Nursing Skill Check: CVAD Device Access

Nursing skills lab procedure for accessing and de-accessing Central Venous Device (CVAD).

West Coast University students, you can find the Skills Checklist and Reference Guide links below:

“Central venous access device, Accessing and D accessing central site – Before beginning this procedure always perform the following steps to ensure patient safety. Perform hand hygiene, provide patient privacy, introduce yourself, use to patient identifiers, verify allergy status, perform environmental safety check, ensure proper body mechanics, verify MD order, provide patient education, materials needed for CVAD accessing central site – mask, dressing change kit, Huber needle, access cap, 10 milliliter normal saline flush, sterile gloves. Assemble supplies before entering patient’s room.

The procedure: Accessing central site – note site condition and appearance,
check for any indicators of infection, erythema, warmth, swelling, tenderness, discharge.

Apply topical anesthetic. Palpate and inspect skin over and around port. Open outer wraps of supplies.

Don gloves and mask. Ask patient to turn head. Put mask on patient. Palpate and inspect skin.

Apply topical anesthetic if necessary. Remove gloves. Perform hand hygiene. Prime and prepare access cap, extension tubing and non-core a needle with prefilled saline syringe. Keep syringe attached to access cap and place on sterile field.

Open sterile dressing change kit and Don sterile gloves. Open chg. Cleanse site with antiseptic.

Remember not to cross the sterile field when disposing items in the appropriate receptacle.

Allow to dry. Immobilize device with non-dominant hand, insert primed needle and two-port at 90 degree angle with dominant hand. Push firmly through skin until needle hits back of port. Pull back slightly on syringe plunger to check for brisk flood return.

Flush with normal saline from syringe attached to injection cap and extension tubing in a pulsatile method. Cover device with sterile transparent dressing. Secure extension tubing in place with tape.

Remove syringe using positive pressure. Flushing technique. If deaccessing port, heparinized line before removing non core a needle. Label site. Dispose of soiled supplies in biohazard bag.

Materials needed for CVAD deaccessing central site: gloves, alcohol prep pads, ten milliliter normal saline syringe flush, biohazard sharps container, 2×2 gauze pad, tape, assemble supplies before entering patient’s room.

The Procedure: Deaccessing Central Site – Don clean gloves. Palpate and inspect skin over and around port. Open clamp on extension tubing. Cleanse access cap with antiseptic. Attach prefilled ten milliliter saline syringe to access cap.

Aspirate for blood flash. Withdraw blood until it reaches but does not enter into syringe. Flush line with normal saline using pulsatile flush method. If port requires heparinization, attach label heparin syringe to access cap of clamped extension tubing and flush line.

Loosen and remove all dressing, stabilizing and covering noncoring Huber needle device.

Use thumb and index finger of non-dominant hand to stabilize device. Use dominant hand to remove Huber needle with upward pull to engage needle safety feature. Apply pressure and tape with sterile gauze if bleeding.

Dispose of soiled supplies. Ensure safe environment. Return bed to lowest height with brakes locked and appropriate side rails up and call light/bell in reach. Wash hands per CDC guidelines.”

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