I guess I have really only seen port-a-cath's placed on the chest, not accessed. I was precepting another nurse the other day and we had a patient that had a port-a-cath already accessed with a huber needle in place (I have never seen this) and we needed to do a blood draw for sodium levels. It is a care home so my preceptor donned mask but not sterile gloves. She swabbed the hub (single lumen) flushed first with 10 mls NS, wasted 10 mls, pulled sample, and then flushed with 10 mls NS again, and 5 mls heparin, push pause but I don't believe she did the positive pressure clamp thing at the end. Then, she said every time they do this draw..every day or more freqently, they change the hubcap on this single lumen extension set. Every 7 days a nurse comes from the outside and does the dressing change.
I've been researching best practice on this and was wondering if you could help me out with proper procedure. Would you really open this system every day to change hubcaps without even having sterile gloves on? Maybe I am way off base as like I said I have zero familiarity here but seems like a great, unnecessary way to introduce infection. In fact, after researching the patient chart, I found that this patient had a recent catheter infection (e-coli). Please help a dumb new grad, LOL
Your facility should have policies on this, unfortunately policies tend to differ on this subject.
The theory behind changing the hub after drawing blood is to ensure that there is no residual blood left in the hub. Hubs tend to have nooks and crannies where blood stagnates and clots. Blood clots make nice homes for bacteria, providing nutrients and even protection from antibiotics and WBCs. Bacteria tend to burrow into these clots and grow. This is the reason why infection is a primary concern after using Cathflo on an occluded central line.
You want to eliminate thrombosis not necessarily to retain catheter patency but to prevent CLABSIs. My facility utilizes hubs with a clear plastic so that we can visually inspect the hub to ensure no blood was left in the hub.
BTW, you need to identify your particular hub type to determine if and when you clamp the catheter.
Edit: Anytime you remove the hub it really should be sterile procedure. Why bother with a mask if you are only going to introduce bacteria with your fingers?
Last edit by Asystole RN on May 21, '12
I think I get what you're asking.
Blood should be drawn from the line without the cap, not through the cap. It sounds like they're drawing through the cap, then replacing it with a new one.
When I draw through any kind of CVC, I first wash my hands with soap and water, don clean gloves, lay out all my supplies on a clean surface, priming my new cap/extension set with NS. I remove the old cap from the line, flush with 10cc NS, then using the same syringe, draw my waste. Then I quickly attach a new syringe, draw the sample, and quickly attach the new cap/extension set and flush. The blood gets tubed AFTER the line is capped.
Masking and sterile gloves are not necessary. Clean gloves, a clean working surface, and preventing contact of the business ends of the line, the caps, the flushes, etc. are all that are required. The gloves are to protect ME from the patient's blood, not to protect the patient from infection. Preventing all of the connecting parts from touching anything and minimizing the amount of time the line is open to air is how infection is prevented.
Under normal circumstances, cap changes are done weekly, although if the person is getting daily blood draws, I would probably just go ahead and change the cap too, because you're already opening up the line, and I don't know for sure that the end of the old cap has remained sterile during the whole procedure.
For accessing ports and doing dressing changes, you use a mask and sterile gloves/sterile technique.
At least, this is the P&P at my place of employment.
Last edit by Anna Flaxis on May 22, '12
I'm sorry, but the more I read your questions, the more concerned I am about nurses at your facility doing anything with central lines! I don't mean to sound itchy with a "b", but I'm concerned about patient safety in a facility that has nurses expected to perform procedures that they have little to no training in, with no policies and procedures in place.
Last edit by Anna Flaxis on May 23, '12