Sunday, September 25, 2011

Peripheral venous catheters

2.2.1 Use the upper extremity for catheter insertion in adults. (1)
2.2.2 Observe the catheter insertion site daily by palpation and
inspection if transparent dressing is used. Visual inspection may
be necessary for opaque dressing if patient has unexplained fever,
pain, local tenderness, other signs of bloodstream infection or
patients cannot communicate. (1, 14)
2.2.3 Replace short, peripheral venous catheter at least every 72-96
hours in adult and remove when no longer indicated. If sites for
venous access are limited, catheter can be maintained for longer
period but close monitoring of insertion site is necessary. Leave
the catheter in place until the therapy is completed, unless a
complication occurs in paediatric patients. (1)2.2.4 Remove the peripheral intravascular catheter if there is sign of
phlebitis or malfunctioning. (1)
2.2.5 Flush the peripheral intravascular lock or needle free device with
normal saline for maintaining the patency and lowering the
overall catheter-related complications though they are not
necessarily infection related. (24)
2.2.6 Efficacy of normal saline solution as an alternative to heparin
solution for the maintenance of peripheral IV devices is to
eliminate the risk of heparin-induced thrombocytopenia,
thrombus, haemorrhage and medication incompatibility which
can provide a safer therapy for patient as well as cost savings. (24,
25, 26). Therefore, normal saline flush is superior and preferable.
2.3 Additional recommendations for peripheral arterial catheters (1)
2.3.1 Use disposable transducer assemblies when possible.
2.3.2 Replace the transducers assemblies at least every 96 hours
together with other components of the system, including the
tubing, continuous-flush device and flush solution.
2.4 Additional recommendations for pressure monitoring system (1)
2.4.1 Keep all components of the system sterile.
2.4.2 Use a closed (continuous) flushing system to maintain the
patency of the system.
2.4.3 Do not infuse the dextrose-containing solution or parenteral
nutrition fluids through the system.
2.5 Umbilical catheters (1)
Avoid tincture of iodine for disinfection of umbilical insertion site in
newborn infants. Other iodine-containing preparation, for example,
povidone iodine, is acceptable.
3 Maintenance of Administration Sets
3.1 Replace administration sets including extension tubings, add-on
devices no more frequently than every 72 hours, unless CABSI is
suspected or confirmed. (1, 27)
3.2 Replace administration sets transfusing blood, blood products or lipid
containing solutions after administration or within 24 hours. (1)3.3 Disinfect IV injection port, stopcocks, needleless intravascular device
or heparin-block with 70% alcohol, 2% Chlorhexidine in alcohol or
iodophor preparation before access. (1, 28, 29)
3.4 IV injection port: there have been reports of higher infection rate
associated with the use of stopcocks (28, 29). When stopcocks are to
be used, cap all stopcocks when not in use. (1)
3.5 Do not draw blood specimens through single-lumen peripheral or
central venous lines intended for infusions except when catheterassociated
bacteremia is suspected. Dedicate a specific lumen from a
multi-lumen for blood-letting. (14)
3.6 Preferably, a single-lumen catheter should be used as it is associated
with reduced risk of CABSI. Multi-lumen catheter should only be
used when there is limited site for iv access.
3.7 Maintain a closed infusion system.
3.7.1 The closed infusion system has been shown to result in
significant reduction in the incidence of CABSI. (30)
3.7.2 The closed infusion system is defined as:
1)the container of intravenous solution is fully collapsible (the
residue after administration does not exceed 5% of the nominal
volume), and hence does not require external air vent to allow the
solution to empty AND
2) the connecting administration set has no air-vent.The whole infusion system is maintained closed to the external
environment while infusing except for the situation listed in para
3.7.3 In the situation when intravenous solution or medication is
delivered by a semi-rigid plastic or glass bottle, an air vent to
empty the solution is allowed.In-line filters: Do not use filters routinely for infection-control
purposes. (1)

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