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This is the Vascular Access Procedure and Practice Guidelines for vascular access devices (VAD) incorporating NHS Greater Glasgow and Clyde (NHSGGC) adult (acute, mental health and community), paediatric and neonatal services. VADs are inserted for therapeutic purposes such as administration of intravenous (IV) fluids, medicines, blood transfusions and parenteral nutrition (PN). Other purposes for specific vascular access devices are renal dialysis, blood sampling and central venous pressure monitoring.
This document is organised with core introduction followed by care and maintenance templates. The information contained is based on current information available. Quality improvement, audit and research within clinical areas mean that this evidence base is constantly evolving. Practitioners should endeavour to use the most up-to-date evidence on which to base their practice.
The purpose of this guideline is to state the care and maintenance of the following VADs:
The detailed procedures for insertion of VADs are outside the scope of this guideline. Practitioners involved with insertion of VADs will be informed of where specific insertion procedure guidance can be found.
Patients with VADS are placed at increased risk of harm if not appropriately managed, for example healthcare associated infections and bloodstream infections are a significant cause of morbidity and mortality (NICE, 2014). Reports of mortality attributed to device related blood stream infections vary between 12.2% and 34.4% (Wong et al, 2016). VAD related bloodstream infections caused by inadequate device management significantly reduces the survival of patients in our care.
Patient harm can be reduced through:
This guideline is relevant to all NHSGGC health board staff that care for patients with a VAD.
This guideline should be used in conjunction with other relevant guidelines and standards:
Staff in specialist clinical areas caring for particularly vulnerable patient groups may have local standard operating procedures (SOP) in use which should be referred and adhered to.
Roles and responsibilities
For the care and maintenance of any VAD, staff should be appropriately trained and supervised until considered competent. A practitioner can be described as competent if they have had the necessary training, clinical experience, skills and knowledge to undertake a task safely and without supervision. If a practitioner deems it appropriate to adapt the guidelines, a risk assessment must be undertaken and documented appropriately.
Last reviewed: 20 December 2019
Next review: 31 August 2021
Author(s): Lynne Robertson
Approved By: Board Clinical Governance Forum