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Learning Objectives ⬇

After completing this chapter, the reader will be able to:

Glossary ⬆ ⬇

Introduction ⬆ ⬇

The presence of a vascular access device (VAD) allows microorganisms direct access to the circulatory system, thus providing risk for the development of a bloodstream infection (BSI). In fact, the presence of a central vascular access device (CVAD) is the most common cause of BSIs. Today such infections are considered preventable. An understanding of infection concepts and terminology, the immune system, common causative organisms, and evidence-based practices shown to decrease infection risk is essential for the nurse providing infusion therapy.

There are also occupational hazards for the nurse who provides infusion therapy, such as exposure to blood-borne pathogens, needlestick injury, and exposure to hazardous drugs (HDs). In addition to protecting the patient from infection, nurses must be aware of such risks and protect themselves by adhering to important safety practices addressed in this chapter. The following organizations set standards or guidelines for infection prevention and health-care worker (HCW) safety:

Nursing Process ⬆ ⬇

The nursing process is a six-step process for problem solving that guides nursing action. See Chapter 1 for details on the steps of the nursing process related to vascular access. The following table focuses on nursing diagnoses, nursing outcomes classification (NOC), and nursing interventions classification (NIC) for infection control and risk management. Nursing diagnoses should be patient specific, and outcomes and interventions individualized. The NOC and NIC presented here are suggested directions for development of outcomes and interventions.

Nursing Diagnoses Related to Infection Control and SafetyNursing Outcomes Classification (NOC)Nursing Interventions Classification (NIC)
Infection risk for related to: Invasive procedure; impaired skin integrity; environmental exposure to pathogensRisk control: Infectious processInfection control; infection protection
Skin integrity impaired related to: External: interruption in barrier protection—venipunctureTissue integrity: SkinSkin care, skin surveillance, incisional (CVAD insertion site) site care
Ineffective protection related to: Immune system diseases, neoplasms, pharmaceutical preparations, treatment regimenHealth-promoting behavior; immune statusInfection prevention, infection protection

Sources: Ackley et al., 2020; Herdman et al., 2021.

Chapter Highlights ⬆ ⬇

References ⬆

PROCEDURES DISPLAY 2-1
Steps in Culturing Catheter-Skin Junction, Catheter, Infusate, and Blood

Delegation

This procedure should not be delegated. It is a registered nurse's responsibility to assess and apply critical thinking skills to obtain the necessary cultures.

ProcedureRationale

    1.Verify orders.

    1.A written order is a legal requirement.

    2.Introduce yourself to the patient.

    2.Establishes nurse-patient relationship

    3.Verify the patient's identity.

    3.Patient safety goal

    4.Perform hand hygiene.

    4.Infection prevention

    5.Explain procedure to patient.

    5.Prepares patient for procedure

Culture: Drainage present at catheter-skin junction
Follow steps 1-5 above

    6.Gather supplies: Clean gloves, culture tube, site care supplies.

    6.Preparation

    7.Don clean gloves.

    7.Standard precautions

    8.Remove dressing over IV site and discard appropriately according to organizational procedures.

    8.Soiled dressings are potentially infectious and must be discarded properly.

    9.Remove gloves and perform hand hygiene.

    9.Standard precautions; always perform hand hygiene between glove changes.

    10.Don another pair of clean gloves.

    11.Swab purulent drainage with a sterile swab and place swab into culture tube using aseptic technique.

    11.To obtain culture

    12.Recap the culture tube.

    13.Perform site care per organizational procedure if catheter is to be left in place.

    14.Remove gloves, perform hand hygiene, label culture tube with patient name, date and time, and source of culture.

    14.Ensures obtaining results from the correct patient

Culture: Catheter tip
Follow steps 1-5 above.

    15.Position patient in supine flat or Trendelenburg for CVAD catheter removal.

    15.Reduces the risk for air embolism during catheter removal.

    16.Gather supplies: Sterile gloves, culture tube, antiseptic solution, gauze dressing (occlusive dressing for central venous access device [CVAD] removal).

    16.Preparation

    17.Put on sterile gloves.

    17.Prevents transfer of skin pathogens onto catheter

    18.Cleanse skin at catheter exit site with antiseptic solution and allow to dry.

    18.To reduce the risk for microorganisms on the skin contaminating catheter during removal process

    19.Place sterile drape in proximity to catheter-skin junction.

    19.For placement of catheter on removal; to reduce risk for contaminating catheter, thus reducing risk for false-positive results

    20.Remove catheter. For patients with CVADs, ask patient to perform Valsalva's maneuver or exhale during procedure. Place occlusive dressing using petroleum-based ointment and gauze or a transparent semipermeable membrane (TSM) dressing to exit site immediately upon removal while carefully placing catheter on sterile drape, avoiding contact with surrounding skin. Pay special attention to reducing risk for air embolism with CVADs, including having patient remain in supine position for 30 minutes post-CVAD removal (see Chapter 9).

    20.To reduce risk for contaminating catheter; to reduce risk for air embolism; safe catheter removal

    21.Remove gloves and perform hand hygiene.

    21.Standard precautions; always perform hand hygiene between glove changes

    22.Put on second pair of sterile gloves.

    22.Standard precautions; maintain aseptic technique with catheter tip culture to reduce false-positive results

    23.Cut a 2-in. segment of CVAD catheter tip using sterile scissors; for short peripheral catheter, cut entire length of catheter from catheter hub.

    24.Uncap culture tube.

    25.Drop catheter segment into culture tube, maintaining aseptic technique.

    26.Recap the culture tube and label with patient's name, date and time, and specimen type.

    26.Ensures obtaining results from the correct patient

Culture: Infusate
Follow steps 1-5.

    27.Gather supplies: Gloves, syringe.

    27.Preparation

    28.Put on gloves.

    28.Standard precautions

    29.Disinfect injection port of infusate container with disinfectant (e.g., 70% alcohol, CHG/alcohol) for at least 15 seconds using a twisting motion and allow to dry.

    29.Prevent cross-contamination from port site

    30.Insert sterile needleless syringe into injection port of infusate bag.

    30.To obtain sterile sample of infusate

    31.Withdraw approximately 5 mL of infusate into syringe.

    31.Amount needed for culture

    32.Remove the syringe from the infusate container.

    33.Inject syringe contents into appropriate culture bottles.

    34.Label culture bottles with patient's name, date and time, and specimen type.

    34.Ensures obtaining results from the correct patient

Source: Infusion Nurses Society (2021).