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2007 Management of Percutaneous Devices Policy
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Management of Percutaneous Devices

Page updated 30 April 2007

Management of Percutaneous Devices (e.g. Peripheral Cannulae, Central Venous Catheters, Arterial and Intrathecal Devices, etc.)

Introduction

Any catheter or device which penetrates the skin allows the opportunity for invasion by saprophytic and pathogenic bacteria and fungi. The longer a device is in situ, and the more lumens and stopcocks involved, the graver this risk. Tunnelled long intravenous lines (eg Hickman, Broviac), large bore lines for renal dialysis (eg Permacath) are often a patient's "life-line" and need to be kept free of infection as far as possible. Skin commensals such as Staphylococcus epidermidis have a tendency to stick to prosthetic material and are then very difficult to remove. Invasion by virulent strains of Staphylococcus aureus may cause septicaemia. Colonisation of any device may lead to chronic blood stream spread which may predispose to endocarditis and endo-luminal arterial colonisation. Invasive organisms may be delivered in infusion fluids and via breaks in the system, such as three-way taps. Therefore strategies for reducing risks to patients and managing infections must be adopted.

Aims

Responsibilities

Those inserting and managing percutaneous devices are accountable for their practice and are responsible for updating their knowledge and maintaining the highest standards of practice. Inserters must not take on this role unless they have been appropriately trained to do so.

No member of staff should handle any percutaneous device (ie flushing, dressing, administering drugs etc) without having been properly trained to do so.

The named nurse for a patient with an existing percutaneous device is responsible for:

Inflammation

Inflammation of a line site demands removal unless the risks of changing a line (eg in the case of a Permacath or Broviac line) are greater than treating expectantly with antibiotics.

Inflammation is characterised by:

Inflammation at a line site or evidence of line-associated sepsis must be reported immediately to a member of the medical team. A senior qualified nurse may take the responsibility of removing a line if there is clear inflammation, the patient is in pain and a doctor is not available. Bacteriological cultures of line sites, line tips and blood cultures should be done when line infection is suspected.

 

References

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Equipment

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Saline vs Hepsal flush

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Lombardi TP, Gunderson B, Zammett LO et al. Efficacy of 0.9% sodium chloride injection with or without heparin sodium for maintaining patency of intravenous catheters in children. Clinical Pharmacy 1988; 7 :832-836