Care Bundle for Vascular Access on the Neonatal Unit
|Publication: 22/01/2015 --|
|Last review: 28/12/2017|
|Next review: 28/12/2020|
|Standard Operating Procedure|
|Approved By: Neonatal IPC and Neonatal Governance Group|
|Copyright© Leeds Teaching Hospitals NHS Trust 2017|
This Standard Operating Procedure is intended for use by healthcare professionals within Leeds unless otherwise stated.
Please check the patients allergy status, as they may be allergic to Chlorhexidine, and alternative ( Providine iodine) solution will be required.
Be aware: Chlorhexidine is considered an environmental allergen.
Refer to the asepsis guidance.
Care Bundle for Neonatal Vascular Access
- The Line Team
- Catheter Type
- Insertion Site
- Use Maximum Aseptic/ Barrier Precautions
- Skin Preparation
- Securing and Dressing of Line
- Safe Disposal of Sharps
- Care of Line Following Insertion
Central to all aspects of CVC insertion. An operator must be assessed as competent by a member of the team before inserting any any vascular access unsupervised.
Choose most appropriate
- Peripheral cannula,
- Double/single lumen umbilical venous catheter,
- Umbilical arterial catheter,
- Nutriline PICC line (2Fr),
- Double lumen long line
Central venous lines with stylets are available to aid insertion. Seldinger packs are also available to use with 1 and 2 Fr lines.
When selecting the vein or artery be aware of the possible complications associated with insertion. Peripheral cannulae should not be attempted in the common long line sites - i.e. ante-cubital fossae and long saphenous vein.
Clean site with 2% chlorhexidine /70% alcohol and allow to dry for 30 seconds.
For peripheral lines use 0.67ml Chlora Prep
For Umbilical lines and CVC use 1.5ml Chlora Prep
In babies under 30 weeks use DABBING motion.
CAUTION – in babies under 28 weeks clean solution off with sterile water to avoid skin burns – ensure no pooling of solution under baby.
- CVC – anchor line using Steri-strip, do not encircle the limb. Secure with a semi-permable transparent dressing to allow full observation of insertion site and limb. Dressings should be assessed every day to ensure they are clean and intact. This should be documented in the medical notes using the appropriate orange sticker.
- Umbilical lines – secure using single suture either side of line. Use clean zinc oxide tape to secure to line following confirmation x-ray. Venous and arterial lines are secured separately.
- Peripheral Lines – anchor line using Steri-strip and secure with a semi-permable transparent dressing to allow full observation of insertion site and limb.
Please ensure all sharps are disposed of safely and the trolley is left clean.
CVC and Umbilical lines insertion – complete Matching Michigan check list and file in notes. Complete Green Insertion sticker and place in clinical notes
Peripheral insertion – complete blue insertion sticker and place in clinical notes. Ensure removal of device is also recorded.
Hourly VIP scores, complete Saving Lives document every shift, ensure lines are not trapped, tangled and all connections are secure. See Saving Lives guidance, SOP for Venous Access Ongoing Care
For arterial lines ensure limbs are pink, warm and well perfused at all times. Any concerns seek medical attention immediately.
|Target patient group:||Newborns on NNU|
|Target professional group(s):||Secondary Care Doctors
Secondary Care Nurses
Allied Health Professionals
Neonatal IPC and Neonatal Governance Group
LHP version 1.0
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