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• No matter what the occasion,SCRUB the catheter ports everysingle time before access.
• Evidence Supports SCRUBBING
using pressure and friction for 15seconds with alcohol and allowto dry.*
• *Kaler, Wendy; Chinn, Raymond (2007) Successful Disinfection of Needleless Access Ports: A Matter of Time and Friction. Journal of the Association for Vascular Access, Volume 12, Number 3, pp. 140-142
•
OHSU Scrub The Hub OHSU Scrub The Hub m i nCam ai n
Upon admission1.Ask patient or family member if Portacath present.2.Assess chest for any vascular access
•Palpate chest for implanted port
•Take a look at patient history, especially if they have achronic illness3.Look at the CXR4.If they have a port, obtain order for access from provider 5.Page your IV Therapy Team for access
…
.Your patient may already have a port
heck and ask
to
save your patient unnecessary line placements and additional
1. Wash your hands prior to touching any part of the hub.
2. Invert the MaxPlus Clear and prime beforeattaching to end of a catheter or tubing.
3. “Scrub the Hub” with friction for 15 seconds prior
to entry.4. Replace the MaxPlus Clear After blood
draws/administration or if blood residue ispresent in the valve.
5. Flush through the hub with 10mL Normal Saline(Use Heparin per flush protocol) and assure hubis clear of all blood residue.
6. When clamping a line, only clamp after flush iscomplete and you have disconnected fromMaxPlus Clear. This ensures blood is clearedfrom the end of the catheter.
7.
8.
1.
Hub Facts-Hubs are easily contaminated whenthey touch the skin.
-If hubs are not disinfected thecontaminate can infuse into the valveand patient.
-Residual blood in the hub serve as amedia for infection.--Clear hubs allows you to seeresidual blood and drugincompatibility precipitant in the hubso you can replace them and decrease
the risk of Catheter Associated BloodStream Infection.
--Reference: Royer, Tim et al(2007) A Five-FoldDecrease of Intravascular Catheter Associated BloodStream Infections: Clearly Beyond the Central LineBundle-
which can contribute to catheter)clottingØ IV tubing clamped?Ø Pump off ?Ø Infusion set empty?Ø Patient position cause kinking?Ø Dressing wet due to break or hole
.in catheterØ :For Ports Check Huber needle
placement
1.2.
1.
ThenAssess for internal obstruction•Remove and inspect valves & tubing•Place 10mL Normal Saline syringe to hub•Attempt to Withdraw 1 st and assess for bloodreturn. Able to infuse? Sluggish? Completelyoccluded?
Assess EACH LUMEN separately
Never leave one clotted lumen
IV Therapy August
Tip of The Month
Central VenousCatheter
Occlusion
After full inspection and confirmation of a catheter occlusion, call IV Therapy andreport your findings
Catheter Occlusion = Risk of infection and venous thrombosis
Immediate Action Required
Reference: Nakazawa, Nadine (2008) Managing Catheter Occlusions with Cathflo. Presentation
P h l e b i t i s S u s p e c t e d ? § D I S C O N T I N U E I N F U S I O N ! § R e m o v e C a t h e t e r § D i s i n f e c t v e n i p u n c t u r e s i t e § A p p l y p r e s s u r e a t r e m o v a l s i t e t o p r e v e n t
b l e e d i n g § E l e v a t e e x t r e m i t y § A p p l y i n t e r m i t t e n t w a r m , m o i s t h e a t f o r 2 0 m i n .
3 - 4 t i m e s p e r d a y . q q q q
q q q q q
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Phlebitis or Inflammation of the Vein§§Pain with flushing or palpation of site§Edema§Erythema or red streak over vein§Palpable firmness of vein§••••••••