protocol); needleless adapter 3. Washes hands and dons non-sterile gloves. 4. Inspects skin over the port and catheter tract for signs and symptoms of infection including erythema, edema, warmth and/or drainage. If findings are positive, does not access catheter and notifies M.D. 5. Palpates chest or arm to locate the center of port. 6. Removes and discards gloves. 7. Using principles of asepsis and sterility opens central line dressing kit and uses sterile wrapper for sterile field. Adds additional sterile supplies to the sterile field. Dons mask and sterile gloves. YES NO Accessing the Implanted CVAD 1. Preps the CVAD port according to policy. Prepped area should be a diameter of four (4) inches with the CVAD port in the center. PREFERRED: Rubs Chloraprep® briskly in back-and-forth motions for 30 seconds and allows to dry. CRITICAL: If using Betadine, learner must apply it in concentric circles, starting from the middle, and allow to dry. Following the Betadine with alcohol or wiping it off will result in failure of this competency. May prep with alcohol before Betadine – alcohol must be permitted to dry, however. 2. Places a sterile drape over the field. Maintains glove sterility or dons new sterile gloves. 3. Using an assistant to hold non-sterile vial of sterile preservative-free 0.9% NS, draws up10 ml. Uses NS to prime the sterile tubing and non-coring needle. Or, without assistant, draws up10 ml. of sterile normal saline – without contaminating gloves or syringe. Uses NS to prime the sterile tubing and non- coring needle. 4. Uses sterile non-dominant hand to palpate and locate the middle of the port septum. Then holds the CVAD firmly between thumb and forefinger to stabilize the port septum. CRITICAL: Once non-dominant hand has been used to palpate and stabilize the port, it cannot be used to touch the non-coring needle or sterile equipment – unless a new sterile glove is first applied. 5. Firmly pushes the non-coring needle into the middle of the CVAD with the needle 90 degrees to the flat bottom of the device. Pushes through the skin and portal system until the needle tip hits the bottom of the portal chamber. Positions (without rocking or tilting the needle) so that tubing extends toward the shoulder/arm. 6. Verifies placement by checking for a blood return. Once blood return verified, flushes 10 ml. sterile NS to clear all blood from catheter. 7. If unable to obtain blood return, rotates needle and aspirates again (does not rock or tilt the needle). If still no blood return, gently flushes with normal saline. Developed by FSH VAT: October, 2004 C
    • Fairview Southdale Hospital Nursing Competency Validation 3 Implanted (Port) Central Venous Access Devices (CVADs): Accessing, Deaccessing, Drawing Blood, and Administering Fluid If this causes any pain or discomfort, removes the needle and starts entire procedure over. CRITICAL: Never pulls non-coring needle out and reinserts it. If septum is missed, starts from beginning with a new sterile dressing kit and new needle. 8. Once the port is successfully accessed, applies sterile transparent dressing over Gripper and extension tubing to maintain sterility and secure in place. CRITICAL: All four edges of the dressing must be sealed. Deaccessing the Implanted CVAD 1. Prepares supplies. 2. Washes hands and dons non-sterile gloves. 3. Clamps extension tubing on Gripper Plus needle. Disconnects infusion tubing from extension tubing, if attached. 4. Cleanses injection cap with alcohol swab. 5. Connects pre-filled syringe with 10 ml. sterile NS. Aspirates to check for blood return. Then, uses intermittent positive flush technique to create turbulence while flushing catheter lumen with 10-30 ml. sterile NS (at least 20 ml. after blood draw). 6. Flushes catheter according to VENOUS ACCESS DEVICE PROTOCOL. CRITICAL: For valved catheter, 5 ml. sterile 0.9% NS to each lumen. If open- end catheter, use 5 ml. Heparin 100 units/ml. Learner must be able to correlate the patient’s device to corresponding device in VENOUS ACCESS DEVICE PROTOCOL. CRITICAL: If not using a POSIFLOW Adapter, must clamp catheter or remove syringe while injecting last ml. of flush solution. 7. Removes transparent dressing from site and discards. 8. Removes the Griper non-coring needle according to manufacturer recommendations. Discards into appropriate biohazard sharps container. 9. Applies pressure to the site and a Band-Aid dressing, as needed. YES NO Blood Collection: Vacutainer Method (PREFERRED) 1. Presses STOP button on pump to pause all CVAD infusions prior to obtaining blood samples. 2. Assembles: vacutainer barrel and female adapter, needleless connector, and blood tubes. 3. Disinfects cap that will be used for blood draw (ideally, distal) with alcohol. Flushes 10 ml. sterile NS into catheter. Aspirates 10 ml. back into same syringe and discards. 4. Inserts vacutainer with needleless connector into the injection cap. Advances each blood tube inside vacutainer barrel to activate retrograde blood flow. Holds blood tubes in place until collection tube fills. Developed by FSH VAT: October, 2004 C
    • Fairview Southdale Hospital Nursing Competency Validation 4 Implanted (Port) Central Venous Access Devices (CVADs): Accessing, Deaccessing, Drawing Blood, and Administering Fluid 5. When all blood samples are drawn, uses intermittent positive flush technique to create turbulence while flushing catheter and cap with at least 20 ml. sterile NS to clear all blood from lumen and cap. 6. Starts fluid infusion, flushes dormant Gripper Plus tubing according to VASCULAR ACCESS DEVICE PROTOCOL, or deaccesses port. YES NO Blood Collection: Syringe Method (IF VACUTAINER METHOD DOES NOT WORK) 1. Presses STOP buttons on pumps to pause infusions before obtaining samples. 2. Assembles syringes, needleless connectors, vacutainer barrel, blood tubes. 3. Disinfects cap on the Gripper Plus extension tubing with alcohol. Flushes 10 ml. sterile NS into cap. Aspirates 10 ml. back into same syringe and discards. 4. Attaches as many 10 ml. syringes as necessary to obtain adequate volume of blood to fill specimen tubes. 5. When all blood samples are drawn, uses intermittent positive flush technique to create turbulence while flushing catheter and cap with at least 20 ml. sterile NS to clear all blood from lumen. 6. Starts fluid infusion, flushes dormant Gripper Plus tubing according to VASCULAR ACCESS DEVICE PROTOCOL, or deaccesses port. 7. Fills blood tubes by inserting needless connector into female adapter on vacutainer barrel. Advances each blood tube inside vacutainer barrel to activate retrograde blood flow. Holds blood tube in place until it fills. YES NO Starting Fluid Infusion 1. Loops extension tubing and tapes securely to patient’s skin to prevent possible tension on non-coring needle during patient movement. 2. Disinfects cap on Gripper extension tubing with alcohol. Connects infusion tubing using needless connector. 3. Observes for signs of infiltration/extravasation around implanted port site as fluid infuses. YES NO Post Procedure 1. Labels tubes at bedside and sends specimens to lab according to policy. 2. Discards sharps in biohazard container. 3. Removes gloves and washes hands. 4. Documents according to policy. Answers the following questions appropriately. Yes No 1. What should your nursing action be if you palpate the implantated portal and note that the septum is facing posterior and the backside is facing the patient’s anterior chest wall? Notify the physician. The port will need surgical revision. Do not attempt to reposition the port. • The catheter could twist or crack. 2. Can you use the lumen if it flushes, but will not aspirate blood? Yes, as long as there is no evidence of infiltration/extravasation and you are not administering • a vesicant solution. But notify the primary care physician. Developed by FSH VAT: October, 2004 C