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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 pic cs Srt pic cs Presentation Transcript

  • SRT PICCsWhy We Do IT
  • CENTRE FOR DISEASE CONTROLGuidelines for the Prevention ofIntravascular Catheter-RelatedInfections, 2011
  • INFUSION NURSES SOCIETY2011 Infusion Nursing Standards of Practice
  • 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 drycompletely.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.
  • WHAT IS A PICC?
  • 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, nursepractitioners, or specially trained certifiedregistered nurses and radiologic technologistsusing ultrasound, chestradiographs, fluoroscopy , and ECG to aid intheir insertion and to confirm placement. PICCinsertion is a sterile procedure, but does notrequire the use of an operating room. Whendone at bedside (that is, in the patientsroom), a suitable sterile field must beestablished and maintained throughout theprocedure.
  • HOW IS A PICC INSERTED?http://www.youtube.com/watch?feature=player_embedded&v=sViSpYptjqk
  • HOW DO PICCS DIFFERSingle or Multi LumenValved or Non-Valved
  • HOW DO PICCs DIFFER?The PICC may have single or multiple lumens.This depends on how many intravenoustherapies are needed.
  • HOW DO PICCs DIFFERUse a CVC with the minimum number of portsor lumens essential for the managementof the patient [65–68]. Category IB (CDC )
  • HOW DO PICCs DIFFERVALVED
  • HOW DO PICCS DIFFERVALVED
  • HOW DO PICCs DIFFERVALVED
  • HOW DO PICCs DIFFERNONVALVED
  • PICC SKIN CLEANING SOLUTIONS- Prepare clean skin with a >0.5% chlorhexidinepreparation with alcohol before centralvenous catheter and peripheral arterialcatheter insertion and during dressingchanges.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 betweenusing chlorhexidine preparations with alcoholand povidone-iodine in alcohol to prepareclean skin.- Antiseptics should be allowed to dryaccording to the manufacturer’srecommendation. (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 2000Neutral Fluid Displacement
  • PRN ADAPTERSBaxter Interlink
  • PRN ADAPTERSCLC2000
  • PRN ADAPTERSCLC2000
  • PRN ADAPTERSICU MEDICAL CLAVE
  • PRN ADAPTERSICU MEDICAL CLAVE
  • PRN ADAPTERSBaxter 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 HeparinLock 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
  • COMPLICATIONSInfectionObstructionPhlebitisMalpositionEmbolism Air/Catheter
  • OBSTRUCTIONThere are a number of causes for obstruction of a PICC.Blood product or drug residue, fibrin sheath, and kinking or pinching offof the catheter.
  • FIBRIN SHEATH
  • FIBRIN SHEATH
  • FIBRIN SHEATH
  • 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)
  • 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)
  • MALPOSITION
  • MALPOSITION
  • MALPOSITION
  • MALPOSITION
  • EMBOLISM AIR/CATHETER50.1 The prevention, identification, and management of airembolism during the insertion, care, and removal of vascular access devices(VADs) shall be established in organizational policies, procedures, and/orpractice guidelines. (IV)
  • EMBOLISM AIR/CATHETERThe nurse should suspect air embolism with the suddenonset of dyspnea, continuedcoughing, breathlessness, chestpain, hypotension, jugular venousdistension, tachyarrhythmias, wheezing, tachypnea,altered mental status, altered speech, changes infacial appearance, numbness, and paralysis. Clinicalevents from air emboli produce cardiopulmonaryand neurological signs and symptoms.1,2 (V)B. The nurse should immediately take the necessaryaction to prevent more air from entering thebloodstream by closing, folding, or clamping theexisting 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.”
  • DO NOT REMOVE A PICC1. Air Embolism2. Syncope3. Venous Spasm4. Catheter Fracture
  • VENOUS SPASM
  • 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 drycompletely.6. Catheters must be secured.7. Do NOT remove a PICC.