Vascular access devices (VADs), care and maintenance (592)

This is the Vascular Access Procedure and Practice Guidelines for vascular access devices (VAD) incorporating NHS Greater Glasgow and Clyde (NHSGGC) adult (acute, mental health and community), paediatric and neonatal services. VADs are inserted for therapeutic purposes such as administration of intravenous (IV) fluids, medicines, blood transfusions and parenteral nutrition (PN). Other purposes for specific vascular access devices are renal dialysis, blood sampling and central venous pressure monitoring.

This document is organised with core introduction followed by care and maintenance templates. The information contained is based on current information available. Quality improvement, audit and research within clinical areas mean that this evidence base is constantly evolving. Practitioners should endeavour to use the most up-to-date evidence on which to base their practice.

The purpose of this guideline is to state the care and maintenance of the following VADs:

• Peripheral Venous Catheter (PVC)
• Midline catheter
• Peripherally Inserted Central Catheter (PICC)
• Non-Tunnelled Central Venous Catheter (CVC)
• Tunnelled Central Venous Catheter (tCVC)
  • Uncuffed tCVC
  • Cuffed tCVC
• Dialysis Central Venous Catheter
• Implantable Ports

The detailed procedures for insertion of VADs are outside the scope of this guideline. Practitioners involved with insertion of VADs will be informed of where specific insertion procedure guidance can be found.

Patients with VADS are placed at increased risk of harm if not appropriately managed, for example healthcare associated infections and bloodstream infections are a significant cause of morbidity and mortality (NICE, 2014). Reports of mortality attributed to device related blood stream infections vary between 12.2% and 34.4% (Wong et al, 2016). VAD related bloodstream infections caused by inadequate device management significantly reduces the survival of patients in our care.

Patient harm can be reduced through:

• Trained and competent staff
• Adherence to relevant policies and guidance
• Underpinning knowledge of different VADs
• Good care and maintenance of VADs
• Appropriate use of care bundles and accurate documentation (e.g. PVC and CVC care plans and patient held records)
• Prevention, early recognition and management of complications
• Inserting VAD only when clinically indicated and removing at earliest opportunity

Scope

This guideline is relevant to all NHSGGC health board staff that care for patients with a VAD.

This guideline should be used in conjunction with other relevant guidelines and standards:

• Guidance for all adults receiving Parenteral Nutrition (home and in-patient) can be found  here.
• Infection prevention and control guidelines can be found here.
• NHSGGC IV Medicine Administration policy can be found here.
• NHSGGC Management of occupational and non occupational exposures to blood borne viruses including needle stick injuries and sexual exposures policy can be found here.

Paediatric guidance:

• Haemato-oncology patient’s fluid and electrolytes management (Schiehallion) can be found here
• Intravenous fluid guidance for previously well children aged 7 days to 16 years can be found here.
• Intravenous fluid therapy in children and young people in hospital can be found here.
• West of Scotland Cancer Network Extravasation in Practice Guidelines, policy and tools can be found here.

Staff in specialist clinical areas caring for particularly vulnerable patient groups may have local standard operating procedures (SOP) in use which should be referred and adhered to.

Roles and responsibilities

For the care and maintenance of any VAD, staff should be appropriately trained and supervised until considered competent. A practitioner can be described as competent if they have had the necessary training, clinical experience, skills and knowledge to undertake a task safely and without supervision. If a practitioner deems it appropriate to adapt the guidelines, a risk assessment must be undertaken and documented appropriately.