VASCULAR ACCES S
flush to decrease the risk of intraluminal occlusion.
l Catheters should be flushed with 0.9% normal saline.
l A turbulent flush should be used by using a ‘push/pause’, stop/start technique and positive pressure clamping sequence. This helps to remove debris from the internal catheter wall.
l Positive flushing prevents reflux of blood into the catheter tip, reducing the risk of catheter occlusion. This is accomplished by maintaining pressure on the plunger of the syringe while clamping or disconnecting the syringe from the needle- free device – this is particularly important when using a negative pressure needle- free device.
l Syringes used for flushing of central venous access devices should be no smaller than 10ml. Smaller syringe sizes will generate excessive pressures and could lead to catheter fracture.
l Do not forcibly flush any vascular access device. If resistance is met and/or no blood return noted, take further steps to locate the cause of the obstruction (check closed clamps or kinked sets, removing dressing).
Standardised training for healthcare professionals
At present, there are no specific training requirements for healthcare professionals on the care and maintenance of vascular access devices. Practice relies on initial healthcare training, departmental and Trust procedures. As with any skill, one without regular practice and reminders could lead to vital steps being forgotten or missed. A good example is a company fire drill; this is undertaken regularly to ensure best practice and all staff involvement and understanding. Similarly, care and maintenance training for vascular access devices could be introduced as standard, to help improve staff education and awareness, all while practicing these vital skills, which will ultimately reduce the potential for incidents. We have also seen the roll out of the National Infection Prevention and Control Manual (NIPCM) for England during 2022, and additional precedence being placed on reducing in-hospital infection rates.7
The
objectives of the manual aim to ‘Reduce variation and optimise infection prevention and control practices across care settings in England’ and ‘Improve the application of knowledge and skills in infection prevention and control’.
According to this manual, a core part of the responsibilities of any healthcare professional and staff member providing care must ‘maintain competence, skills and knowledge in infection prevention and control by attending education events and/ or completing training’. Therefore, at this
JANUARY 2023
Further useful resources for clinicians involved in intravascular therapies: l ANTT:
https://www.antt.org/ l VASCUFIRST:
https://vascufirst.com/ l RCN: Infusion Guidelines https://www.
rcn.org.uk/clinical-topics/Infection- prevention-and-control/Standards-for- infusion-therapy
l INS Guidelines:
https://www.ins1.org/ policies-and-procedures-for-infusion- therapy/
time, more than ever, we see the case for the introduction and standardisation of training for all clinicians who interact with a vascular access device.
Vascular access devices and training
As a medical device provider of a wide range of intravascular devices, Vygon is committed to offering staff training and education. We understand the need for regular training for all healthcare professionals that can be delivered in a way that best suits the departmental and individual needs, whether this be on-site training within the department or Trust, workshops, or e-learning so an individual can study at their own pace. We even offer a CPD-accredited competency. Through the delivery of our vascular access devices, we place an importance on partnership with the Trust to help them with standardisation of training and practice throughout departments, governance, and quality improvement projects. We offer mentorship within the clinical areas, and support via our intravascular hub and from our team of clinical educators, who have many years of experience within the speciality. The clinical educators hold a current Nursing and Midwifery Council (NMC) PIN number, and continued study ensures that their knowledge remains current.
CSJ
References 1. Weston, V. (2019). Assessment for Catheter Function, Dressing Adherence and Device Necessity. In: Moureau, N. (eds) Vessel Health and Preservation: The Right Approach for Vascular Access. Springer, Cham. https://doi. org/10.1007/978-3-030-03149-7_17
2. Napalkov, P. et al. (2013) ‘Incidence of catheter- related complications in patients with central venous or hemodialysis catheters: a health care claims database analysis.’, BMC cardiovascular disorders. BioMed Central, 13, p. 86. doi: 10.1186/1471-2261-13-86
3. Ullman, A. J. et al. (2016) ‘Central venous Access device SeCurement and Dressing Effectiveness (CASCADE) in paediatrics: Protocol for pilot randomised controlled trials’, BMJ Open, 6(6), pp. 1–9. doi: 10.1136/bmjopen-2016-011197. 4. World Health Organization (2011) Report on
the burden of endemic healthcare-associated infection worldwide: clean care is healthy care, Geneva: WHO. Available at:
www.who.int/iris/ bitstream/10665/80135/1/ 9789241501507_ eng.pdf
5. Aseptic Non-Touch Technique (ANTT)®
https://www.antt.org/
Found at:
6. Infusion Nurses Society, Policies and Practices for Infusion Therapy. (2021) Found at: https://www.
ins1.org/policies-and-procedures-for-infusion- therapy/
7. National Infection Prevention and Control Manual (NIPCM) for England. (2022) Found at: https://
www.england.nhs.uk/national-infection-prevention- and-control-manual-nipcm-for-england/
About the author
Linda Kelly (PhD) is the international clinical educator for Vygon and specialises in the field of intravascular therapies. With an extensive clinical background, she developed one of the first nurse-led vascular access services in the UK. During this time in practice, Linda won two awards for her work in vascular access: Nursing Standard Vascular Nuse of the Year and The Nursing Times Nurse of the Year. Linda has traversed the world of academia as a lecturer in Advanced Clinical Practice, and programme lead for Advancing Practice MSc, and Urgent Care programmes respectively. Since 2016, she has been in residency at Vygon as the international clinical educator, advising, teaching and supporting clinicians in all aspects of vascular access. She is a regular contributor for publications in topics related to vascular access and can often be seen presenting at national and international conferences. Most recently, Linda authored two chapters in the Vessel, Health and Preservation open access textbook and acted as a reviewer of the updated 2021 Infusion Nurses Society (INS) Infusion Therapy Standards of Practice.
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