Policy Manual sample

MDT Home Health Care Agency, Inc. Flushing the CVC: CVC catheters are flushed every 24 hours when not in use, or after each use (check MD order). A. Clean the cap with alcohol swab. Always remember to perform a 10-15 second friction scrub with alcohol before entering a vascular access device and allow to dry for 30 seconds. B. Clean the cap. Use non-sterile gloves to remove tubing or cap. C. Flush line with 5ml NS being careful not to inject air. D. Flush with 5ml of 10 unit/cc Heparin using positive injection pressure technique when removing the syringe by closing the slide clamp while injecting the final 1cc of heparinized solution. E. If line is triple lumen only flush all ports every 24 hours or after use of any of the ports. If using only one (1) line of triple lumen, always access white port. Flush other two (2) ports if not in use daily with 5cc of the 10units of Heparin. a. Single Lumen: if medicine ordered daily, flush with 5ml of Heparin 10 units/ml. If medicine ordered twice daily or more often flush port with 5ml Heparin 10 units/cc with each use. b. Double Lumen: if medicine ordered daily, flush white port with each use with Heparin 5cc 10 units and brown port with Heparin 5ml/10 units/cc daily only. c. Triple Lumen: if medicine ordered daily, flush all ports with 5ml of Heparin 10 units/ml. If medicine ordered twice daily or more, flush white port and flush with Heparin 10 units/cc after each use. Intermittent Medication Administration: A. With a 10ml syringe filled with 5ml NS, gently aspirate to check for blood return. B. Flush with 5ml NS using sterile technique before medication administration. C. Administer medication. D. Flush with an additional 5ml NS. E. Flush with 5ml of 10 units/cc Heparin, using positive injection pressure technique by closing the slide clamp while injecting the final 1cc of heparinized solution. Blood Draw from CVC: If obtaining blood for culture, draw two samples, one from the suspicious line as determined by medical staff and one from a peripheral site and label the specimens with type of line and location. A. Turn off all running IV’s. B. Disinfect catheter port with alcohol swab using friction for 10-15 seconds and the allowing to dry for 30 seconds. C. Flush with 5ml NS (20cc if patient is on TPN and wait 5 minutes prior to blood draw). D. Draw and waste 5ml of blood. E. Draw sample. F. Flush with 20ml NS. G. Resume IVF or flush with 5ml of 10 units/cc Heparin if only accessing once daily. If accessing more often use Heparin 10u/cc 5/cc (also). Documentation: A. Document in the nursing notes as needed. B. Document patient education in the nursing notes. C. Document site and site condition on the IV Flow Sheet, if applicable. D. Document the rate and IV fluid type on the MAR, if applicable. Site Care and Dressing Changes: Observe the dressing site every shift for evidence of infection and document the assessment. Leave the initial occlusive pressure dressing on the exit site for 24 HOURS after surgery. Change the central line dressing, using aseptic technique, every seven (7) days and anytime the dressing is wet, loose, or non-occlusive. A. Equipment: Central venous catheter dressing kit and an appropriate dressing. B. Procedure: a. Explain procedure to patient and position for comfort. Home Health Agency Nursing Care & Procedures K-238