Quality statement 5: Vascular access devices

Quality statement

People who need a vascular access device have their risk of infection minimised by the completion of specified procedures necessary for the safe insertion and maintenance of the device and its removal as soon as it is no longer needed.

Rationale

Vascular access devices are one of the main causes of healthcare-associated infections, and bloodstream infections associated with central venous device insertion are a major cause of morbidity. The risk of infection is greatly reduced by complying with all parts of the process for safe insertion and maintenance of the device and its removal as soon as it is no longer needed.

Quality measures

Structure

Evidence of a written protocol to ensure that people who need a vascular access device have their risk of infection minimised by the completion of specified procedures necessary for the safe insertion and maintenance of the device and its removal as soon as it is no longer needed.

Data source: Local data collection.

Process

Proportion of people with a vascular access device who had their risk of infection minimised by the completion of specified procedures necessary for the safe insertion and maintenance of the device and its removal as soon as it is no longer needed.

Numerator – the number of people in the denominator for whom all of the specified procedures were completed for the safe insertion and maintenance of the device and its removal as soon as it is no longer needed.

Denominator – the number of people who have had a vascular access device.

Data source: Local data collection. Contained in NICE clinical guideline 139 clinical audit tool – vascular access devices and the UK Renal Registry Annual Report.

Outcome

Incidence of vascular access device-related bloodstream infection.

Data source: Local data collection.

What the quality statement means for service providers, healthcare workers and commissioners

Service providers ensure that systems and facilities are in place to enable staff to complete specified procedures necessary for the safe insertion and maintenance of the vascular access device and its removal as soon as it is no longer needed, in order to minimise risk of infection.

Healthcare workers ensure that they complete specified procedures necessary for the safe insertion and maintenance of the vascular access device and its removal as soon as it is no longer needed, in order to minimise the risk of infection.

Commissioners ensure that they commission services in which specified procedures necessary for the safe insertion and maintenance of the vascular access device and its removal as soon as it is no longer needed are completed, in order to minimise the risk of infection.

What the quality statement means for patients, service users and carers

People who need a vascular access device have their risk of infection minimised by healthcare workers carrying out procedures to make sure that the device is inserted, looked after and removed correctly and safely. These procedures include things like using sterile procedures when inserting the device, using the correct antiseptics and dressings, and removing the device as soon as it is no longer needed. A vascular access device is a tube that is inserted into a main vein or artery and used to administer fluids and medication, monitor blood pressure and collect blood samples.

Source guidance

Definitions of terms used in this quality statement

Vascular access device

A vascular access device is an indwelling catheter, cannula or other instrument used to obtain venous or arterial access. Both central and peripheral vascular access devices are available.

Specified procedures necessary for the safe insertion, maintenance and appropriate removal of vascular access devices

General asepsis
  • Healthcare workers must decontaminate their hands before accessing or dressing a vascular access device, using an alcohol handrub or by washing with liquid soap and water if hands are contaminated. An aseptic technique must be used for vascular access device catheter site care, when accessing the system and when administrating intravenous medication.

Skin decontamination
  • The skin should be decontaminated at the insertion site with 2% chlorhexidine gluconate in 70% alcohol and allowed to dry before inserting a vascular access device.

Vascular access device site care
  • A sterile transparent semipermeable membrane dressing should be used to cover the vascular access device insertion site. This should be changed every 7 days, or sooner if it is no longer intact or if moisture collects under the dressing.

  • A single-use application of 2% chlorhexidine gluconate in 70% alcohol (or aqueous povidone iodine) should be used and allowed to dry when cleaning the insertion site during dressing changes.

Vascular access device management
  • A single-use application of 2% chlorhexidine gluconate in 70% alcohol (or aqueous povidone iodine) should be used to decontaminate the access port or catheter hub. The hub should be cleaned for 15 seconds and allowed to dry before accessing the system.

  • Preferably, a sterile 0.9% sodium chloride injection should be used to flush and lock catheter lumens.

  • Administration sets for blood and blood components should be changed when the transfusion episode is complete or every 12 hours (whichever is sooner), or according to the manufacturer's recommendations. Administration sets used for total parenteral nutrition infusions should generally be changed every 24 hours. If the solution contains only glucose and amino acids, administration sets in continuous use do not need to be replaced more frequently than every 72 hours.

Review of vascular access devices
  • Peripheral vascular catheter insertion sites should be inspected during every shift at a minimum, and a visual phlebitis score should be recorded.

  • Central venous catheter insertion sites should be inspected daily.

[Adapted from NICE clinical guideline 139 and epic3: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England]