Peripheral venous catheter care

Authors: Brikez Yu. I.

Editor: Rednenko V.V.

Equipment for the practical skill:

• manipulation table (see Preparing of the workplace for injections and intravenous infusions)
• disinfection table (see Preparing of the workplace for injections and intravenous infusions)
• medicines
• heparin solution in a vial (5000 U / 1 ml)
• sodium chloride solution 9 mg / ml in ampoule volume of 5.0 ml
• sodium chloride solution 9 mg / ml in vial (bottle) volume of 100 ml
• 5 ml syringes with needle of size 0.8x 40 mm - 3 pcs.
• sterile plug in packaging

• tray - 2 pcs.
• MAR

Clinical situation:

• You are a nurse at a hospital’s therapeutic department. Take care of PVC without intravenous medicine administration.

Order of the skill performance:

Preparatory stage: ( you are in the treatment room)

• inform the patient about the procedure, get verbal consent to giving it, ask him to take the required position
• perform hygienic hand antiseptics
• put on PPE (non-sterile gloves)
• check the expiration date and integrity of the packaging of medicines and sterile items
• syringes preparing
  • take 5 ml syringe, withdraw 1 ml of sodium chloride 9 mg / mlinto the syringe for remove heparinized solution
    
  • take 5 ml syringe, withdraw 5 ml of sodium chloride 9 mg / mlinto the syringe for flushing the PVC
  • take 5 ml syringe, withdraw 3 ml of heparinized solution into the syringe
  • discard any air that has been withdrawn into syringe and discard any excess medication (needles without caps) by pressing on the syringe plunger with the first finger of your dominant hand
  • remove the needles from the syringes with the first and second fingers of your non dominant hand, place it in the container “Disinfection of sharp medical items”
  • place the syringeswith the medicines into the opened syringe packages 
• place medical items in the tray (for temporary placement)
  • place 3 syringes
  • opened package with sterile gauze pads 
  • sterile plug in packaging
  • sterile roll bangage

Main stage: (you are in the patient's room)

• place the trays next to the patient on his bedside table
• remove the bandage and gauze pad from the PVC
• place in a container for temporary placement of used medical items
• remove the heparinized solution from the PVC:
  • take a gauze pad and place it under the IV set port (luer lock)

• place the first finger (thumb) of your left hand on the injection port (extra PVC port) and the same time place the third finger of your left hand on PVCtip supposed location
• press the vein with the third finger of your left hand at PVC tip supposed location
• remove the plug from the IV set port(luer lock) with the first and second fingers of your right hand (make rotational motions)and place it in a container for temporary placementof used medical items
• take a syringe with 1.0 ml of sodium chloride 9 mg / ml connect it to the IV infusion port
• release the pressure of the third finger of your left hand on the vein and slowly pull the syringe plunger "towards you" until blood appears inside the syringe
• press the vein again with the third finger of the left hand and disconnect the syringe from the IV infusion port of the PVC
• place the syringe in a container for temporary placement of used medical items
• flush the PVC:
  • take a syringe with 5.0 ml of sodium chloride 9 mg / ml, (scale of the syringe barrel in front of you)and connect it to the IV infusion port
  • release the pressure of the third finger of your left hand on the vein on PVCtip supposed location
  • slowly inject 4 - 4.5 ml of sodium chloride 9 mg / ml, pressing the plunger of the syringe with the first finger (thumb) of your right hand
  • press the vein again with the third finger of your left hand at PVC tip supposed location
  • disconnect the syringe with 0.5 -1.0 ml of sodium chloride 9 mg / ml from the IV infusion port of the PVCby rotating movement
  • place the syringe in a container for temporary placement of medical items
  • take a new luer lock plug with the first and second fingers of your right hand, close the IV infusion port of the PVC by rotating movement
  • remove the third finger of your left hand from supposed location of the PVC tip
• inject heparinized solution:
  • place the first and the second fingers of your left hand on thecatheter wings, with the fingers of your right hand open the injection port cap
  • take a syringe with 3.0 ml of heparinized solution with your right hand connect it to the injection port by rotating movement
  • place the second and third fingers of your right hand on the flange of the syringe barrel, the first finger on the plunger
  • slowly inject 2.0-2.5 ml of heparinized solution pressing the plunger of the syringe with the thumb of your right hand, leaving 0.5-1.0 ml of solution in the syringe
  • disconnect the syringe from the IV infusion port of the catheter by rotating movement
  • place the syringe in a container for temporary placement of medical items
  • close the injection port cap with your right hand
•  treat the skin around the catheter:
  • remove the gauze pad with your right hand, holding the catheher wings with the first and second fingers of your left hand
  • place the used pad in the container “Disinfection of dressings, PPE”
  •  take one cotton ball (or gauze pad) with your right hand and wet it with skin antiseptic
  • treat the skin around the PBC by circular motion from the center to the periphery
  • remove the fingers of your left hand from the catheter wings
  •  wait until antiseptic has completely evaporated from the surface of the skin
  • fix the PBC with a self-adhesive bandage, indicating the time and date of setting the PBC on the bandage
  •  cover the catheter site with a sterile dressing ( one gause pad and bandage)
  •  residence time of the PVC in a vein is no more than 72 hours
• inform the patient 
  • do not remove the dressing
  • do not moisten the venipuncture site

Final stage: ( you are in the treatment room)

• take the syringes from the container for temporary placement of medical items
•  rinse in the container "Washing syringes and other medical items"
•  the disassembled syringes place in the container “Disinfection of syringes and other medical items”
• take the used dressing from the container for temporary placement of medical items
•  place the used dressing in the container “Disinfection of dressings, PPE”
• remove gloves and place them in the container “Disinfection of dressings, PPE” 
• wash your hands
• recordtime and date of procedure in the medical record