To maintain a port of entry to venous flow when all available peripheral ports have failed.

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1 I. Purpose: To maintain a port of entry to venous flow when all available peripheral ports have failed. II. General Comments: Since its development, these catheters have been used with increasing frequency in cancer centers. Although complications are few, the potential for infection involving the catheter is present at any time following insertion. Insertion of catheters is done in surgery. Caregivers should always utilize personal protective equipment. III. Procedure for Broviac/Hickman Catheters: 1. Wash hands before and after manipulation of catheter. 2. Clean area around catheter with 3 ml. ChloraPrep. Dry area, do NOT apply an ointment, and change dressing every other day or any time it becomes damp. 3. The catheter is used for hyperalimentation, IV solutions, medications, chemotherapy and drawing blood. It is not unusual for the connectors to be interrupted times daily. 5. For new broviac catheters also change the dressing in the cephalic incisional area. 6. Aseptic technique is necessary for all manipulations of catheters. IV. Procedure for Infusaports: 1. Wash hands. 2. Palpate entry septum. 3. The insertion site should be properly prepped. Use the following method. a. Disinfect clean skin with an appropriate antiseptic before catheter insertion and during dressing changes. Although a 2% chlorhexidine based preparation such as ChoraPrep is preferred, tincture of iodine can be used. b. Allow the antiseptic to remain on the insertion site and to air dry before catheter insertion. c. How to Use the ChloraPrep 3-ml Applicator: Implement maximal barrier protocols.

2 used Using aseptic technique, remove the applicator form its package, assuring its sterility. Holding the applicator downward, gently squeeze the wings to release the solution. For dry sites such as the arm or abdomen, scrub the site with the friction pad for a full 30 seconds using a back and forth motion, then allow it to dry. (For most sites such as the groin, use a back and forth motion to scrub the site for 2 full minutes. Allow to dry). d. Do not apply organic solvents (e.g., acetone and ether) to the skin before insertion of catheters or during dressing changes. Wash off iodine solution with 70 percent isopropyl alcohol. Both agents should be applied with friction working from the center of the field to the periphery. In those patients allergic to iodine, cleanse area vigorously with 70 percent isopropyl alcohol for at least one minute. Neither aqueous benzalkonium nor hexachlorophene should be to scrub the IV site. e. Put on sterile gloves. f. Stabilize entry site with fingers. g. ALWAYS use a HUBER point needle. h. Prime Huber point needle with normal saline. i. Insert needle into center of entry septum until needle reaches bottom of port. j. Attach saline syringe and aspirate until small amount of blood returns. k. Attach syringe with medication and infuse at appropriate rate. l. IV tubing for continuous infusion may be attached at this time if indicated. m. Apply dressing support for Huber point needle. n. Coil tubing and tape securely. o. A transparent dressing is recommended. IV. Procedure for Infusaports: (cont d) p. When IV push or continuous infusion is complete leave same needle in place. q. Flush with saline using same Huber point needle. r. Flush with heparin using same Huber point needle. s. Remove Huber point needle. Discard in sharps container. t. Apply dressing, if indicated, when finished using prot. After incision has healed dressing is not necessary. u. Flush port every 4 to 6 weeks when not in use. v. Wash hands when procedure is complete. Change IV line every 72 hours. Extension tubing and needle can remain in place for up to 7 days. Observe injection site every shift for signs of extravasation when in use. If signs and/or symptoms occur notify doctor. Using the same Huber point needle prevents multiple sticks for the patient and helps preserve the site since number of injections into site is limited. No precautions are needed during syringe changes due to fluid reservoir in port. V. Care of the Broviac/Hickman Catheter A. Precautions:

3 1. Prevent infections by using aseptic technique while cleaning the dressing over the exit site every other day, or whenever the dressing becomes soiled. 2. Prevent air embolism by using injection site caps for drawing blood, flushing with heparin lock solution, giving an infusion, or chemotherapy. 3. Preventing clotting of the catheter by flushing with 2.5cc of heparin lock solution twice weekly or at completion each time catheter is utilized. VI. Procedure for Broviac Care: 1. Clean area around catheter with 3 ml. ChloraPrep, dry area, and change dressing every other day or any time it becomes damp. 2. For new broviac catheters, also change the dressing in the cephalic incisional area. VI. Procedure for Broviac Care: (cont d) 3. For Oncology patients: Flush catheter with 2.5cc of heparin lock solution (10 u/cc) twice weekly on Monday and Thursday unless patient has an IV infusing continuously. 4. If patient has his/her IV discontinued, blood drawn, or complete blood transfusion through the catheter, always flush with 10cc s normal saline and follow with 2.5cc heparin lock solution to flush. Continue with twice weekly schedule. VII. Procedure for Cleaning Exit Site: Equipment needed for cleaning the exit site: 3 ml. ChloraPrep 4x4 gauze sponges A. Prepare materials needed for cleaning the site. 1. Open 3 to 4 packs of gauze sponges. 2. Open ChloraPrep B. Wash hands thoroughly with soap and water and dry well. C. Remove old dressing carefully, making sure that no extra pressure is added to the catheter. Do not use scissors to remove tape/dressing (it may cut catheter). D. Wash hands again and dry them well. E. With a 3 ml. ChloraPrep, start at the site and wash in back and forth movements. (At this time remove all dried or crusty drainage, noting any unusual drainage or redness around the site).

4 F. Dry site with a 4x4. G. Do NOT apply ointment to the exit site. H. Place a sterile pad beneath the catheter site, and one over the catheter. I. Secure with tape. VII. Procedure for Cleaning the Exit Site: (cont d) J. Loop the catheter onto the chest and secure it with tape. Do not allow the catheter to hand loose because the added pressure could cause the catheter to displace. VIII. Changing Catheters with Caps to Injection Caps. Procedure is as follows: Equipment Needed: Plastic or padded hemostat and/or clamp ChloraPrep Sepp Injection site cap 4x4 gauze sponge 1. Wash hands with soap and water. 2. Open 4x4 gauze sponge 3. Open ChloraPrep Sepp. 4. Open injection site cap package. 5. Place opened ChloraPrep Sepp on clean surface. 6. Use plastic or padded hemostat to clamp the catheter. Do not use scissors. 7. Unscrew the cap and remove. 8. Clean end of catheter with ChloraPrep Sepp. 9. Use aseptic technique. Remove protector on cap and attach unit (cap) securely. You must push and twist clockwise to lock. 10. Remove hemostat/clamp. Note: Injection site caps for venous access catheters must be luer lock caps. (Attach to catheter, push and twist clockwise). General Comments: Using molded circle on septum as a guide, introduce needle straight through center of cap. Under no circumstances should needles longer than 1 inch or greater than 18 gauge is size be used. IX. Aspirating Blood Samples from Hickman/Broviac Catheters: Equipment Needed: 4x4 gauze sponges

5 1 10cc syringe filled with 10cc or normal saline for Injection with 23 ga 1-inch needle cc syringe with 2,000 units of beef lung heparin with 23 ga 1-inch needle. 10cc syringe with 20 ga 1-inch needle to aspirate the blood samples. 1 10cc syringe used for a wasted sample with 20 ga 1-inch needle. Tubes needed for blood samples. Procedure for Aspiration of Blood: Once in place, we feel that the broviac should be used to obtain blood samples. Observe appropriate barrier precautions when handling blood. 1. Gather all materials as listed above. 2. Open 4x4 gauze sponges. 3. Open ChloraPrep Sepp. 4. Remove the needle with syringe from the catheter and discard this sample. 5. Clean the rubber catheter tip with ChloraPrep Sepp. 6. Aspirate the appropriate amount of blood. 7. Clean the rubber tip with a ChloraPrep Sepp. 8. Flush catheter with 10cc normal saline. 9. Remove the needle with syringe. 10. Clean the rubber tip with a ChloraPrep Sepp. 11. Insert the needle with syringe containing the heparin and inject slowly. 12. Remove the needle with syringe. 13. Clean rubber tip with a ChloraPrep Sepp. 14. Put samples in the blood tubes. 15. Re-loop the catheter. 16. Re-tape rubber catheter tip to the chest. Gauze maybe used over catheter prior to taping. DO NOT RECAP NEEDLES, DISPOSE IN APPROPRIATE CONTANERS

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