Introduction, purpose, scope, roles & responsibilities and consent

This is the clinical guideline for care and maintenance of vascular access devices (VADs) in paediatric services within NHS Ayrshire and Arran (NHSA&A). VADs are inserted for therapeutic purposes such as administration of intravenous (IV) fluids, medicines, biologics, blood transfusions, parenteral nutrition (PN) and cytotoxic drugs. Other purposes for specific VADs are renal dialysis, blood sampling and central or arterial pressure monitoring.  

This document is organised with core introduction followed by care and maintenance standard operating procedure (SOP) templates. These outline commonly used procedures with either a standard or surgical approach to Aseptic Non-Touch Technique (ANTT®). 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.  

Patients with VADS are placed at increased risk of harm if not appropriately managed, e.g. 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 15% and 30% (Hattori et al, 2018). VAD related bloodstream infections caused by inadequate device management significantly reduces the survival of patients in our care.   

Patient harm can be reduced through: 

• Trained and competent staff.
• Adherence to relevant policies and guidance.
• Underpinning knowledge of different VADs. 
• Good care and maintenance of VADs. 
• Appropriate use of care bundles and accurate documentation (e.g. PVC and CVAD care plans and device specific diaries) 
• Prevention, early recognition and management of complications.
• Inserting a VAD only when clinically indicated and removing at the earliest opportunity.
• Robust governance and regular audit of VAD related complications.

The purpose of this guideline is to state the care and maintenance required for the following VADs:

Peripheral devices:

• Peripheral venous cannula (PVC)
• Midline catheter.

Central venous catheters:

• Peripherally inserted central catheter (PICC)
• Non-tunnelled central venous catheter (ntCVC)
• Cuffed tunnelled central venous catheter (tCVC)
• Dialysis central venous catheter (DCVC)
  • Non-tunnelled dialysis central venous catheter (ntDCVC)
  • Tunnelled dialysis central venous catheter (tDCVC)
• Implanted port-a-cath.

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. 

This guideline is relevant to all health care practitioners that care for patients with a VAD within NHSA&A areas. This includes registered nurses and medical staff. This guideline should be used in conjunction with other relevant guidelines and SOPs. A list of appropriate guidelines is included near the end of this document.

To be involved in 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, following clinical risk assessment, a practitioner deems it appropriate to deviate from the guidelines; this must be clearly documented in the patient’s notes. 

Consent is required before healthcare practitioners undertake any care for a patient. This may be informal (verbal) or formal (written) for more complex procedures. The patient should be fully informed and provided with patient information leaflets when necessary.

In emergency situations, common law and duty of care reasoning allows healthcare practitioners to use clinical judgement as to whether the risks of delaying a procedure outweigh the need for formal consent. The healthcare practitioner must ensure that it is necessary, reasonable and proportionate.  

Children and young people: Those under 16 years have legal capacity to consent (or refuse) treatment on their own behalf, if they are deemed capable of understanding the nature and possible consequences of treatment.  A parent or legal guardian may consent to medical treatment if the child lacks decision-making capacity.