Wednesday, October 3, 2018

Hemodialysis central venous catheter scrub - the -hub protocol ... part 7




Antiseptic use and selection

Bloodline disinfection

When accessing the line, disinfecting the ends of the sterile blood lines is not required if care has been taken not to contaminate the ends of the blood lines (ie  through careful aseptic technique). Blood lines can become contaminated during connections and disconnections, as well as during the priming process. Contact with contaminated prime waste in prime buckets that have not been properly cleaned and disinfected or through backflow from waste handling ports must be avoided. Disinfecting the bloodlines does not address this issue

Hemodialysis central venous catheter scrub - the -hub protocol ... part 6




Antiseptic use and selection

Handling catheter hubs

Catheter hubs should always be handled aseptically. Once disinfected, the catheter hubs should not be allowed to touch nonsterile surfaces. This might be best performed by holding them until the antiseptic dries. During this time, the staff member performing the procedure should also ensure that the catheter remains clamped.

When disinfecting catheter hubs, clean, nonsterile gloves can be used if aseptic technique is maintained.

Hemodialysis central venous catheter scrub - the -hub protocol ... part 5




Antiseptic use and selection

Soaking caps

The role of soaking caps in an antiseptic prior to removing them is not clear. It is not a healthcare infection control practice advisory comittee guidelines recommendation. This procedure is described in the 2000 National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) Vascular Access  Guidelines.

Hemodialysis central venous catheter scrub - the -hub protocol ... part 4




Antiseptic use and selection

As describe in  healthcare infection control practices advisory committee (HICPAC) guidelines for the prevention of intravascular catheter-related infections, prior to accessing the catheter hub it should be disinfected with an appropriate antiseptic (greater than 0.5% chlorhexidine with alcohol, 70% alcohol, or 10% povidone-iodine). There is not enough evidence to recommend one antiseptic over the others. Generally, antiseptics should be allowed to dry for maximal effect.

If using 70% alcohol, sterile antiseptic pads should be used (sterile pads are labeled sterile and packaging for non sterile pads often does not state whether the pads are sterile or non sterile). For practical reasons, pads or similar products might be preferred over other forms of antiseptics (eg swabsticks) for disinfecting the catheter as they are malleable and allow for vigorous cleaning of small spaces.

If using an antiseptic that leaves a residue (eg chlorhexidine), avoid allowing large amounts of antiseptic to enter the lumen of the catheter to avoid potential toxicities to the patient.
If using chlorhexidine, removing all blood residue is particularly important to maximise the effect of the antiseptic

Hemodialysis central venous catheter scrub - the -hub protocol ... part 3




Catheter connection and disconnection steps

Disconnection steps:
  • Perform hand hygiene and don new clean gloves
  • Clamp the catheter (always clamp the catheter before disconnecting. Never leave an uncapped catheter unattended)
  • Disinfect the catheter hub before applying the new cap using an appropriate antiseptics
  • Always handle the catheter hub aseptically. One disinfected, do not allow the catheter hubs to touch non sterile surfaces. Hold the catheter until the antiseptic has dried
  • Attach the new sterile caps to the catheter aseptically. Use caution if tape is used to secure caps to the catheter
  • Ensure that catheter is still clamped
  • Remove gloves and perform hand hygiene

Hemodialysis central venous catheter scrub - the -hub protocol ... part 2




Catheter connection and disconnection steps

Connection steps:
  • Perform hand hygiene and new clean gloves
  • Clamp the catheter (Always clamp the catheter before removing the cap. Never leave an uncapped catheter unattended)
  • Disinfect the hub with caps removed using an appropriate antiseptic
  • Always handle the catheter hubs aseptically. Once disinfected, do not allow the catheter hubs to touch nonsterile surface
  • Attach sterile syringe, unclamp the catheter, withdraw blood, and flush perfacility protocol
  • Repeat for other limb (this might occur parallel)
  • Connect the ends of the blood lines to the catheter aseptically
  • Remove gloves and performhand hygiene

Hemodialysis central venous catheter scrub - the -hub protocol ... part 1




DEFINITION

Catheter     :

A central venous catheter or a central line

Hub             :

The end of the central venous catheter that connects to the blood lines or cap

Cap              :

A device that screws on to and occludes the hub

Limb            :

The catheter portion that extends from the patient's body to the hub

Blood lines :

The arterial and venous ends of the extracorporeal circuit that connect the patient's catheter to the dialyzer