VASCULAR ACCES S
for the patient-specific clinical conditions, and the following factors should be taken into account before choosing and placing a line. For example, is it a vesicant or irritant solution, what is the osmolarity of the solution, and how long is the therapy anticipated to last?
By selecting the right vascular access device from the outset, this helps to prevent repeat cannulations which can increase the risk of infection. This practice also proactively supports timely clinical intervention, reduces vessel damage, and preserves vessel integrity.
Handwashing best practice & ANTT When placing, or interacting with the device, a clinician should always refer to handwashing best practice and refer to the aseptic non-touch technique (ANTT). If a patient is being treated in an outpatient setting, or is using a self-administration vascular access device, ensure they are advised of, and adequately trained on correct handwashing technique to prevent complications.
Needle-free devices and active disinfection
One cannot ignore the role of needle-free devices within this scenario as a vital medical component that attaches to the end of vascular access devices. Clinicians should be aware of the differing devices available on the market, how their design and internal functionality can impact their associated risks of infection and the importance of active disinfection – or ‘scrubbing the hub’ as its more often known.
Clinicians must also note that needle-free connectors should be changed as per the manufacturer’s recommendations.6
Dressing and regular monitoring of vascular access sites, patient education and advocacy There are multiple functions of dressings, including providing security for the catheter to prevent dislodgement. They also create a barrier impermeable to water and bacteria.
They protect the catheter site from extrinsic contamination and discourage bacterial production at the insertion site.
Dressings should be transparent to allow visual inspection of the site, they should be self-adhesive and provide stability, thus reducing the risk of vein intima trauma, phlebitis and contamination. A sterile transparent film dressing must be applied and maintained on vascular access devices. All dressings must be changed at established intervals in accordance with organisational policies/procedures and manufacturers’ guidelines, and immediately if the integrity of the dressing is compromised. Furthermore, regular monitoring of vascular access device sites is crucial, as is the ability to spot the warning signs of such issues. Signs can include visual indications (these include redness around the area, swelling, etc), physical indications (such as warmth surrounding the area, or increased pain reported by the patient), or administrative indications (such as increased pressure required when flushing). As with any infection prevention, early intervention is key. A case can also be argued for increased patient education and self-advocacy relating to vascular access devices. This can be done by raising patient awareness on the core signs and issues they may see around site, when a vascular access device is on their person, and alerting medical professionals for earlier intervention.
Adequate catheter clearance The flushing of catheters is one of the most important preventative measures used to prevent occlusion, which should be done at regular intervals to promote and maintain patency and prevent the mixing of incompatible medications and/or solutions. Protocols for flushing should be established within each organisation, but here is some useful guidance on flushing: l A vascular access device should be clamped after completion of the final
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WWW.CLINICALSERVICESJOURNAL.COM JANUARY 2023
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