CLINICAL GUIDELINE FOR CHANGING A CATHETER EXIT SITE DRESSING (I.E. MIDLINE/ CVC/ PICC/ HICKMAN) Summary. Start

Transcription

1 CLINICAL GUIDELINE FOR CHANGING A CATHETER EXIT SITE DRESSING (I.E. MIDLINE/ CVC/ PICC/ HICKMAN) Summary. Start 1. Assemble all your equipment before you start. 2. Explain and discuss the procedure with the patient. 3. Ensure patient not allergic to CHG 1. Wash hands using Ayliffe technique 2. Clean trolley using detergent wipe and then alcowipe the top surface 3. Assemble equipment on bottom of the trolley 4. Open dressing pack onto the surface of the trolley 5. Alcogel hands. 6. Open the dressing pack wrapping by holding the corners, avoid touching the inside contents with your fingers. Arrange items for use using the yellow bag as a glove or forceps. 7. Open remaining equipment onto your sterile field 8. Alcogel hands 9. Place the sterile towel from the dressing pack (touching corners only) at the catheter exit site to create an aseptic field 10. Remove the old dressing and Griplock securement device making sure you do not pull on the catheter. 11. Observe the catheter for signs of infection, redness, crusting, pus and/or leakage * VIP score 12. Alcogel hands and put on sterile gloves. 13. Wipe around the catheter site with the chloraprep working outwards, allow to completely air dry. 14. Position clean Griplock securement device, insert catheter and apply dressing Dispose of waste, wash hands with soap and water and complete documentation End Page 1 of 8

2 1. Aim/Purpose of this Guideline 1.1. The catheter dressing is designed to minimise the possibility of the catheter becoming infected. The dressing should be changed 24 hours post insertion and weekly thereafter unless dressing becomes soiled or damaged in the meantime. This procedure applies to all medical staff and registered nurses involved in changing catheter exit site dressings. The procedure is in place to ensure compliance with Trust guidance. 2. The Guidance 2.1. Responsibilities 2.2. Individual practitioners must ensure they are competent to undertake duties to the standards within this document and should have an appreciation and understanding of the vascular access device. The team leader is responsible for ensuring sufficient and appropriate training is available and undertaken Method 2.4. Equipment Basic dressing pack includes sterile gloves/ sterile towel/ gallipot/ gauze 1 x3ml applicator 2% Chlorhexidine in 70% Isopropyl (chloraprep./ CHG) Transparebt semi permeable dressing ie Tegaderm IV advanced Griplock securement device Mepore tape Clean dressing trolley 2.5. Pre procedure 1. Assemble all your equipment before you start. 2. Explain and discuss the procedure with the patient. 3. Ensure patient not allergic to CHG 2.6. Procedure 1. Wash hands using Ayliffe technique 2. Clean trolley using detergent wipe and then alcowipe the top surface 3. Assemble equipment on bottom of the trolley 4. Open dressing pack onto the surface of the trolley 5. Alcogel hands. 6. Open the dressing pack wrapping by holding the corners, avoid touching the inside contents with your fingers. Arrange items for use using the yellow bag as a glove or forceps. 7. Open remaining equipment onto your sterile field 8. Alcogel hands 9. Place the sterile towel from the dressing pack (touching corners only) at the catheter exit site to create an aseptic field 10. Remove the old dressing and Griplock securement device making sure you do not pull on the catheter. 11. Observe the catheter for signs of infection, redness, crusting, pus Page 2 of 8

3 and/or leakage * VIP score 12. Alcogel hands and put on sterile gloves. 13. Wipe around the catheter site with the chloraprep working outwards, allow to completely air dry. 14. Position clean Griplock securement device, insert catheter and apply dressing 2.7. Post procedure 1. Dispose of waste, wash hands with soap and water and complete documentation NB *points to check when observing the catheter redness, crusting, pus, leakage, extravasation. If any of the above are noted or you have any concerns notify the medical or surgical team responsible for the patient. 3. Monitoring compliance and effectiveness Element to be monitored Lead Tool Frequency Reporting arrangements Acting on recommendations and Lead(s) Change in practice and lessons to be shared Compliance with procedure Tracy Lee Nutrition Nurse Incident reporting/ Nutrition team database Annual Nutrition Steering Group Chair Nutrition Steering Group Senior Nurses Forum, Ward Safety Briefings 4. Equality and Diversity 4.1. This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement which can be found in the 'Equality, Diversity & Human Rights Policy' or the Equality and Diversity website Equality Impact Assessment The Initial Equality Impact Assessment Screening Form is at Appendix 2. Page 3 of 8

4 Appendix 1. Summary Guideline for Changing a Catheter Exit Site Dressing (i.e. Midline/ CVC/ PICC/ Hickman) The summary guidance from page 1 has also been published separately as Appendix 1 and can be accessed via the Document Library by searching for Catheter Exit or click here. Page 4 of 8

5 Appendix 2. Governance Information Document Title Date Issued/Approved: 17 Jun 15 Date Valid From: 17 Jun 15 Clinical Guideline for Changing a Catheter Exit Site Dressing (i.e. Midline/ CVC/ PICC/ Hickman) Date Valid To: 17 Jun 18 Directorate / Department responsible (author/owner): Tracy Lee, Nutrition Nurse Contact details: (or x 2409) Brief summary of contents Suggested Keywords: Target Audience Executive Director responsible for Policy: Date revised: This document replaces (exact title of previous version): Approval route (names of committees)/consultation: This procedure applies to all medical staff and registered nurses involved in changing catheter exit site dressings. The procedure is in place to ensure compliance with Trust guidance. Catheter, infection, dressings, nutrition. RCHT PCH CFT KCCG Medical Director New Document New Document Nutrition Steering Group Divisional Manager confirming approval processes Name and Post Title of additional signatories Name and Signature of Divisional/Directorate Governance Lead confirming approval by specialty and divisional management meetings Signature of Executive Director giving approval Publication Location (refer to Policy on Policies Approvals and Ratification): Document Library Folder/Sub Folder Sally Rowe, Divisional Director CSSC Not Required {Original Copy Signed} Name: {Original Copy Signed} Internet & Intranet Intranet Only Clinical / Dieticians Page 5 of 8

6 Links to key external standards Related Documents: Training Need Identified? None RCHT Patient Identification Policy RCHT Consent to Treatment/Examination RCHT Standards of Record keeping RCHT Infection Control RCHT Total Parenteral Nutrition for adults RCHT Clinical guideline for the use of intravascular catheters in adults at RCHT RCHT Aseptic non touch technique policy No Version Control Table Date Version No Summary of Changes Changes Made by (Name and Job Title) 17 Jun 15 V1.0 Initial Issue Tracy Lee, Nutrition Nurse All or part of this document can be released under the Freedom of Information Act 2000 This document is to be retained for 10 years from the date of expiry. This document is only valid on the day of printing Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy on Document Production. It should not be altered in any way without the express permission of the author or their Line Manager. Page 6 of 8

7 Appendix 3. Initial Equality Impact Assessment Form Name of Name of the strategy / policy /proposal / service function to be assessed (hereafter referred to as policy) (Provide brief description): Clinical Guideline for Changing a Catheter Exit Site Dressing (i.e. Midline/ CVC/ PICC/ Hickman) Directorate and service area: Clinical / Is this a new or existing Policy? New Dieticians Name of individual completing Telephone: (or x 2409) assessment: Tracy Lee, Nutrition Nurse 1. Policy Aim* See para 1. Who is the strategy / policy / proposal / service function aimed at? 2. Policy Objectives* See para Policy intended Outcomes* 4. *How will you measure the outcome? 5. Who is intended to benefit from the policy? 6a) Is consultation required with the workforce, equality groups, local interest groups etc. around this policy? b) If yes, have these *groups been consulted? C). Please list any groups who have been consulted about this procedure. 7. The Impact Please complete the following table. Are there concerns that the policy could have differential impact on: Equality Strands: Yes No Rationale for Assessment / Existing Evidence Age Sex (male, female, transgender / gender reassignment) Race / Ethnic communities /groups See para 1. See para 3. All patients No Page 7 of 8

8 Disability - Learning disability, physical disability, sensory impairment and mental health problems Religion / other beliefs Marriage and civil partnership Pregnancy and maternity Sexual Orientation, Bisexual, Gay, heterosexual, Lesbian You will need to continue to a full Equality Impact Assessment if the following have been highlighted: You have ticked Yes in any column above and No consultation or evidence of there being consultation- this excludes any policies which have been identified as not requiring consultation. or Major service redesign or development 8. Please indicate if a full equality analysis is recommended. Yes No 9. If you are not recommending a Full Impact assessment please explain why. Signature of policy developer / lead manager / director Date of completion and submission Names and signatures of members carrying out the Screening Assessment 1. Tracy Lee 2. Keep one copy and send a copy to the Human Rights, Equality and Inclusion Lead, c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Knowledge Spa, Truro, Cornwall, TR1 3HD A summary of the results will be published on the Trust s web site. Signed Date Page 8 of 8