CVAD governance

Section Recommendation statement Grading of recommendations
47. CVAD management is provided by nursing staff that are proficient in this activity and/or by nursing staff under the direct supervision of nursing staff that are proficient as per institutional policy (1-3). Consensus
48. To prevent errors or breaches of asepsis, administration set and dressing changes should be performed when the clinician is unlikely to be interrupted. Consensus
49. Infusions on each lumen of the CVAD are to be labelled as per the National Recommendations for User-applied Labelling of Injectable Medicines, Fluids and Lines (4). National Guidelines and NSW Policy
50.

Evaluation of patient outcomes in relation to device failure include:

  1. surveillance of catheter-related bloodstream infection
  2. unintended removal and other complications as reported in the institutional incident management system
  3. audits of clinical practice. Use the audit tool.
National Guidelines and NSW Policy
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.

Recommendations of the Australian Commission on Safety and Quality in Healthcare

Two documents of the Australian Commission on Safety and Quality in Healthcare (ACSQHC) are referenced in this document and have been used to formulate recommendation statements.

The 2010 Australian Guidelines for the Prevention and Control of Infection in Healthcare(5)  include recommendations related to aseptic technique, use of disinfection solutions, needs assessment, administration set changes and disconnection.

The Labelling Standard (4) facilitates identification by clinicians of the correct medicine and/or fluid and route of administration of injectable medicines. The recommendations were produced as injectable medicines, fluids and devices used to administer infusions have been identified as a patient safety issue. The Labelling Standard supports prevention of medicine administration errors by:

  1. promoting safer use of injectable medicines
  2. standardising user-applied labelling of injectable medicines
  3. outlining the minimum requirements for user-applied labelling of injectable medicines including that:
    1. any medicine and fluid removed from the manufacturers’ or hospital pharmacy’s original packaging must be identifiable
    2. all containers with medicines leaving the hands of the person preparing the medicine must be labelled
    3. any medicine or fluid that cannot be identified (e.g. unlabelled syringe or other container) should be considered unsafe and discarded
    4. only one medicine at a time should be prepared and labelled before the preparation and labelling of a subsequent medicine.

Competence

CVAD management requires knowledge and technical skills in order to minimise risk to patients with these devices. It is clear from the NSW incident data and the practice review survey that care is variable. Standardisation of practices related to CVADs is required to improve patient safety. A number of guidelines also make recommendations in relation to education, training and competency (1-3). For this reason, proficiency should be measured by standard competency assessment tools (3) as required.

For NSW Health clinicians only: CVADs: The fundamentals on HETI online.

Grading 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 (6)

References

  1. Pratt RJ, Pellowe CM, Wilson JA, Loveday HP, Harper PJ, Jones SRLJ, et al. epic2: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. Journal of Hospital Infection. 2007;65 Suppl 1:S1-64. PubMed PMID: 17307562.
  2. Adams S, Barrett L, Brooks S, Dahler A, Jansens W, Shaw H. Central venous Access Devices: Principles for Nursing Practice and Education. Cancer Nurses Society of Australia. 2007.
  3. Society IN. Infusion Nursing standards of Practice. Journal of Infusion Nursing. 2011;34(1S):S1-S109.
  4. Care ACoSaQiH. National Standard for User-applied Labelling of Injectable Medicines, Fluids and Lines, . Sydney: ACSQHC; 2012.
  5. Koehler A, Baggoley C, Christiansen K, Coates L, Collignon P, Cooper C, et al. Australian Guidelines for the Prevention and Control of Infection in Healthcare  (2010). In: Care ACoSaQiH, editor.: Australian Government; 2010.
  6. 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.