We have a few questions that we need clarified.
Under Standard # 14 documentation, practice criteria # B 7 confirmation of the anatomic location of the catheter tip for all CVADs prior to initial use etc. Does initial use mean only at the time of insertion or is the recommendation for chest X-ray every time the patient is admitted to the hospital with a CVAD before the catheter is used?
Under Standard #43.2 administration set shall be changed whenever the peripheral catheter site is rotated or when a new central vascular access device is placed. Does this mean only the IV tubing administration set or are you suppose to hang a new bag and new tubing?
Under Standard # 49 infection practice criteria K, obtaining blood cultures. We have a descrepency between nursing practice and lab practice with regard to wasting the initial draw. So is the INS standard of practice for drawing blood cultures the following: remove the old cap, scrub the hub with 2 alcohol pads, place new cap, scrub the new cap, then draw the blood sample without flushing the catheter and without wasting the initial blood draw. Is that the correct process for blood culture draw? Why not just draw the blood culture sample direct hub to hub?
Thanks so much,
Rhonda
Yes intial use means at the time of insertion. We did not write anything specific about a repeat xray with each admission, however that has become common practice simply because of the frequency with which catheters move. See the standard on Catheter Malposition.
New fluid container and new sets would be the best practice. There are no recent studies at all about fluid containers and this standard is only addressing sets. New sets are definitely indicated when a new catheter is placed.
Re drawing blood cultures, a standard is not as procedure-specific as your original post and this standard therefore does not include all that you have listed. Research is showing that blood cultures should 1) not be obtained through a used needleless connector, and 2) wasting the intial sample is not required. See the references in the standards for this. You can draw the sample direct hub to hub but the available research reports removing the old, adding a new connector and then drawing the sample. So that is the way it was written.
Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861