External 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 external ports.

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External Port Competency

  1. 1. Fairview Southdale Hospital Nursing Competency Validation 1 External Central Venous Access Devices (CVADs): Flushing, Drawing Blood, and Administering Fluid Jugular and Subclavian Catheters, Tunneled Catheters, and Percutaneously Inserted Central Catheters (PICCs), Dialysis Catheters 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. 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 needleless 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 to flush valved catheter: non sterile gloves; alcohol wipes; (1-2) pre-filled 10 ml. syringes of sterile NS. Supplies to flush open-end catheter: 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. New injection cap or PosiFlow adapter, in case blood cannot be cleared. 3. Inspects the insertion site 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. Developed by FSH VAT: October, 2004 C
  2. 2. Fairview Southdale Hospital Nursing Competency Validation 2 External Central Venous Access Devices (CVADs): Flushing, Drawing Blood, and Administering Fluid YES NO Flushing the External CVAD 1. Prepares supplies. 2. Washes hands and don non-sterile gloves. 3. Disconnects infusion tubing from external port of the CVAD, if necessary. 4. Cleanses injection cap with alcohol swab. 5. Connects pre-filled 10 ml. NS syringe and aspirates for blood return. Flushes the 10cc NS. 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 Heparin solution as prescribed in VENOUS ACCESS DEVICE PROTOCOL or physician’s order. 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. 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. 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. If no infusion, flushes lumen as directed in VENOUS ACCESS DEVICE PROTOCOL. YES NO Blood Collection: Syringe Method 1. Presses STOP button on pump to pause all CVAD infusions prior to obtaining blood samples. 2. Assembles: syringes, needleless connectors, vacutainer barrel, 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. Attaches as many 10 ml. syringes as necessary to obtain adequate volume of blood to fill specimen tubes. Developed by FSH VAT: October, 2004 C
  3. 3. Fairview Southdale Hospital Nursing Competency Validation 3 External Central Venous Access Devices (CVADs): Flushing, 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. 6. Restarts fluid infusion or flushes lumen as directed in VENOUS ACCESS DEVICE PROTOCOL. 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 collection tube fills. YES NO Post Procedure 1. Labels tubes and sends specimens to Clinical 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 can you do if blood does not flow into the blood tube or syringe? Have patient change position, cough, move arm above head, or hold a deep breath. • Attempt to flush catheter with NS and attempt to withdraw blood again. • Replace blood tube with a new one. • If still unsuccessful, call the Vascular Access Team for consultation. VAT may determine • that Alteplace can clear a thrombus formation. In either event the physician will need to be notified. Draw the blood specimen peripherally. • 2. If the Dacron cuff presents outside the skin on a patient, what should you do? Notify the physician immediately. The catheter has migrated outward. • 3. When is it permissible to draw blood or administer fluids/medications through a dialysis catheter? When you have a written order from the physician. The order must contain complete • instructions for flush routine (what, how much, how often). Developed by FSH VAT: October, 2004 C

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