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  • Guidelines for the Prevention of Intravascular Catheter-Related Infections CDC
  • Bard Access
  • NavilystVaxcel
  • Groshong Valve
  • Cook
  • Guidelines for the Prevention of Intravascular Catheter-Related Infections CDC
  • INS 2011
  • Statlock
  • INS 2011

Srt piccs Srt piccs Presentation Transcript

  • SRT PICCsWhy We Do IT
  • MEMORY AID1. Wash your hands first.2. Use body fluid precautions.3. Aseptic care of vascular access devices.4. The fluid pathway must remain sterile.5. All cleaning solutions must be allowed to dry completely.6. Catheters must be secured.7. Do NOT remove a PICC.
  • WHAT IS A PICC?A peripherally Inserted Central Catheter (PICC)is a long, thin, flexible tube that is used forgiving intravenous fluids and medications. It isinserted through a peripheral vein, preferablyin the upper arm and advanced until the tip ofthe catheter reaches a large vein above theheart.
  • WHY INSERT A PICC?PICC lines can remain in place for extendedperiods of time provided that there are nocomplications. PICCs placement in the SVCprovides better hemodilution than shorterperipheral catheters and are thereforeindicated for hypotonic, isotonic, hypertonicand vesicant therapy. Prolonged IV antibiotictreatment, TPN Nutrition, ChemotherapySome PICCs are engineered to allow additionalfunctions including high pressure injection (upto 300 psi).
  • WHO INSERTS A PICC? PICCs are usually inserted by physicians, nurse practitioners, or specially trained certified registered nurses and radiologic technologists using ultrasound, chest radiographs, fluoroscopy , and ECG to aid in their insertion and to confirm placement. PICC insertion is a sterile procedure, but does not require the use of an operating room. When done at bedside (that is, in the patients room), a suitable sterile field must be established and maintained throughout the procedure.
  • HOW IS A PICC INSERTED? http://www.youtube.com/watch?feature=play er_embedded&v=sViSpYptjqk
  • HOW DO PICCS DIFFER Single or Multi Lumen Valved or Non-Valved
  • HOW DO PICCs DIFFER? The PICC may have single or multiple lumens. This depends on how many intravenous therapies are needed.
  • HOW DO PICCs DIFFER Use a CVC with the minimum number of ports or lumens essential for the management of the patient [65–68]. Category IB (CDC )
  • PICC SKIN CLEANING SOLUTIONS - Prepare clean skin with a >0.5% chlorhexidine preparation with alcohol before central venous catheter and peripheral arterial catheter insertion and during dressing changes. If there is a contraindication to chlorhexidine, tincture of iodine, an iodophor, or 70% alcohol can be used as alternatives [82, 83]. Category IA - No comparison has been made between using chlorhexidine preparations with alcohol and povidone-iodine in alcohol to prepare clean skin. - Antiseptics should be allowed to dry according to the manufacturer’s recommendation. (CDC)
  • PICC CARE DRESSINGWear either clean or sterile gloves whenchanging the dressing on intravascularcatheters. Category IC (CDC)
  • PICC CARE DRESSINGPerform hand hygiene procedures, either bywashing hands with conventional soap andwater or with alcohol-based hand rubs (ABHR).Hand hygiene should be performedbefore and after palpating catheter insertionsites as well as before and after inserting,replacing, accessing, repairing, or dressing anintravascular catheter. Palpation of theinsertion site should not be performed afterthe application of antiseptic, unless aseptictechnique is maintained [12, 77–79]. CategoryIB2. Maintain aseptic technique for the insertionand care of intravascular catheters [37, 73](CDC)
  • PICC CARE DRESSING- Replace transparent dressings used ontunneled or implanted CVC sites no more thanonce per week (unless the dressing is soiled orloose), until the insertion site has healed.Category II- Replace catheter site dressing if the dressingbecomes damp, loosened, or visibly soiled[84, 85]. Category IB- If the patient is diaphoretic or if the site isbleeding or oozing, use a gauze dressing untilthis is resolved [84–87]. Category II- Replace dressings used on short-term CVCsites every 2 days for gauze dressings. (CDC)
  • PICC CARE DRESSING36.1 Vascular access device (VAD) stabilizationshall beused to preserve the integrity of the accessdevice, minimize catheter movement at thehub, and preventcatheter dislodgment and loss of access.36.2 VADs shall be stabilized using a methodthat doesnot interfere with assessment and monitoringof theaccess site or impede vascular circulation ordelivery of the prescribed therapy.
  • PICC CARE DRESSING-- Use a sutureless securement device to reducethe risk of infection for intravascularcatheters [105]. Category II
  • PRN ADAPTERSNegative Fluid Displacement - Baxter Healthcare Interlink - ICU Medical ClavePositive Fluid Displacement - ICU Medical CLC 2000 Neutral Fluid Displacement
  • PRN ADAPTERS baxter interlink
  • PRN ADAPTERS baxter one link
  • PICC CARE FLUSHINGThe Infusion Nursing Standards of Practice establishes the national standard forall infusion therapy. This standard on flushing emphasizes the goals of maintaining patency and preventingcontact between heparin and incompatible solutions.The standard incorporates the concepts of catheter flushing and locking. Flushingassesses catheter patency and functionality and removes the previously infusedmedication. Locking the catheter creates a closed column of fluid inside the catheterlumen intended to prevent blood from moving into the lumen. (IV) SASH Saline Admixture Saline Heparin Lock non-valved catheters with positive pressure.
  • PICC CARE FLUSHING45.1 Vascular access devices shall be flushed priorto each infusion as part of the steps to assess catheterfunction.45.2 Vascular access devices shall be flushed after eachinfusion to clear the infused medication from thecatheter lumen, preventing contact between incompatiblemedications.45.3 Vascular access devices shall be locked after completionof the final flush solution to decrease the risk ofocclusion. (IV)SASH Saline Admixture Saline Heparin
  • Infection Obstruction Phlebitis Malposition Embolism Air/CatheterCOMPLICATIONS
  • PHLEBITISA. The nurse should routinely assess allvascular access sitesfor signs and symptoms of phlebitis based onpatientpopulation, type of therapy, type of device,and riskfactors. Signs and symptoms of phlebitisinclude pain,tenderness, erythema, warmth, swelling,induration,purulence, or palpable venous cord; thenumber orseverity of signs and symptoms that indicatephlebitisdiffer among published clinicians andresearchers.1-9 (IV)
  • EMBOLISM AIR/CATHETER 50.1 The prevention, identification, and management of air embolism during the insertion, care, and removal of vascular access devices (VADs) shall be established in organizational policies, procedures, and/or practice guidelines.
  • EMBOLISM AIR/CATHETER The nurse should suspect air embolism with the sudden onset of dyspnea, continued coughing, breathlessness, chest pain, hypotension, jugular venous distension, tachyarrhythmias, wheezing, tachypnea, altered mental status, altered speech, changes in facial appearance, numbness, and paralysis. Clinical events from air emboli produce cardiopulmonary and neurological signs and symptoms.1,2 (V) B. The nurse should immediately take the necessary action to prevent more air from entering the bloodstream by closing, folding, or clamping the existing catheter or by occluding the puncture site (IV)“ Prevention of air embolism is the goal and this can beaccomplished with all petroleum-based products includinga plain Vaseline gauze.”
  • INFECTIONA. VAD-related infection includes exit-site, tunnel,port pocket, and catheter-related bloodstreaminfection (CR-BSI). Infusate-related bloodstreaminfections are caused by intrinsic or extrinsic contaminationof the administration delivery system,infusing fluids and medications.1-7 (IV)
  • MEMORY AID1. Wash your hands first.2. Use body fluid precautions.3. Aseptic care of vascular access devices.4. The fluid pathway must remain sterile.5. All cleaning solutions must be allowed to dry completely.6. Catheters must be secured.7. Do NOT remove a PICC.