VASCULAR ASSES DEVICE

Today our topic is......

⚫Administration set change

⚫Maintaining vascular assess device pattency, flushing and locking

⚫VAD:on going assessment ,site care and dressing change

⚫VAD removal

⚫IV line flushing protocol

So before explaining about this topic first we have to know.....

WHAT IS VASCULAR ASSES DEVICE....

Vascular access devices (VADs) are cetheter inserted into veins via peripheral or central vessels for diagnostic or therapeutic reasons, such as blood sampling, central venous pressure readings, administration of medication, fluids, total parenteral nutrition (TPN) and blood transfusions

⚫INDICATION OF VAD...

1.Poor peripheral vein access or repeated blood draws

2.medication administration

⚪Antibiotic treatments

⚪Irritating infusion

⚪Chemotherapy

⚪Cardiac medication

3.Intravenous hydration or feeding

⚪Fluid administration

⚪Nutritional

4.seriois ill or injured patient like transvenous pacing

5.Dialysis

⚪Short term or long term therapy

6.Blood and blood Product administration

7.Bone marrow transplantation

8.Hemodynamic monitoring

⚪Cvp monitoring

⚪BP monitoring

⚪LA monitoring

⚪RA monitoring

⚫TYPES OF VAD...

1 peripheral

2.central

*Picc

*Ports

*Tunneled

. Hickman

. Boviac

. groshong

. Dialysis

*Nontonneled

. Internal jugular

. Subclavian

. Femural

⚫ASSESSMENT OF

V. A. D

*Superficial inspection of V. A. D

1.number of lumen

2.compatibillity

*DRESSING..

Is the dressing dry and intact

*SITE..

Is the site free from

Redness

Inflammation

Drainage

Pain

Bleeding

*Other sign of infection or complications

Hematoma, skin erosion, cetheter damage

for better understanding lets watch some video.....

Assessment of VAD....

How ever the entire infusion system from the solution container to vascular asses device (VAD) insertion site should regularly checked for....

*System integrity

*infusion accuracy

*expiry date of infusate, dressing and administration set

CARE OF VASCULAR ASSES DEVICE

IT includes.....

*Hand hygiene

*Scrub the hub

*Flushing

*Changing the dressing

*proper fixation of dressing

*maintaining closed system

So lets talk about.....

⚫SCRUB THE HUB..

Healthcare providers should be aware that the catheter hub is a known source for the development of catheter related blood stream infections and that needleless connectors are recognized as sources for microbial contamination. The CDC uses specific wording on their recommendations to "scrub" rather than "wipe" the hubs on intravenous (IV) catheter ports with alcohol or chlorhexadine before accessing. The needleless connector or port should be consistently and thoroughly disinfected performing a minimum 15 second scrub the hub with 70% alcohol in clock wise and anti clock wise direction

⚫FLUSHING

Infusion Nursing Standards of Practice clearly define three purposes of catheter flushing;

to assess catheter function

to maintain catheter patency, and

to prevent contact between incompatible medications or fluids that could produce a precipitate

So For effective catheter flushing, the nurse must have an understanding of technique and the equipment used within his/her institution as well as the type of catheter in use.

⚫Moment of ROUTINE IV FLUSHING...

1.After cetheter insertion

2.Before medication delivery

3.In between two medication

4.After medication delivery

5.After withdrawal of blood

6.Every 6-8 hrs if the line is not use

⚫FLUSHING VOLUME

DEVICE	INTERMITTENT	TPN	BLOOD PRODUCT ADMINISTRATION	BLOOD DRAWS	FLUSHING FREQ W/ NO THERAPY	HEPARIN LOCKING
(Short) Peripheral IV	Pre admin and Post admin; Minimum of 2 ml NS	N/A	Pre admin 2 ml Post admin 10 ml NS	N/A	At least every 12 hours	N/A
Midline	Pre admin and Post admin; Minimum of 3 ml NS	N/A	Pre admin 3 ml Post admin 10 ml NS	N/A	At least every 12 hours	3 ml of 10 unit/ml Heparin
PICC	Pre admin and Post admin; Minimum of 5 ml NS	5 ml NS	Pre admin 5 ml Post admin 10 ml NS	Pre draw 5 ml NS Post draw 10 ml NS	Non-valved: at least q 24°	5 ml of 10 unit/ml Heparin
					Valved: at least weekly	N/A
Non-Tunneled	Pre admin and Post admin; Minimum of 5 ml NS	5 ml NS	Pre admin 5 ml Post admin 10 ml NS	Pre draw 5 ml NS Post draw 10 ml NS	Non-valved: at least q 24°	5 ml of 10 unit/ml Heparin
					Valved: at least weekly	N/A
Tunneled	Pre admin and Post admin; Minimum of 5 ml NS	5 ml NS	Pre admin 5 ml Post admin 10 ml NS	Pre draw 5 ml NS Post draw 10 ml NS	Non-valved: at least 1 - 2 times per week	5 ml of 10 unit/ml Heparin
					Valved: at least weekly	N/A
Port	Pre admin and Post admin; Minimum of 5 ml NS	5 ml NS	Pre admin 5 ml Post admin 10 ml NS	Pre draw 5 ml NS Post draw 10 ml NS	Accessed-Non-valved: at least 1-2 times per week	3-5 ml of 100 unit/ml Heparin
					Valved: at least weekly	N/A
					Deaccessed: at least monthly	3-5 ml of 100 unit/ml Heparin

⚫STERILE DRESSING

Site care including skin antisepsis and dressing changing should be done at established intervals.... Or immediately if dressing integrity is dumped or loosened or visibly soiled and also be changed if moisture Drainage or blood Product present under the dressing

* A sterile dressing must be applied and aseptic technique must be follow when providing site care and changing the dressing of VAD

*Label the dressing with the date performed or the date to be changed based on organization Policy

for better we prefer video so lets to watch......

⚫ADMINISTRATION OF SET CHANGE...

when an administration set needs to be changed.... It depends upon several factor like

type of infusion (continuous verses intermittent)

immediately upon suspected contamination,

or when the integrity of the administration set system has been compromised

Recommendations from the Centers for Disease Control and Prevention (HICPAC)
² Recommendations from the Infusion Nurse Society's 2011 Infusion Nursing Standards of Practice

Regardless of infusate, change set immediately if contamination is suspected or product integrity is compromised. A sterile covering device should be used to cover the distal end of an administration set after intermittent use. Change needleless access devices at least as frequently as the administration set.

ADMINISTRATION TYPE	ADMINISTRATION SET	SET CHANGE FREQUENCY
Continuous (Infusions NOT containing blood, blood products or Intravenous fat emulsions)	Primary Set Secondary "piggyback" set	If infusate is administered continuously via primary or secondary administration set, including add-on devices, change set(s) no more frequently than at 96 hour intervals, but at least every 7 days.¹ Primary and secondary continuous administration sets should be changed no more frequently than every 96 hours. Extending the administration set change to every 7 days may be considered when an anti-infective central vascular access device is being used.²
Intermittent (Infusions NOT containing blood, blood products or Intravenous fat emulsions)	Primary Set	No frequency recommendation. Unresolved issue. ¹ Replace set every 24 hours. ²
Intravenous Fat Emulsion (IVFE) TPN containing IVFE	Primary Set Secondary "piggyback" set	Standard Set Change Interval: Every 24 Hours
TPN (without IVFE)	Primary Set	No recommendation ¹ Replace no more often than every 96 hours. ²
Blood / Blood Products	Primary Set Filter	Replace within 24 hours of initiating the infusion. ¹ Replace administration set and filter every 4 hours. ²
Propofol	Primary Set	Replace tubing used to administer propofol infusions every 6 or 12 hours, when the vial is changed, per the manufacturer's recommendation. ¹ A dedicated administration set should be used and should be replaced every 12 hours when the vial is changed, and according to the manufacturer's directions for use. ²