Disconnecting an infusion to a central line, PICC line or Hickman line

NHS Ayrshire & Arran guidelines
NHS Ayrshire and Arran

When disconnecting an infusion pump a strict aseptic technique must be followed. A trolley should be set in a similar way to doing the dressing change and flushing the line with the required equipment.

Equipment required

  • sterile dressing pack
  • one pair of sterile gloves
  • plastic apron
  • disposal bag and appropriate disposal bin
  • antiseptic hand hygiene product chlorhexidine gluconate BP 2% & isopropyl alcohol 70% wipes
  • 10ml Luer-Lok syringes
  • blunt needle
  • 0.9% sodium chloride (10mls per lumen). 10ml PosiFlush XS may be used – ensure the packaging stipulates XS as only these syringes are externally sterile
  • 10iu heparinised 0.9% sodium chloride, (2mls per lumen) – only for Hickman or PICC lines with clamps (do not use in central lines)
  • Curos port protector(s) (non sterile - do not place onto sterile area).

If an infusion is running via one lumen only, then only the one lumen will need flushed with 0.9% sodium chloride and locked with 2mls of 10iu of heparinised 0.9% sodium chloride (only for Hickman or PICC lines with a clamp).

If a chemotherapy pump needs to be removed from a Hickman or PICC line the oncology unit must be contacted immediately. Only a chemotherapy trained nurse or trained district nurse (with the appropriate equipment) should disconnect the chemotherapy pump.

Procedure

Please note: if your hands are not socially clean and you need to wash your hands with soap and water (rather than alcohol gel), this must be carried out a minimum of 2 meters away from the working surface/dressing trolley and any CVAD equipment.

  1. Clean hands with alcohol gel as per the WHO 5 moments for hand hygiene. Put on sterile gloves using an aseptic technique.
  2. Draw up 0.9% sodium chloride solution for flushing (10mls per lumen) or 10ml PosiFlush XS may be used – ensure the packaging stipulates XS as only these syringes are externally sterile. Draw up heparin sodium solution 10iu/ml (2mls per lumen) using an aseptic technique. Heparin should only be used in Hickman and PICC lines with clamps. Heparin should not be used in central lines.
  3. Stop the infusion and close any clamps. Remove the infusion from the CVAD and dispose into appropriate bin according to the waste management for the type of product. Clean the end of the line thoroughly with chlorhexidine gluconate BP 2% & isopropyl alcohol 70% wipe for 30 seconds and allow to dry completely for 30 seconds.
  4. Attach syringe with 10mls of 0.9% sodium chloride (open clamp if applicable) and flush using a brisk push/pause action, closing the clamp on the last push to create positive pressure in the line.
  5. (If the Hickman or PICC line has a clamp) Attach syringe with heparin sodium solution into needle free device, open clamp and inject the solution with a brisk push/pause action closing the clamp as the last of the solution is inserted. Remove the syringe from the needle free device. Do not use heparin in central lines.
  6. Apply a Curos port protector onto the end of each lumen.
  7. Dispose of all waste appropriately as per waste management guidelines:
    1. NHS Ayrshire & Arran segregation of waste policy
    2. NHS Ayrshire & Arran waste disposal policy.
  8. Remove PPE and clean hands with alcohol gel as per the WHO 5 moments for hand hygiene.
  9. Document procedure including any problems, action taken and review date in the DRS 6104 (Appendix 5) and appropriate notes.