Pediatric emergency medicine trisk 4666 4666

TABLE 135.6 TIPS FOR THE ROUTINE USE OF INDWELLING VENOUS ACCESS DEVICES Aseptic technique Do not use clamps or hemostats with teeth for external catheters Flush entire intravenous circuit before accessing system Always close clamps when any part of the circuit is open Clean the needleless cap for 15 seconds and allow to dry prior to every entry into the cap Do not infuse fluids or medications until patency is established Flush the catheter/port with 5–10 mL of saline between medications Flush cap or port with heparin when procedure is complete When a tunneled CVC is accessed, these steps should be followed: Before accessing the system, prime the intended IV circuit, including connection tubing, with saline to remove air Clamp the IV tubing closed Clamp any external portions of central catheter on the protected area near the hub Clean the cap on the end of the system using at last 15 seconds of mechanical friction, preferentially with a device, such as Site-Scrub, that contains alcohol, povidone iodine, or chlorhexidine Allow the solution to dry Repeat cap cleaning prior to each entry Flush the system with to mL of saline in a 5- to 10-mL syringe and then aspirate to mL of blood to check patency; not use this as a blood sample —discard Absence of blood return may indicate the formation of fibrin sheath on internal catheter tip or malpositioning of the tip If no blood returns, consider treatment with tPA if a fibrin sheath is suspected If not successful after two doses, consider a dye study and not use the catheter for vesicant infusion Draw off blood needed for laboratory analysis and administer medications or fluids as needed Flush again with saline and then either flush the device with heparin or connect the IV tubing to the needleless cap using Luer lock connections If the catheter is to be heparin-locked, clamp the line prior to removal of the flush syringe; this maneuver is not necessary for the saline-flushed Groshong device If the needleless cap is removed, discard the old needleless cap and replace it with a new one using sterile technique