Registered Nurses' Association of Ontario

Practice Recommendations

Recommendations

 

*Type of Evidence

 

Site selection: Peripheral

 

1.0

 

Nurses will select a peripheral insertion site appropriate for the required therapy and with the least risk of complication.

 

 

IV

 

Site and Catheter Care Safety/Infection Prevention Control

 

2.0

 

Nurses will prevent the spread of infection by following routine practices and using additional precautions.

 

IV

 

Skin Antisepsis

 

3.0

Nurses will consider the following factors when performing catheter site care using aseptic technique:

  • Catheter material (composition);
  • Antiseptic solution; and
  • Client’s tolerance (skin integrity, allergies, pain, sensitivity and skin reaction)

 

 

IV

 

Tip Placement

 

4.0

 

Nurses will not use the central venous access device (CVAD) until tip placement has been confirmed.

 

 

Dressings

5.0

 

Nurses will consider the following factors when selecting and changing VAD dressings:

  • Type of dressing;
  • Frequency of dressing changes; and
  • Client’s choice, tolerance and lifestyle.

 

IV

 

Securement

6.0

Nurses must stabilized the VAD in order to: III

  • Promoted assessment and monitoring of the vascular access site;
  • Facilitate delivery of prescribed therapy; and
  • Prevent dislodgement, migration, or catheter damage.

 

III

 

Patency/Flushing/ Locking

7.0

 

8.0

Nurses will maintain catheter patency using flushing and locking techniques.

Nurses will know what client factors, device characteristics and infusate factors can contribute to catheter occlusion in order to ensure catheter patency for the duration of the therapy.

IV

IV

 

Occlusion

 

9.0

 

Nurses will assess and evaluate vascular access devices for occlusion in order to facilitate treatment and improve client outcomes.

 

IV

 

Blood Withdrawal

 

10.0

Nurses will minimize accessing the central venous access device (CVAD) in order to reduce the risk of infection and nosocomial blood loss.

 

IV

 

Add-Ons

 

11.0

Nurses will change all add-on devices a minimum of every 72 hours.

 

IV

 

Documentation

 

12.0

Nurses will document the condition of vascular access devices including:

  • The insertion process;
  • Site assessment; and
  • Functionality.

 

III

 

Client Education

 

13.0

 

Nurses will help clients to attain the highest level of independence through client education.

 

IV

 

Clinical Management
Care and Maintenance to Reduce Vascular Access Complications
Practice Recommendations