Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Multidisciplinary Care in Regional Victoria
Document related concepts
Transcript
Management of Central Venous Access Devices 2. HICKMAN CATHETER Nurse Education Workforce Strategy – Gippsland Region Gippsland Oncology Nurses Group (GONG) TUTORIAL HICKMAN CATHETER This Tutorial Hickman Description Advantages / Disadvantages Confirm Placement Principles of Care > Accessing > Syringe Size > Removal > Flushing > Heparin Lock > Cap/ Bung Description > Changing a Cap / Bung > Changing a Dressing > Changing and IV line > Taking Blood > Documentation Complications > Blockage of lumen > Infection > Thrombosis > Damage Resources GONG Products Management of Central Venous Access Devices Acknowledgements This project is an initiative of : Nurse Education Workforce Strategy –Gippsland Content supplied by: Gippsland Oncology Nurses Group (GONG)- an initiative of Gippsland Region Integrated Cancer Services (GRICS) Special thanks: Anny Byrne (Gippsland Regional Integrated Cancer Services) Anne Maree Day (West Gippsland HealthCare Group) Dianne Fahy (Nurse Education Workforce Strategy) Anne Johnson (Latrobe Regional Hospital) Linda Langskaill (Central Gippsland Health Service) Melanie Regan (Gippsland Regional Integrated Cancer Services) See other sources and references at the end of this presentation. Further reading is encouraged to complement these tutorials. CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETER 3. PORT 4. PICC TUTORIAL HICKMAN CATHETER This Tutorial Hickman Description Advantages / Disadvantages Confirm Placement Principles of Care > Accessing > Syringe Size > Removal > Flushing > Heparin Lock > Cap/ Bung Description > Changing a Cap / Bung > Changing a Dressing > Changing and IV line > Taking Blood > Documentation Complications > Blockage of lumen > Infection > Thrombosis > Damage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETER 3. PORT 4. PICC Management of Central Venous Access Devices Scope of Tutorial • What is a Hickman Catheter? • List the advantages and disadvantages • What care should be provided when changing a cap/bung? • What is the strength of heparin lock used for a Hickman catheter? • Describe how to flush in a ‘pulsatile’ manner • What is the minimum size syringe used when accessing a Hickman Catheter? • List the essentials for documentation • What are the main complications with a Hickman Catheter and how to troubleshoot them? TUTORIAL HICKMAN CATHETER This Tutorial Hickman Description Advantages / Disadvantages Confirm Placement Principles of Care > Accessing > Syringe Size > Removal > Flushing > Heparin Lock > Cap/ Bung Description > Changing a Cap / Bung > Changing a Dressing > Changing and IV line > Taking Blood > Documentation Complications > Blockage of lumen > Infection > Thrombosis > Damage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETER 3. PORT 4. PICC Management of Central Venous Access Devices Hickman Catheter - Description • A Hickman Catheter is a tunnelled Central Venous Catheter. The tip of the Hickman Catheter resides in the Superior Vena Cava. The remaining lumen is tunnelled under the skin and exits the chest or abdominal wall. A cuff attached to the lumen adheres to the skin and tissues close to the exit site, which anchors the catheter. • A Hickman catheter can consist of single, double or triple lumens. • A Hickman catheter is used for intermediate and long term therapies usually in the haematology setting. TUTORIAL HICKMAN CATHETER This Tutorial Hickman Description Advantages / Disadvantages Confirm Placement Principles of Care > Accessing > Syringe Size > Removal > Flushing > Heparin Lock > Cap/ Bung Description > Changing a Cap / Bung > Changing a Dressing > Changing and IV line > Taking Blood > Documentation Complications > Blockage of lumen > Infection > Thrombosis > Damage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETER 3. PORT 4. PICC Management of Central Venous Access Devices Hickman Catheter ADVANTAGES DISADVANTAGES • Large bore lumens • High maintenance • Pain free when accessed • Altered body image • Single, double or triple lumens for multiple infusions • Theatre for insertion / removal • Increased risk of infection TUTORIAL HICKMAN CATHETER This Tutorial Hickman Description Advantages / Disadvantages Confirm Placement Principles of Care > Accessing > Syringe Size > Removal > Flushing > Heparin Lock > Cap/ Bung Description > Changing a Cap / Bung > Changing a Dressing > Changing and IV line > Taking Blood > Documentation Complications > Blockage of lumen > Infection > Thrombosis > Damage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETER 3. PORT 4. PICC Management of Central Venous Access Devices Confirmation of placement • Every time the Hickman Catheter is accessed, the nurse is responsible for confirming correct placement by: – – – – Aspiration of blood Ability to easily infuse solutions Normal appearance of site and patient’s chest Written x-ray report confirming correct placement of Hickman Catheter available in patient record • If unable to confirm correct placement refer to the troubleshooting section of the GONG Cancer Care Guidelines ‘Hickman Catheter Management’ (see Resources) TUTORIAL HICKMAN CATHETER This Tutorial Hickman Description Advantages / Disadvantages Confirm Placement Principles of Care > Accessing > Syringe Size > Removal > Flushing > Heparin Lock > Cap/ Bung Description > Changing a Cap / Bung > Changing a Dressing > Changing and IV line > Taking Blood > Documentation Complications > Blockage of lumen > Infection > Thrombosis > Damage Resources GONG Products Management of Central Venous Access Devices Principles of Care • Clamps are ESSENTIAL on Hickman catheters • Must be left open when a positive pressure bung is in use • Must be closed if a nonpositive pressure bung is in use • Must be closed when the system is opened i.e. cap/bung removed Non Positive Pressure Bung Positive Pressure Bung CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETER 3. PORT 4. PICC Note: Above is a sample of one type of bung currently available TUTORIAL HICKMAN CATHETER This Tutorial Hickman Description Advantages / Disadvantages Confirm Placement Principles of Care > Accessing > Syringe Size > Removal > Flushing > Heparin Lock > Cap/ Bung Description > Changing a Cap / Bung > Changing a Dressing > Changing and IV line > Taking Blood > Documentation Complications > Blockage of lumen > Infection > Thrombosis > Damage Resources GONG Products Management of Central Venous Access Devices Accessing • A clean technique* is required for accessing a closed system through a cap/bung • Aspirate for blood return to check patency and position • Flush with 10 ml normal saline in a pulsatile manner when position confirmed • Connect to IV line • * Recommended clean technique: clean gloves and CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETER 3. PORT 4. PICC clean with 3 alcohol swabs and allow to air dry before proceeding to access a closed system TUTORIAL HICKMAN CATHETER This Tutorial Hickman Description Advantages / Disadvantages Confirm Placement Principles of Care > Accessing > Syringe Size > Removal > Flushing > Heparin Lock > Cap/ Bung Description > Changing a Cap / Bung > Changing a Dressing > Changing and IV line > Taking Blood > Documentation Complications > Blockage of lumen > Infection > Thrombosis > Damage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETER 3. PORT 4. PICC Management of Central Venous Access Devices Syringe Size • Syringes no smaller than 10 ml to be used • Smaller syringes increase the pressure in the catheter wall and increase the risk of rupture of the catheter TUTORIAL HICKMAN CATHETER This Tutorial Hickman Description Advantages / Disadvantages Confirm Placement Principles of Care > Accessing > Syringe Size > Removal > Flushing > Heparin Lock > Cap/ Bung Description > Changing a Cap / Bung > Changing a Dressing > Changing and IV line > Taking Blood > Documentation Complications > Blockage of lumen > Infection > Thrombosis > Damage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETER 3. PORT 4. PICC Management of Central Venous Access Devices Catheter Removal • Only to be performed by a doctor in a hospital setting TUTORIAL HICKMAN CATHETER This Tutorial Hickman Description Advantages / Disadvantages Confirm Placement Principles of Care > Accessing > Syringe Size > Removal > Flushing > Heparin Lock > Cap/ Bung Description > Changing a Cap / Bung > Changing a Dressing > Changing and IV line > Taking Blood > Documentation Complications > Blockage of lumen > Infection > Thrombosis > Damage Resources GONG Products Management of Central Venous Access Devices Flushing • Flush with Normal Saline 10 ml in a pulsatile (stop/start) manner: that is, push then pause the plunger of 10ml syringe continuously in short bursts until syringe empty • On accessing the Hickman Catheter to determine patency • Before and after drug administration • After blood sampling • Weekly, when not in use CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETER 3. PORT 4. PICC TUTORIAL HICKMAN CATHETER This Tutorial Hickman Description Advantages / Disadvantages Confirm Placement Principles of Care > Accessing > Syringe Size > Removal > Flushing > Heparin Lock > Cap/ Bung Description > Changing a Cap / Bung > Changing a Dressing > Changing and IV line > Taking Blood > Documentation Complications > Blockage of lumen > Infection > Thrombosis > Damage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETER 3. PORT 4. PICC Management of Central Venous Access Devices Heparin Lock • Weak heparin lock (heparinization) 50u/s in 5ml is all that is required – After each use, and weekly, when a non-positive pressure bung is in use * Remember never use a syringe smaller than a 10ml TUTORIAL HICKMAN CATHETER This Tutorial Hickman Description Advantages / Disadvantages Confirm Placement Principles of Care > Accessing > Syringe Size > Removal > Flushing > Heparin Lock > Cap/ Bung Description > Changing a Cap / Bung > Changing a Dressing > Changing and IV line > Taking Blood > Documentation Complications > Blockage of lumen > Infection > Thrombosis > Damage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETER 3. PORT 4. PICC Management of Central Venous Access Devices Cap / Bung Description • The positive pressure bung maintains a positive pressure in the line to prevent back flow of blood into the end of the catheter. • A positive pressure bung should be used with a Hickman Catheter. If a positive pressure bung is unavailable then use a non positive pressure bung and weak heparinization is required. Non Positive Pressure Bung Positive Pressure Bung Note: Above is a sample of one type of bung currently available TUTORIAL HICKMAN CATHETER This Tutorial Hickman Description Advantages / Disadvantages Confirm Placement Principles of Care > Accessing > Syringe Size > Removal > Flushing > Heparin Lock > Cap/ Bung Description > Changing a Cap / Bung > Changing a Dressing > Changing and IV line > Taking Blood > Documentation Complications > Blockage of lumen > Infection > Thrombosis > Damage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETER 3. PORT 4. PICC Management of Central Venous Access Devices Changing a Cap / Bung • Aseptic technique required using a sterile tray and sterile gloves • Positive pressure cap/bung should always be insitu and must be changed at least every 7 days • Clamp line before removing cap/bung TUTORIAL HICKMAN CATHETER This Tutorial Hickman Description Advantages / Disadvantages Confirm Placement Principles of Care > Accessing > Syringe Size > Removal > Flushing > Heparin Lock > Cap/ Bung Description > Changing a Cap / Bung > Changing a Dressing > Changing and IV line > Taking Blood > Documentation Complications > Blockage of lumen > Infection > Thrombosis > Damage Resources GONG Products Management of Central Venous Access Devices Changing a dressing • Always use an aseptic technique • Initial dressing should be changed 24 hours post insertion • Dressing should be changed every 7 days or earlier if necessary • Dressing usually not required 21 days post insertion • Entry site may be left uncovered when healed CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETER 3. PORT 4. PICC TUTORIAL HICKMAN CATHETER This Tutorial Hickman Description Advantages / Disadvantages Confirm Placement Principles of Care > Accessing > Syringe Size > Removal > Flushing > Heparin Lock > Cap/ Bung Description > Changing a Cap / Bung > Changing a Dressing > Changing and IV line > Taking Blood > Documentation Complications > Blockage of lumen > Infection > Thrombosis > Damage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETER 3. PORT 4. PICC Management of Central Venous Access Devices Changing an IV Line • A clean technique* is required when the system is closed ie. bung is in place • Continuous IV infusion line is changed every 72 hours • For intermittent IV infusion, change line with each infusion • Change IV TPN/Lipid line every 24 hours • Blood product infusion sets changed to an IV infusion set on completion of the blood product infusion *Recommended clean technique: clean gloves and clean with 3 alcohol swabs and allow to air dry before proceeding to access a closed system TUTORIAL HICKMAN CATHETER This Tutorial Hickman Description Advantages / Disadvantages Confirm Placement Principles of Care > Accessing > Syringe Size > Removal > Flushing > Heparin Lock > Cap/ Bung Description > Changing a Cap / Bung > Changing a Dressing > Changing and IV line > Taking Blood > Documentation Complications > Blockage of lumen > Infection > Thrombosis > Damage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETER 3. PORT 4. PICC Management of Central Venous Access Devices Taking Blood • Perform initial flush to determine patency (except for blood cultures) • Discard the first 5ml of blood withdrawn before collecting sample • When taking blood cultures do not perform initial flush to determine patency, do not discard a sample. Retain initial sample for blood culture • Flush Hickman Catheter, in a pulsatile manner, with 20ml of Normal Saline after blood sampling and continue with treatment as ordered and / or heparinization if required TUTORIAL HICKMAN CATHETER This Tutorial Hickman Description Advantages / Disadvantages Confirm Placement Principles of Care > Accessing > Syringe Size > Removal > Flushing > Heparin Lock > Cap/ Bung Description > Changing a Cap / Bung > Changing a Dressing > Changing and IV line > Taking Blood > Documentation Complications > Blockage of lumen > Infection > Thrombosis > Damage Resources GONG Products Management of Central Venous Access Devices Documentation Clear, consistent documentation is essential after each treatment or shift. This should include: • Ability to confirm placement • Medications and flushes administered • Strength of heparinization (if used) • Type of bung/cap used • Dressing change • Signs and symptoms of infection or thrombosis • Troubleshooting CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETER 3. PORT 4. PICC * Written x-ray report confirming correct placement at time of insertion should be available in patient documentation TUTORIAL HICKMAN CATHETER This Tutorial Hickman Description Advantages / Disadvantages Confirm Placement Principles of Care > Accessing > Syringe Size > Removal > Flushing > Heparin Lock > Cap/ Bung Description > Changing a Cap / Bung > Changing a Dressing > Changing and IV line > Taking Blood > Documentation Complications > Blockage of lumen > Infection > Thrombosis > Damage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETER 3. PORT 4. PICC Management of Central Venous Access Devices Complications 1. Blockage of lumens 2. Infection at insertion site or in catheter 3. Thrombosis 4. Damage to exposed catheter TUTORIAL HICKMAN CATHETER This Tutorial Hickman Description Advantages / Disadvantages Confirm Placement Principles of Care > Accessing > Syringe Size > Removal > Flushing > Heparin Lock > Cap/ Bung Description > Changing a Cap / Bung > Changing a Dressing > Changing and IV line > Taking Blood > Documentation Complications > Blockage of lumen > Infection > Thrombosis > Damage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETER 3. PORT 4. PICC Management of Central Venous Access Devices 1. Blockage of lumen Difficulty flushing and/or aspirating blood • Ensure any clamps are open • Change position of patient • Change cap or bung TUTORIAL HICKMAN CATHETER This Tutorial Hickman Description Advantages / Disadvantages Confirm Placement Principles of Care > Accessing > Syringe Size > Removal > Flushing > Heparin Lock > Cap/ Bung Description > Changing a Cap / Bung > Changing a Dressing > Changing and IV line > Taking Blood > Documentation Complications > Blockage of lumen > Infection > Thrombosis > Damage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETER 3. PORT 4. PICC Management of Central Venous Access Devices 2. Infection • Redness, discharge, tenderness, heat, patient feels unwell, pain and swelling at Hickman Catheter site may be symptoms of infection • If signs of infection are present do not access Hickman Catheter and consult physician • Septic shower may occur immediately after flushing due to infection in the line. There may be an absence of obvious infection at entry site, however the patient will experience rigors and generally feel unwell. Consult physician TUTORIAL HICKMAN CATHETER This Tutorial Hickman Description Advantages / Disadvantages Confirm Placement Principles of Care > Accessing > Syringe Size > Removal > Flushing > Heparin Lock > Cap/ Bung Description > Changing a Cap / Bung > Changing a Dressing > Changing and IV line > Taking Blood > Documentation Complications > Blockage of lumen > Infection > Thrombosis > Damage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETER 3. PORT 4. PICC Management of Central Venous Access Devices 3. Thrombosis • Do not access Hickman Catheter and consult physician TUTORIAL HICKMAN CATHETER This Tutorial Hickman Description Advantages / Disadvantages Confirm Placement Principles of Care > Accessing > Syringe Size > Removal > Flushing > Heparin Lock > Cap/ Bung Description > Changing a Cap / Bung > Changing a Dressing > Changing and IV line > Taking Blood > Documentation Complications > Blockage of lumen > Infection > Thrombosis > Damage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETER 3. PORT 4. PICC Management of Central Venous Access Devices 4. Damage to exposed catheter Check catheter every time it is accessed for: – Perishing, splitting, damage and if the cap is firmly in place – Refer to physician if integrity is compromised – This is more common in children TUTORIAL HICKMAN CATHETER This Tutorial Hickman Description Advantages / Disadvantages Confirm Placement Principles of Care > Accessing > Syringe Size > Removal > Flushing > Heparin Lock > Cap/ Bung Description > Changing a Cap / Bung > Changing a Dressing > Changing and IV line > Taking Blood > Documentation Complications > Blockage of lumen > Infection > Thrombosis > Damage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETER 3. PORT 4. PICC Management of Central Venous Access Devices Resources GONG Cancer Care Guidelines have been accepted to guide the management of all patients with a CVAD in Gippsland and are available at each Gippsland Health Service. Also available on-line at: www.gha.net.au/grics TUTORIAL HICKMAN CATHETER This Tutorial Hickman Description Advantages / Disadvantages Confirm Placement Principles of Care > Accessing > Syringe Size > Removal > Flushing > Heparin Lock > Cap/ Bung Description > Changing a Cap / Bung > Changing a Dressing > Changing and IV line > Taking Blood > Documentation Complications > Blockage of lumen > Infection > Thrombosis > Damage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTION 2. HICKMAN CATHETER 3. PORT 4. PICC Management of Central Venous Access Devices GONG Products www.gha.net.au/grics
