CVL Care and Management APSNA Pre-Conference Workshop April 30, 2018 Repair of Tunneled Silastic Catheters (Broviac, Hickman) “An ounce of prevention is worth a pound of cure” • Dressing and securement to protect the most vulnerable part of the catheter • There are a variety of new dressings and securement devices available Eliminate/minimize risks related to age, developmental level, and diagnosis • Keep tubes “out of sight, out of mind” • Prevent pulling and stretching of lines; anchor tubing with tape/securement device • Position hub/cap away from diapers, ostomies, little hands and mouths Role modeling for families: children may go home with these lines; families will be responsible for the care at home. Parents watch we do and how we do it. These are teachable moments for families. System and Organizational Considerations: Who repairs lines at your facility? Who repairs lines at other facilities in your community (community standard)? How do individuals learn the technique and maintain competence? What are your Organizational Policy/Procedure and Guidelines? Do your policies incorporate manufacturers’ recommendations and evidence-based guidelines? Repair process or protocol Criteria for repair: • Complete dissection, tear, hole, separation, ballooning • At least 5cm catheter remaining distal to insertion site • If double lumen and damage is on adapter leg, at least 2-1/2 cm catheter distal to bifurcation • LIP order to repair
Transcript
CVL Care and Management APSNA Pre-Conference Workshop
April 30, 2018
Repair of Tunneled Silastic Catheters (Broviac, Hickman)
“An ounce of prevention is worth a pound of cure”
• Dressing and securement to protect the most vulnerable part of the catheter • There are a variety of new dressings and securement devices available
Eliminate/minimize risks related to age, developmental level, and diagnosis • Keep tubes “out of sight, out of mind” • Prevent pulling and stretching of lines; anchor tubing with tape/securement device • Position hub/cap away from diapers, ostomies, little hands and mouths Role modeling for families: children may go home with these lines; families will be responsible for the care at home. Parents watch we do and how we do it. These are teachable moments for families. System and Organizational Considerations: Who repairs lines at your facility? Who repairs lines at other facilities in your community (community standard)? How do individuals learn the technique and maintain competence? What are your Organizational Policy/Procedure and Guidelines? Do your policies incorporate manufacturers’ recommendations and evidence-based guidelines? Repair process or protocol Criteria for repair:
• Complete dissection, tear, hole, separation, ballooning • At least 5cm catheter remaining distal to insertion site • If double lumen and damage is on adapter leg, at least 2-1/2 cm catheter distal to
bifurcation • LIP order to repair
CVL Care and Management APSNA Pre-Conference Workshop
April 30, 2018 Critical Elements: • Timely emergency care when damage discovered (clamp catheter, protect from
contamination, try to ensure flushed or heparinized, repair within 24 hours) • Have and use the correct repair kit for the catheter • Prevent/detect central line infection and/or bacteremia: blood culture post-repair • Sterile procedure with at least 2 persons • Instrument tray or individual additional supplies: sterile bowls, scissors, smooth
clamp, drapes or towels Critical points in the repair procedure: • Approximation of catheter and repair segment at junction • Adequate adhesive glue application under sleeve • Adequate time for adhesive glue to cure (mechanical strength takes 48 hours) • No use for at least 4 hours • Splint repair joint for 48 hours to stabilize joint Documentation: • Reason for repair • Information about catheter (date inserted, brand, size) • Confirm correct repair kit for catheter • Repair kit reference number, lot number, and expiration date • Repair completed • Any problems • Blood culture obtained • Post repair instructions for use and care • Patient tolerance of procedure Post repair monitoring: • Patency of line • Repair site for leakage • Blood culture results • Signs/symptoms of infection • Patient/family or staff education re: dressings and securement
CVL Care and Management APSNA Pre-Conference Workshop
April 30, 2018 Resources:
Repair Kits for Hickman, Leonard and Broviac Central Venous Catheters: Instructions for Use--Package Insert and available online:
Video repair Broviac catheter (UCSF Benioff Children’s Hospital Oakland): https://www.youtube.com/watch?v=rM3m5k5AvUk
Video repair Cook Catheter (Arnold Palmer Emergency Department): https://www.youtube.com/watch?v=bS-ouBiZIDY
References:
Gordon, S., & Gardiner, S. (2013). Central line infections in repaired catheters: A retrospective review. The Journal of the Association for Vascular Access, 18(3), 164-166.
Infusion Nurses Society. (2016). Policies and procedures for infusion nursing (5th Ed.).
Infusion Nurses Society. Lundgren, I. S., Zhou, C., Malone, F. R., McAfee, N. G., Gantt, S., & Zerr, D. M. (2012).
Central venous catheter repair is associated with an increased risk of bacteremia and central line-associated bloodstream infection in pediatric patients. Pediatric Infectious Disease Journal, 31(4), 337-40.
McNiven, C., Switzer, N., Wood, M., Persad, R., Hancock, M., Forgie, S., & Dicken, B.
J. (2016). Central venous catheter repair is not associated with an increased risk of central line infection or colonization in intestinal failure pediatric patients. Journal of Pediatric Surgery, 51(3), 395-397.
Small, M., Major, G. A. D., & Gabe, S. M. (2012). PMO-065 Repair of fractured central
venous catheters for parenteral nutrition: Techniques and risk of infection. Gut, 61, A99.
