4.6 Checklist: Access an Implanted Venous Access Device

Checklist: Access an Implanted Venous Access Device^[1],[2]

• Review the client’s medical record for information about the implanted venous access device. Determine if the device is “power injectable.”
• Ensure confirmation of catheter tip placement.
• Verify the provider’s order if required by the facility.
• Determine whether the client has a history of allergies or contraindications to the antiseptic, anesthetic, or prescribed solution.
• Gather the necessary equipment:
  • Gloves
  • Masks
  • Sterile gloves
  • Sterile drape
  • Safety-engineered noncoring needle (smallest gauge necessary to accommodate the prescribed therapy and length that allows external components to sit level with the skin and securely within the implanted venous access device) with attached extension set tubing
  • Antiseptic pad or applicator (chlorhexidine-based, povidone iodine, or alcohol)
  • Sterile 10-mL syringes (or syringes specifically designed to generate lower injection pressure) prefilled with preservative-free normal saline solution
  • Sterile transparent semipermeable dressing (may be chlorhexidine-impregnated)
  • Sterile needleless connector
  • Securement device (follow agency policy)
• Perform hand hygiene.
• Confirm the client’s identity using at least two patient identifiers and check allergies.
• Provide privacy.
• Explain the procedure to the client and family (if appropriate) and answer any questions.
• Assess the client’s pain tolerance and discuss preferences for using local anesthetic. If warranted, prepare and administer EMLA cream or intradermal lidocaine prior to accessing the implanted venous access device, as prescribed.
• Raise the client’s bed to working level.
• Perform hand hygiene.
• Put on gloves.
• Ask the client to put on a mask and then position them for comfort with their head turned toward the opposite side of the implanted venous access device.
• Assess the skin overlying and surrounding the implanted venous access device. Report abnormal findings to the provider.
• Palpate and locate the septum; assess for device rotation.
• Remove and discard gloves.
• Perform hand hygiene.
• Put on a mask.
• Perform hand hygiene.
• Open the supplies and prepare a sterile field using a sterile drape. Using sterile technique, place the supplies on the sterile field.
• Perform hand hygiene.
• Put on sterile gloves.
• Clean the site of the implanted venous access device with an antiseptic solution following the manufacturer’s instructions.
• Attach a needleless connector to the extension set attached to the noncoring needle.
• Maintaining sterility of the syringe tip, attach a syringe containing preservative-free normal saline solution to the needleless connector and prime the extension set and noncoring needle with preservative-free normal saline solution. Clamp the extension set tubing.
• Palpate and stabilize the implanted venous access device with the nondominant hand.
• Grasp the noncoring needle with the dominant hand and insert the noncoring needle perpendicular to the skin through the septum of the implanted venous access device until the needle tip comes in contact with the back of the implanted venous access device.
• Unclamp the extension tubing and aspirate for blood return and then flush the implanted venous access device with preservative-free normal saline solution.
• Secure the noncoring needle with an engineered-stabilization device. Support the wings of the noncoring needle with sterile gauze; make sure that the gauze doesn’t prevent visualization of the needle insertion site.
• If applicable, place a chlorhexidine-impregnated sponge dressing beneath the needle, following the manufacturer’s directions.
• Apply a sterile semipermeable transparent dressing over the insertion site, noncoring needle, and upper portion of the extension tubing.
• Label the dressing with the current date or the date the dressing change is due as directed by the facility.
• Discard the used supplies. Dispose of used equipment and waste in an appropriate receptacle.
• Remove and discard gloves and mask.
• Perform hand hygiene.
• In an inpatient setting, help the client into a comfortable position and place personal items, the tray table, and the call light within easy reach. Make sure the client knows how to use the call light to summon assistance. To ensure the client’s safety, raise the appropriate number of side rails and lower the bed to the lowest position. Ensure the bed is locked.
• Perform hand hygiene.
• Document procedure and assessments.

Documentation Cues:

• Date and time
• Location appearance of the site
• Needle gauge and length
• Number of attempts to access implanted venous access device
• Any unexpected outcomes and interventions
• Amount and type of flush solution used
• Patency of the catheter
• Presence of blood return
• Lack of resistance when flushing
• Client’s tolerance of the procedure
• Teaching provided to the client and family (if applicable), understanding of that teaching, and any need for follow-up teaching