CVAD fluid and drug administration

Section Recommendation statement Grading of recommendations
17. Ensure drugs are compatible when administering multiple intravenous medications via the CVAD lumen. Refer to drug resources such as Micromedex or the institutional pharmacist. Consensus
18. Crystalloid solutions without drug additives (e.g. 0.9% saline) should only be changed when the administration set is changed, when the catheter is changed and or when the infusion is complete. Consensus
19. All blood products should be infused as per the National Blood Authority Australia Patient Blood Management Guidelines (1). National Guidelines
The evidence review for these recommendations was current to December 2012. Clinicians are advised to check the literature as research may have been published that change these recommendations.

A large number of medications and fluids are usually administered to critically ill patients via a CVAD. Administration of intravenous medications is governed by policies and procedures to reduce the risk of medication errors. Incompatible medications administered via the same lumen of the CVAD without appropriate flushing of the lumen may lead to deleterious side effects for the patient such as blockage of the CVAD lumen or, more seriously, an embolus of crystallised medication administered when attempting to access the lumen.

Blood and blood products

The National Health and Medical Research Council, the Australian & New Zealand Society of Blood Transfusion and the National Blood Authority have developed a series of five patient-focused, evidence-based modules that together outline Patient Blood Management Guidelines. The modules include evidence-based recommendations from a systematic review and practice points based on consensus decision making, where the systematic review found insufficient high-quality data to produce evidence-based recommendations. It was the consensus of this GDN that any recommendations from these guidelines relating to practices for post insertion management of CVADs should be adopted. Access the modules.

Grades of recommendations

Grade of recommendation Description
A Body of evidence can be trusted to guide evidence
B Body of evidence can be trusted to guide practice in most situations
C Body of evidence provides some support for recommendation/s but care should be taken in its application
D Body of evidence is weak and recommendation must be applied with caution
Consensus Consensus was set as a median of ≥ 7
Grades A–D are based on NHMRC grades (2)

References

  1. National Blood Authority. Patient Blood Management Guidelines. Federal Government.
  2. Hillier S, Grimmer-Somers K, Merlin T, Middleton P, Salisbury J, Tooher R, et al. FORM: an Australian method for formulating and grading recommendations in evidence-based clinical guidelines. BMC Medical Research Methodology. 2011;11:23. PubMed PMID: 21356039.

Disclaimer

The information on this page is general in nature and cannot reflect individual patient variation. It reflects Australian intensive care practice, which may differ from that in other countries. It is intended as a supplement to the more specific information provided by the doctors and nurses caring for your loved one. ICNSW attests to the accuracy of the information contained here but takes no responsibility for how it may apply to an individual patient. Please refer to the full disclaimer.