Department Policy Code: D: PC- · PDF fileDepartment Policy Code: D: PC-5100 Entity: Fairview Pharmacy Services Department: Fairview Home Infusion Manual: Policy and Procedure Manual

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Department Policy

Code: D: PC-5100

Entity: Fairview Pharmacy Services

Department: Fairview Home Infusion

Manual: Policy and Procedure Manual

Category: Home Infusion

Subject: Access Device Management, General Policies

Purpose: Fairview Home Infusion qualified staff will be knowledgeable in

Access Device Management.

Definition: Access Devices refer to a large variety of manufactured devices that

can be inserted percutaneously or surgically and are designed to

allow for the local or systemic treatment of illnesses via the venous,

arterial, enteral, intracavitary, intraspinal and subcutaneous routes.

Policy: The following policies address common guidelines to be used for

care of many of the access devices. Refer to Attachment I and

device specific policies and procedures for additional information.

I. Written physician orders for initiation, care and management of

the access device shall be documented on the Plan of Care and

include:

A. Type of device including the name and number of lumens.

B. Use of an anesthetic (e.g. Emla or Lidocaine) for insertion of

percutaneous catheters, if appropriate and indicated.

C. Concentration, amount and frequency of heparin flushing

solution, if applicable.

D. Amount and frequency of saline flushing solution, if

applicable.

E. Type and frequency of site care.

F. Whether or not the access device may be used for blood

drawing, if applicable.

G. Whether or not the access device may be repaired, if

applicable.

II. Following receipt of a physician’s order, a nurse deemed

competent may:

A. Remove a non-tunneled central venous catheter.

B. Remove catheter sutures (excluding PICC’s)

C. Insert a different catheter type.

D. Insert a catheter, following Nurse Practice Guidelines.

E. Perform a catheter repair following manufacturer

instructions.

F. Perform a catheter exchange for Peripherally Inserted Central

Catheters (PICC).

III. General guidelines for protection of all catheter types include:

A. Never use scissors near a catheter.

B. If a needle is used to access the injection cap, never use one

longer than 1” to avoid puncturing the catheter.

C. Routine clamping of a CVC is necessary when not in use. If

the clamp is not part of the catheter, use a smooth-edged

clamp over a piece of tape placed on the catheter.

Damage may occur if a clamp with teeth is applied to the

catheter.

EXCEPTION: The Groshong catheter should not be

clamped unless the integrity of the valve has been comprised

or a catheter repair is being performed. (A clamp must

always be available).

D. Avoid using acetone solutions or iodine tinctures which can

cause silicone to dry and crack.

E. 5. When drawing blood from a multi-lumen catheter, the

distal lumen should be used.

IV. As part of patient/caregiver education, the nurse shall instruct the

patient/caregiver in appropriate access device management

including catheter site care, injection cap change, flushing and

signs/symptoms and management of infected, displaced,

damaged or obstructed catheter/port/feeding tube.

V. A needleless system shall be utilized in administering all

intravenous therapies.

VI. All connections in the intravenous system (catheter and tubing)

shall be luer lock.

VII. Catheter occlusions will be cleared to restore patency with a

physician order and protocols with clinical evidence to support

the procedure.

Procedure: I. Central Venous Catheters – Central venous catheters (CVC) are

either surgically or percutaneously placed and are catheters

whose distal tip is located in the superior vena cava or high right

atrium. Veins most appropriate for central venous access are the

internal jugular and subclavian veins. When the femoral ein is

used for central venous access, correct tip location is the inferior

vena cava.

A. Non-Tunneled or Percutaneous – Short-term percutaneous

CVCs inserted directly into the selected vein based on

anatomical landmarks. The veins typically used to gain

access to the central venous system are the jugular veins and

the subclavian vein.

1. Polyurethane is the most commonly used material.

2. Intended for days to several weeks of IV access.

3. Multiple lumen features.

4. In-room or outpatient insertion procedure.

5. For short-term use only.

6. Requires routine sterile dressing changes.

7. Patient self-care difficult due to chest insertion site.

B. Tunneled Catheter – a catheter designed to have a portion lie

within a subcutaneous passage before exiting the body.

Tunneled catheters have a Dacron cuff attached, which after

insertion, is located within the subcutaneous tunnel. Central

venous access with the tunneled catheter is usually

accomplished by a percutaneous approach using a Seldinger

(over-the-guide wire) technique into the subclavian or

internal jugular veins. The point at which the catheter exits

the body (exit site) is considerable distance from the actual

venous insertion site, thus making it more difficult for

microorganisms to reach the venous system. Both tunnel

length and proper location of the cuff are important to

prevent catheter dislodgment. Exit site sutures placed post

insertion to prevent dislodgment of catheter allowing for the

Dacron cuff to adhere. Sutures can be removed after 10 days

with physicians order.

1. Silastic is most commonly used material.

2. Intended for long-term intermittent, continuous, or

daily IV access.

3. The optimal time interval for removal of a central

venous catheter is unknown; ongoing and frequent

monitoring of site should be performed and

documented.

4. May be single or multiple lumen.

5. Sterile dressing changes every seven (7) days and

PRN.

6. May be open ended or valved (Groshong).

7. Placement can be done as outpatient surgical

procedure.

C. Peripherally Inserted Central Catheter (PICC Lines) –

Catheters inserted into the cephalic or basilic vein in the

antecubital fossa. The tip is located in the superior vena cava

at the juncture of the right atrium. X-ray verification is

needed to verify placement.

1. Intended for long-term intermittent, continuous, or

daily IV access.

2. The optimal time interval for removal of a

peripherally inserted central catheter is unknown;

ongoing and frequent monitoring of site should be

performed and documented.

3. May be single of multiple lumen.

4. Sterile dressing changes every seven (7) days and

PRN.

5. May be open ended or valved (Groshong).

6. Single lumen Groshong PICC can be repaired

externally.

7. Placement can be done as outpatient surgical

procedure.

II. Implanted Ports – A totally implanted system consisting of a

reservoir which is made of plastic, titanium or stainless steel well

with self-sealing silicone septum attached to a radiopaque

catheter made of silicone or polyurethane. It is not visible, since

the reservoir is implanted as a sterile procedure by a surgeon

under the skin in the subcutaneous fascia. May be placed in an

artery, epidural/intrathecal space, intrapleural or peritoneal

space.

P.A.S. Port: - Implanted vascular access device placed in

forearm and catheter threaded into the cephalic or basilica

vein in the antecubital fossa. The tip is located in the

superior vena cava.

III. Midline Catheters – Catheters placed in the antecubital fossa and

threaded 6-8 inches, whose tip remains in the upper arm, not

extending past the axilla. Not a central venous catheter. IV

therapy administered in this catheter must meet peripheral IV

therapy criteria. Therapeutic use 2-4 weeks.

IV. Peripheral Venous Catheters or Steel Needles – Catheters or

needles used to access peripheral veins. Visual length is ¾ - 2

inches.

A. Placed for short-term therapy (usually less than seven (7)

days.

B. Peripheral catheters should not be routinely used for blood

draws.

C. Site must be changed every 48 – 72 hours.

V. Subcutaneous Catheters or Needles – Devices used for infusion

of opioids, deferoxamine, heparin, or hormonal therapy. 25-27

gauge catheters or needles are changed every three (3) days.

VI. Intraspinal Catheters/Ports (Epidural or Intrathecal) – Device

which is usually tunneled through the subcutaneous tissue and

whose catheter tip resides in the epidural or intrathecal space.

VII. Enteral Access Devices – Feeding tubes which are either

nasogastric (NG) or nasointestinal (NI) for short-term use and

gastrostomy or jejunostomy tubes placed for long-term feedings.

Site Care and Dressing Change

Dressings shall be changed at established intervals, immediately

upon suspected contamination, or when integrity of dressing is

compromised. Gauze dressings shall be changed every 48 hours on

peripheral and central catheters. Transparent semi-permeable

membrane dressings shall be changed at the time of access site

rotation or every three (3) to seven (7) days, whichever comes first.

BioPatch® disk will be used with each dressing change for all

patients 2 months of age or older with central IV catheters (excludes

implanted ports).

Prior to Beginning Procedure

A. Wash hands.

B. Assemble equipment.

C. Don sterile gloves and other PPE.

D. Use aseptic technique and observe Standard Precautions

throughout procedure.

Site Care and Dressing Change

A. Remove dressing from VAD insertion site.

B. Inspect site and catheter.

C. Disinfect catheter-skin junction using antiseptic solution.

Using friction, apply antiseptic solution

1. If using alcohol, apply friction for a minimum of

30 seconds.

2. If using chlorhexidine gluconate, use friction

according to manufacturer’s labeled use and

directions.

Only one application is necessary.

Prepared site will be approximately the size of dressing

(i.e., 2 to 4 inches diameter)

Allow antiseptic solution to air dry (do not blow or blot

dry)

Repeat twice as necessary depending on antiseptic

solution.

Use of Gauze Dressing

A. Position sterile gauze over catheter insertion site.

B. Seal dressing edges with tape.

C. Change dressing every 48 hours.

D. Change dressing immediately if integrity is compromised or

it there is drainage or moisture.

E. Label dressing with initials and date.

Note: When transparent semipermeable membrane (TSM) is applied

over gauze, it is considered a gauze dressing.

Use of Transparent Semipermeable Membrane (TSM)

A. Secure “wings” of catheter in PICC stabilization device if

needed.

B. Position sterile dressing over insertion site.

C. Apply TSM according to manufacturer’s labeled use and

directions.

D. Gently smooth dressing from center toward edge; do not

apply excessive tension as skin shearing may result.

E. Avoid sealing TSM dressing edges with tape.

F. Do not cover TSM with roller bandage.

G. Change dressing immediately if integrity is compromised or

if there is excessive drainage or moisture.

H. Change dressing at the following intervals:

For peripheral-short catheter sites: change TSM dressing

at time of site rotation

For catheter sites other than peripheral-short catheter

sites: change TSM dressing every three (3) to seven (7)

days.

Note: When TSM is applied over gauze, it is considered a gauze

dressing and must be changed every 48 hours.

I. Label dressing with initials and date.

Post-Site Dressing

A. Discard used supplies.

B. Remove gloves.

C. Wash hands.

Flushing

Flushing is performed to ensure and maintain patency of the

catheter, and to prevent mixing of medications and solutions that are

incompatible.

Flushing with anticoagulant citrate will be performed to maintain

catheter patency for patients requiring a Heparin flush who are

allergic to heparin. The volume or amount of anticoagulant citrate

will be equal to the amount of Heparin used to flush the vascular

access device.

Routine flushing shall be performed with the following:

Administration of blood and blood components.

Blood sampling.

Administration of incompatible medications or solutions.

Administration of medication.

Intermittent therapy.

When converting from continuous to intermittent

therapies.


A. Wash hands.





Flushing

A. Follow manufacturer’s labeled use and directions for flushing

VADs.

B. If resistance is met or an absent blood aspirate is noted, the

nurse should take further steps to assess patency. The

catheter should not be forcibly flushed.

C. Disinfect catheter injection or access cap with antiseptic

solution.

D. With preservative-free 0.9% sodium chloride (USP):

Flush to maintain patency of intermittent VADs with

closed distal tip and three-position valve.

Connect preservative-free 0.9% sodium chloride (USP)-

filled syringe to catheter via insertion into prepared

injection or access cap.

Inject flush solution using the pulse technique.

Disconnect syringe from injection or access cap.

E. With heparin only:

Flush to maintain patency of intermittent VADs.

Connect heparin-filled syringe to catheter via insertion

into prepared injection or access cap.

Inject flush solution using the pulse technique.

Disconnect syringe from injection or access cap.

F. Using the SASH (Saline-Administration-Saline-Heparin) or

SAS (Saline-Administration-Saline) method:

Use SASH flushing procedure when heparin is used for

flushing.

Use SAS flushing procedure when saline is used for

flushing.

Connect first preservative-free 0.9% sodium chloride

(USP)-filled syringe to injection or access cap.

Flush with preservative-free 0.9% sodium chloride

(USP); remove syringe and discard.

Disinfect cap with appropriate antiseptic solution.

Connect medication to injection or access cap.

Administer medication.

Disconnect medication from injection or access cap.

Disinfect injection or access cap with appropriate

antiseptic solution.

Connect second preservative-free0.9% sodium chloride

(USP)-filled syringe to injection or access cap.

Flush with preservative-free 0.9% sodium chloride

(USP); remove syringe and discard.

If needed for heparin flushing (SASH), disinfect injection

or access cap with antiseptic solution.

If needed (SASH), connect heparin-filled syringe to

injection or access cap.

If needed (SASH), inject heparin flush solution using the

pulse technique.

If used for heparin flushing (SASH), disconnect syringe

from injection or access cap and discard.

Post Flush

A. Discard used supplies in appropriate receptacles.

B. Remove gloves.

C. Wash hands.

D. Document in patient’s permanent medical record.

Blood Specimen Collection

Blood specimen collection for blood sample assay determination, or

therapeutic indications may be drawn:

Peripherally via peripheral venipuncture

From peripheral vascular access device(s) at the time of

insertion

From central vascular access device(s)

Blood specimens may not be drawn from an infusion administration

set or proximal to an existing infusion site.

An indwelling peripheral or midline catheter is not routinely used for

blood specimen collection.

The nurse shall be knowledgeable concerning blood specimen

collection technique and practices, including order of the draw.

Collaborate with organizational laboratory for

confirmation of order of draw and appropriate collection

equipment.


A. Wash hands.


C. Don gloves.


throughout blood specimen collection procedure.

From Peripheral Vascular Access Device

A. Blood specimen collection from a peripheral vascular access

device is performed only at the time of initial insertion of the

device.

Do not routinely collect blood specimens from indwelling

peripheral or midline catheters.

B. Apply tourniquet.

C. Select the appropriate vein for intended infusion therapy

since catheter will be left in place post-blood collection (See

policy for Peripheral Venous Access Placement).

D. Attach blunt cannula of tube holder into catheter adapter of

blood collection equipment, and advance specimen tube.

Observe for backflow of blood into tube.

Obtain desired amount of blood.

Obtain blood specimens before initiating therapy.

If more than one tube of blood is needed, change tubes

slowly and steadily, taking care not to move catheter in

cannulated vein and cause patient undue pain of

discomfort.

E. Release tourniquet.

F. Remove last tube from barrel holder and set aside.

G. Stabilize VAD.

H. Secure connection junctions.

I. Dress access site.

J. Initiate therapy.

From Central Vascular Access Device (CVAD)

A. Discontinue administration of all infusates into the CVAD

prior to obtaining blood samples.

B. Check patency of CVAD by flushing with 10ml preservative-

free 0.9% sodium chloride (USP).

C. When drawing from multi-lumen catheters, the distal lumen

is the preferred lumen from which to obtain specimen (or the

lumen recommended by the manufacturer).

D. Blood samples may be collected from CVAD by syringe

method or vacutainer, as recommended by the manufacturer

of the CVAD.

E. Specimens collected from certain CVADs may be adversely

affected by catheter composition or material; check with

CVAD manufacturer for recommendations on product use.

Using the vacutainer method:

A. Clamp catheter.

B. Attach connector to vacutainer barrel holder.

C. Place blood tube into vacutainer holder.

D. Disinfect access cap with alcohol.

E. Remove cover and insert vacutainer connector into access

cap.

F. Unclamp catheter.

G. Advance blood tube inside vacutainer holder to activate

retrograde blood flow.

H. Hold tube in place until blood flow ceases: this is considered

the “discard”.

I. The volume should be 1.5 to 2 times the full volume of the

CVAD.

J. Clamp catheter and remove blood tube from vacutainer

holder, leaving holder connected to access cap.

K. Discard blood tube immediately into appropriate container.

L. Insert another blood tube, unclamp catheter, and obtain blood

specimens as ordered.

M. After all samples are collected, clamp catheter.

N. Remove vacutainer holder and connector from access cap.

O. Disinfect access cap with alcohol.

P. Flush catheter using 10ml preservative-free 0.9% sodium

chloride (USP).

Q. Change access cap and extension set, if needed.

Using the syringe method:

A. Clamp catheter.

B. Remove access cap and discard.

C. Disinfect catheter hub with alcohol.

D. Attach empty 5-ml syringe to catheter hub.

E. Unclamp catheter.

F. Withdraw 1.5 to 2 times fill volume of CVAD of blood and

discard.

G. Re-clamp catheter.

H. Remove and discard syringe immediately into appropriate

container.

I. Attach second syringe to catheter hub, size to be determined

by amount of blood needed.

J. Unclamp catheter.

K. Withdraw blood into syringe.

L. Several syringes may be needed to obtain required amount of

blood.

M. Re-clamp catheter and remove syringe.

N. Cleanse catheter and remove syringe.

O. Attach prefilled access cap attached to 10-ml syringe with

10ml preservative-free 0.9% sodium chloride (USP).

P. Unclamp catheter.

Q. Flush with preservative-free 0.9% sodium chloride (USP).

R. Transfer blood to collection tubes or vials and rotate vials

using appropriate needles or needleless system.

S. 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 preservative-free 0.9%

sodium chloride (USP) and attempt to withdraw blood

again.

Replace blood tube with a new one.

If still unsuccessful, notify physician.

Draw the blood specimen peripherally.

From Implanted Port

A. Access implanted port

B. Clamp extension set and remove access cap.

C. Attach empty 10-cc syringe to hub of extension tubing and

unclamp.

D. Aspirate 3 to 5 cc of blood into syringe.

E. Re-clamp extension set.

F. Remove and discard syringe immediately into an appropriate

container.

G. Attach a syringe to extension tubing hub and unclamp.

H. Withdraw blood into syringe.

I. Several syringes may be needed to obtain required amount of

blood.

J. Clamp extension tubing and remove syringe with blood.

K. Transfer blood to collection tubes or vials and rotate vials

using appropriate needles or needless system.

L. Attach prefilled access cap attached to 10-ml syringe

containing 10 ml preservative-free 0.9% sodium chloride

(USP).

M. Unclamp catheter.

N. Flush with preservative-free 0.9% sodium chloride (USP).

O. Clamp extension tubing and remove syringe.

P. Attach heparin-filled syringe and unclamp catheter.

Q. Flush with 3 to 5 ml heparin (100 units/ml), as appropriate.

R. Remove noncoring needle

If port is to remain accessed, see policy Implanted Port.

Post-Blood Drawing

A. Monitor patient’s response.

B. Label blood samples before leaving the patient’s side with:

Patient’s name

Patient ID number

Date and time of specimen collection

C. Send samples to testing laboratory:

Place blood specimen in sealed container for transport.

Identify container with “BIOHAZARD” label.

Certain specimens may need to be placed on ice during

transport; check with laboratory used by the organization.

D. Discard used supplies in appropriate receptacles.

E. Remove gloves.

F. Wash hands.

G. Document in patient’s permanent medical record, including

amount of blood used for sampling and patient response to

procedure.

Catheter Removal

A catheter shall be removed with an order from a physician or

authorized prescriber when therapy is completed, during routine site

rotation, when contamination or complication is suspected, or when

tip location is no longer appropriate for prescribed therapy.

Follow manufacturer’s labeled use and directions for catheter

removal.

A nurse educated and competent in the removal of nontunneled,

noncuffed CVADs may do so per organizational policy.


A. Wash hands.





E. Educate patient as to procedure.

F. Place patient in supine position for removal of all CVADs.

Patient may assume sitting or reclining position for removal

of peripheral-short or midline device.

Educate patient in Valsalva maneuver for all CVAD

removal procedures.

Catheter Removal

A. Discontinue administration of all infusates.

B. Remove dressing from insertion site.

C. Remove stabilization device.

D. Inspect catheter-skin junction.

E. Disinfect catheter-skin junction.

F. Place first two fingers of nondominant hand lightly above

catheter-skin junction site with gauze between fingers.

G. Using gentle, even pressure, slowly retract catheter from site

with dominant hand while holding site with gauze.

Use extreme caution when removing central nontunneled,

noncuffed catheters or PICCs to prevent occurrence of air

embolism.

Patient to perform Valsalva maneuver during removal.

H. If resistance or complication occurs, discontinue removal and

notify physician immediately.

I. Assess integrity of removed catheter. Compare length of

catheter to original insertion length to ensure entire catheter

is removed, and document in patient’s chart.

J. Dress exit site.

Apply pressure to site with gauze for 30 seconds,

minimum.

Secure gauze to site, cover with occlusive material such a

transparent semipermeable membrane (TSM) dressing.

Change dressing every 24 hours until exit site is healed.

K. For CVAD removal:

Apply pressure to site with gauze for 30 seconds,

minimum.

Apply new gauze with application of approved antiseptic

ointment to exit site.

Secure gauze to site, cover with occlusive adhesive

material.

Change dressing every 24 hours until exit site is healed.

Patient should remain in supine position for 30 minutes

post-CVAD removal.

Post-Catheter Removal

A. Discard used supplies.

B. Remove gloves.

C. Wash hands.

D. If catheter defect is noted, report to manufacturer and

regulatory agencies. Complete Occurrence Report as

established by the organization.

E. Document in patient’s permanent medical record.

External Ref: Intravenous Nursing Society; Infusion Nursing an evidence based

approach, 3rd edition, 2010 Policies and Procedures for Infusion

Nursing 4th Edition, 2011

Plumer’s Principles and Practices of Intravenous Therapy;

Weinstein,S., 1997

CDC Guideline for Access Devices 1996

Internal Ref:

Source: Clinical Managers, Compliance and Education Coordinators

Approved by: FHI Assistant Director, Medical Director

Date Effective: 03/19/1999, 1/1/2002

Date Revised: 10/2000, 4/04, 6/08, 2/10, 7/10, 8/2012, 12/2012

Date Reviewed: 8/2012, 12/2012

Revised on 8/2012 Code: D:PC-5100

Fairview Home Infusion (FHI) – Infusion Access Device Guide last revised 11/2012

Do not use syringes smaller than 10ml to flush/ administer meds into catheter TSM-Transparent Semi-permeable Membrane Heparin Allergy – Anticoagulant Citrate may be used in equal volumes to heparin if patient is allergic N/A-Not applicable

> 10kg to Adult

Device/Catheter Routine Flush with Medication

Administration Flushing with Blood Draws Flushing with No Therapy Dressing Change

BioPatch

Cap and/or Extension Set Change

Clamping Vs. Non-Clamping

Peripheral Venous

Catheter (PIV) - 0.9% Sodium Chloride 10 ml

- Medication

- 0.9% Sodium Chloride 10 ml

N/A*

(Not used for blood draws)

0.9% Sodium Chloride 10 ml

every 12 hours TSM*-with PIV

restart; and prn

Gauze-not

recommended due

to catheter

dislodging and

unable to visualize

site

No BioPatch

With PIV restart

Use clamp on extension set to

prevent reflux of blood

Midline, Open-

ended (Extended

Dwell Peripheral)


- Medication


- Heparin 10 units/ml 5 ml

N/A


Heparin 10 units/ml 5 ml

every 24 hours

TSM-weekly and prn

Gauze-every 48

hours

No BioPatch

Cap – weekly

Ext set – weekly

Either – anytime the device is

compromised

Use clamp to prevent reflux of blood

Midline, Valved

(Extended Dwell

Peripheral)


- Medication


*exception for pregnant

patients – also use Heparin 10

units/ml 5ml

N/A



every 24 hours


patients – also use Heparin

10 units/ml 5ml

TSM-weekly and prn

Gauze-every 48

hours

No BioPatch

Cap – weekly

Ext set – weekly


compromised

Clamping is unnecessary due to distal

end of catheter design

• Clamp must always be available



> 10kg to Adult

Device/Catheter Routine Flush with Medication

Administration

Flushing with Blood Draws Flushing with No Therapy Dressing Change

BioPatch

Cap and/or Extension Set Change Clamping

Vs. Non-Clamping

Central Lines, Open-

ended (PICC, Non-

tunneled central

catheter, tunneled

chest catheter)


- Medication



- 0.9% Sodium Chloride 10 ml predraw

- Draw 5ml blood discard prior to obtaining sample

- 0.9% Sodium Chloride 20 ml postdraw

- Heparin 10 units/ml 5 ml; then change cap


every 24 hours

TSM-weekly and prn

Gauze-every 48 hours

BioPatch with each

dressing change

Cap – weekly & after each blood draw; Ext

set – weekly; Either – anytime the device is

compromised


Central Lines, Valved

(PICC, Non-tunneled

central catheter,

tunneled chest

catheter)


- Medication


*exception for pregnant patients – also use

Heparin 10 units/ml 5ml



- 0.9% Sodium Chloride 20 ml postdraw; then

change cap




every week


patients – also use Heparin 10

units/ml 5ml

TSM-weekly and prn


BioPatch with each

dressing change



compromised

Clamping is unnecessary due to distal end of

catheter design


Implanted Port,

Open-ended


- Medication








every month if not accessed

Heparin 100units/ml 5ml daily

if accessed but no therapy

TSM-weekly with

needle change


No BioPatch



compromised


Implanted Port,

Valved


- Medication






- 0.9% Sodium Chloride 20 ml postdraw; then

change cap





0.9% Sodium Chloride 10ml

daily if accessed but no

therapy


patients – also use Heparin

100units/ml 5ml

TSM-weekly with

needle change


No BioPatch



compromised

Clamping is unnecessary due to distal end of

catheter design




≤ 10kg

Device/Catheter Routine Flush with

Medication Administration Flushing with Blood Draws Flushing with No Therapy Dressing Change

BioPatch



Peripheral Venous

Catheter (PIV) - 0.9% Sodium Chloride 3 ml

- Medication


N/A*



every 8 hours TSM*-with PIV restart; and

prn

Gauze-not recommended

due to catheter dislodging

and unable to visualize site

No BioPatch

With PIV restart

Use clamp on extension set to prevent

reflux of blood

Midline, Open-ended

(Extended Dwell

Peripheral)


- Medication



N/A



every 24 hours

TSM-weekly and prn


No BioPatch

Cap – weekly

Ext set – weekly


compromised


Midline, Valved

(Extended Dwell

Peripheral)


- Medication


N/A



every 24 hours TSM-weekly and prn


No BioPatch

Cap – weekly

Ext set – weekly


compromised

Clamping is unnecessary due to distal end

of catheter design




≤ 10kg

Device/Catheter Routine Flush with

Medication Administration

Flushing with Blood Draws Flushing with No Therapy Dressing Change

BioPatch



Central Lines, Open-

ended (PICC, Non-

tunneled central

catheter, tunneled

chest catheter)


- Medication








every 24 hours

TSM-weekly and prn


BioPatch with each

dressing change for

patients > 37 weeks

corrected age

Cap – weekly & after each blood draw; Ext set –

weekly; Either – anytime the device is compromised


Central Lines, Valved

(PICC, Non-tunneled

central catheter,

tunneled chest

catheter)


- Medication




- 0.9% Sodium Chloride 10 ml postdraw: then change

cap


every week

TSM-weekly and prn


BioPatch with each

dressing change for

patients > 37 weeks

corrected age



Clamping is unnecessary due to distal end of catheter

design


Implanted Port,

Open-ended


- Medication






- Heparin 100 units/ml 3 ml: then change cap



Heparin 100units/ml 3ml


therapy

TSM-weekly with needle

change


No BioPatch




Implanted Port,

Valved


- Medication




- 0.9% Sodium Chloride 10 ml postdraw; then change

cap



0.9% Sodium Chloride 5ml


therapy

TSM-weekly with needle

change


No BioPatch



Clamping is unnecessary due to distal end of catheter

design


Documents

Department Policy Code: D: PC- · PDF fileDepartment Policy Code: D: PC-5100 Entity: Fairview Pharmacy Services Department: Fairview Home Infusion Manual: Policy and Procedure Manual