Using Ventricular Assist Devices Policies and Procedures

Using Ventricular Assist Devices Policies and Procedures Section 1 – USING VADs II-1 Policy (Section 1) – A. Excepting emergencies, newly placed external or implanted vascular access devices, placement must be confirmed by x-ray prior to infusing any medications or solutions. Note: lines inserted into the femoral vein do not require chest x-ray. B. Administration sets connected to a VAD must be cleaned and prepped using alcohol anywhere along the administration set where entry is made, using a friction scrub for 15 seconds. If the patient displays symptoms of infection: (i.e. febrile, chilling, or has drainage from the VAD exit site), blood and/or site cultures need to be obtained. A physician order is required. C. Emergency care of the VAD includes all of the following: 1. Notify the physician immediately to obtain order(s) if a VAD is cracked, leaking, or has a hole. Clamp the VAD between the site of the defect and the exit site. Clamping must be done atraumatically either with a plastic clamp or with a metal clamp padded with gauze. 2. If the VAD Dacron cuff protrudes from the exit site, secure the VAD with tape and notify the physician. 3. If symptoms of VAD infiltration occur (i.e. edema of the neck, chest, back or abdomen, or shortness of breath), stop the infusion and call the physician immediately. D. For patients who are being treated with antibiotics for sepsis or r/o sepsis, antibiotics ought to be rotated to each lumen of a multi-lumen VAD at least every 24 hours, if possible, i.e. it is optimal to rotate each antibiotic dose, or minimally every 24 hours, until blood cultures are negative for 72 hours. (See Reference Below to II-1-D) E. All central venous access devices which are Present on Admission (POA) or inserted with the intent of the patient being discharged with the device, e.g., hemodialysis, chemotherapy, long term antibiotic therapy, etc. do not require daily validation of medical necessity, but should be inspected for signs and symptoms of infection. All other Central venous devices shall be evaluated for medical necessity on a daily basis. Section 2 – OBTAINING SPECIMENS FROM VADs II – 2 POLICY – (Section 2) – Medical Center A. Aseptic technique is to be used when obtaining laboratory specimens from any type of Vascular Access Devices (VAD). B. Drawing blood from a VAD is performed only by a licensed healthcare professional within their scope of practice using needle-free devices when obtaining or transferring specimens. C. Specimens must be labeled in the presence of the patient and must include patient name, medical record number, date of birth, visit number (for Medical Center only), and date and time of specimen collection. Write the first initial and last name of the person who collected the specimen on the label. Vascular Access Device (VAD), External and Implanted, Catheter Care Page 3 of 17 D. Labs requiring a blue top anticoagulant tube (such as PT/PTT/INR or other clotting studies) should be drawn peripherally. In those instances in which these studies must be drawn through the VAD, this specimen should be the last specimen drawn. E. Syringes less than 10 ml are not to be used when flushing a VAD in order to avoid causing excessive pressure or fracture to the VAD. F. When drawing from a child less than two years of age, a stopcock is used to maintain a closed system and the discard blood is returned to the child within 60 seconds. G. To prevent over-heparinizing a pediatric patient, no more than 50units/kg should be given within a four-hour interval. If flushing does exceed this amount, an MD order should be obtained and individualized for that patient. H. For multi-lumen VADs: When drawing labs from one lumen, clamp other lumen(s) for duration of the blood draw, even if other lumen(s) is heparin locked. This prevents blood from possibly being introduced into second lumen when heparin locked. It also prevents possible contamination of lab specimen if fluid is infusing in second lumen. I. Heparin for routine VAD flushes requires an order in both inpatient and outpatient settings. The dosing and frequency guidelines are found on Attachment C of this policy. II-4 POLICY – (Section 4) – A. An RN who has demonstrated competency in this procedure may perform needle insertion, site care, and needle removal of an implanted Vascular Access Device. B. The surgeon will access the port in the operating room on newly placed ports. C. Sterile technique must be utilized when accessing the implanted VAD. D. Only a 90-degree safety non-coring needle is used to access implanted VADs. Needles are changed every seven days. The recommended non-coring needle sizes for both adult and pediatric patients is 19-22 gauge, 3/4 – 1†. Blood or more viscous solutions require a lower gauge needle. Needle length is dependent upon the amount of subcutaneous tissue and depth of port. Do not access port if area is blistered or there are signs/symptoms of infection. E. Post-op dressings can be removed 24 hours post-op (unless ordered otherwise by physician). Steri-strips at insertion site should remain in place for 7-10 days. F. Implanted VAD site dressing changes are to be done once a week, with the needle change, or whenever it becomes loose, wet, or soiled. G. A heparin-locked non-coring needle may remain inserted for seven days for intermittent IV infusions. If a non-coring needle was placed and the patient does not require therapy, the needle must be removed by an RN prior to the patient being discharged home. H. Topical anesthetics may be used to help minimize the pain of needle insertion.