Non-tunnelled central venous catheter (ntCVC)

• PPE (minimal consideration disposable apron and gloves)
• Clean tray or trolley
• 10ml luer lock syringe (x1 per lumen)
• IV 0.9% sodium chloride (NaCl) (appropriate volume for patient and VAD)
• X2 21g safety hypodermic needle or 18G blunt filter needle
• 2% chlorhexidine in 70% isopropyl alcohol wipe/wand (0.5% chlorhexidine in 70% isopropyl alcohol is recommended as an alternative for babies less than 3 months old)
• Curos cap (disinfection cap) (x1 per lumen)
• Clinical waste bag
• Sharps bin.

• Explain the process to the child and parent and gain consent.
• Perform hand hygiene.
• Clean tray or trolley with disinfectant wipes.
• Perform hand hygiene.
• Apply PPE.
• Decontaminate neck of ampoule with 2% chlorhexidine and 70% alcohol wipe and allow to dry.  Using ANTT, draw up flush using 10ml syringe and hypodermic needle. Dispose of needle into sharps bin protect tip of syringe by placing onto sterile field or by placing in Micro Critical Field (sterile syringe packet).
• Ensure ntCVC is clamped.
• ‘Scrub the hub’ threads with the 2% chlorhexidine in 70% isopropyl alcohol wipe for 30 seconds. Allow to dry.
• If removing lock – using ANTT, attach an empty 10ml syringe, unclamp and gently aspirate 2-5mls of blood from the ntCVC. Reapply clamp and discard syringe.
• Using ANTT, attach 10ml syringe filled with 0.9% NaCl to the NFAD, unclamp lumen/catheter, pull back to ensure flashback is achieved (if appropriate), flush the catheter using a push/pause technique, maintaining positive pressure on the plunger of the syringe. Reapply clamp and detach syringe. Never flush if resistance felt.
• If lock is being used then administer lock following previous step. Check if lock is required in child’s care plan.
• Apply curos caps to lumen after use.
• Repeat procedure for all lumens.
• Check all sutures and dressing are in place and secure.
• Discard all disposable equipment.
• Remove PPE and discard as healthcare waste.
• Perform hand hygiene.

Record procedure and complete CVAD bundle.

• PPE (minimal consideration disposable apron and gloves)
• Clean tray or trolley
• Sterile gloves
• Sterile dressing pack
• 2% chlorhexidine in 70% isopropyl alcohol wipe/wand (0.5% chlorhexidine in 70% isopropyl alcohol is recommended as an alternative for babies less than 3 months old)
• Medical adhesive remover (if required)
• Sterile chlorhexidine impregnated semi permeable transparent dressing or sterile semi permeable transparent dressing and sterile chlorhexidine impregnated patch
• Sterile swab for culture (only if signs of infection)
• Clinical waste bag.

• Explain the process to the child and parent and gain consent.
• Perform hand hygiene.
• Clean tray or trolley with disinfectant wipes.
• Perform hand hygiene.
• Open dressing pack. Using ANTT, assemble sterile field and open all equipment onto sterile field.
• Perform hand hygiene.
• Apply PPE.
• Loosen and carefully remove the old dressing in an upward direction towards the exit site, taking care not to pull or dislodge the catheter. Medical adhesive remover can be used here to aid in the removal of the dressing.
• Inspect exit site and surrounding skin for signs of phlebitis or infection. Swab area if required.
• Discard gloves and apply sterile gloves.
• Place the sterile drape under the CVAD to create a sterile field
• Whilst holding the catheter with a sterile swab from the dressing pack, clean the exit site and surrounding skin with the 2% chlorhexidine in 70% isopropyl alcohol wipe/wand starting at the exit site, in a ‘circular’ pattern for 30 seconds before working outward to the periphery (an area slightly larger than the new dressing). Allow to dry for at least 30 seconds.
• Cover exit site with sterile chlorhexidine impregnated patch and apply sterile semi permeable dressing. Or apply sterile chlorhexidine impregnated semi permeable transparent dressing, ensuring good adherence to the skin.
• Discard all disposable equipment.
• Remove PPE and discard as healthcare waste.
• Perform hand hygiene.

Record procedure and complete CVAD bundle.

• PPE (minimal consideration disposable apron and gloves)
• Clean tray or trolley
• Sterile gloves
• Sterile dressing pack
• 2% chlorhexidine in 70% isopropyl alcohol wipe/wand (0.5% chlorhexidine in 70% isopropyl alcohol is recommended as an alternative for babies less than 3 months old)
• Medical adhesive remover (if required)
• NFAD (x1 per lumen)
• 10ml luer lock syringe (x1 per lumen)
• IV 0.9% sodium chloride (NaCl) (appropriate volume for patient and VAD)
• X2 21g safety hypodermic needle or 18G blunt filter needle
• Sterile chlorhexidine impregnated semi permeable transparent dressing or sterile semi permeable transparent dressing and sterile chlorhexidine impregnated patch
• Catheter lock (if required)
• Curos cap (disinfection cap) (x1 per lumen)
• Sterile swab for culture (only if signs of infection)
• Clinical waste bag
• Sharps bin

• Explain the process to the child and parent and gain consent.
• Perform hand hygiene.
• Clean tray or trolley with disinfectant wipes.
• Perform hand hygiene.
• Decontaminate neck of ampoule with 2% chlorhexidine and 70% alcohol wipe and allow to dry.  Using ANTT, draw up flush using 10ml syringe and hypodermic needle. Dispose of needle into sharps bin protect tip of syringe by placing onto sterile field or by placing in Micro Critical Field (sterile syringe packet) and place to the side.
• Open dressing pack. Using ANTT, assemble sterile field and open all equipment onto sterile field.
• Perform hand hygiene.
• Apply PPE.
• Loosen and carefully remove the old dressing in an upward direction towards the exit site, taking care not to pull or dislodge the catheter. Medical adhesive remover can be used here to aid in the removal of the dressing.
• Inspect exit site and surrounding skin for signs of phlebitis or infection. Swab area if required.
• Discard gloves and apply sterile gloves.
• Place the sterile drape under the CVAD to create a sterile field.
• Whilst holding the catheter with a sterile swab from the dressing pack, clean the exit site and surrounding skin with the 2% chlorhexidine in 70% isopropyl alcohol wipe/wand starting at the exit site, in a ‘circular’ pattern for 30 seconds before working outward to the periphery (an area slightly larger than the new dressing). Allow to dry for at least 30 seconds.
• Cover exit site with sterile chlorhexidine impregnated patch and apply sterile semi permeable dressing. Or apply sterile chlorhexidine impregnated semi permeable transparent dressing, ensuring good adherence to the skin.
• Remove needle free access device and discard. ‘Scrub the hub’ threads with the 2% chlorhexidine in 70% isopropyl alcohol wipe for 30 seconds. Allow to dry. Apply primed needle free access device.
• If removing lock – using ANTT, attach an empty 10ml syringe, unclamp and gently aspirate 2-5mls of blood from the ntCVC. Reapply clamp and discard syringe.
• Using ANTT, attach 10ml syringe filled with 0.9% NaCl to the NFAD, unclamp lumen/catheter, pull back to ensure flashback is achieved, flush the catheter using a push/pause technique, maintaining positive pressure on the plunger of the syringe. Reapply clamp and detach syringe. Never flush if resistance felt.
• If lock is being used then administer lock following previous step. Check if lock is required in child’s care plan.
• Apply curos caps to lumen after use.
• Repeat procedure for all lumens.
• Check all sutures holding the ntCVC are in place and secure.
• Discard all disposable equipment.
• Remove PPE and discard as healthcare waste.
• Perform hand hygiene.

Record procedure and complete CVAD bundle.

ntCVC removal should be considered when there is no longer a clinical need for the device, infection is suspected or a more permanent VAD is required.

• PPE (minimal consideration disposable apron and gloves)
• Clean tray or trolley
• Dressing pack
• Stitch cutter
• 2% chlorhexidine in 70% isopropyl alcohol wipe/wand (0.5% chlorhexidine in 70% isopropyl alcohol is recommended as an alternative for babies less than 3 months old)
• Sterile hydrocolloid dressing
• Clinical waste bag
• Sharps bin.

• Explain the process to the child and parent and gain consent. The explanation should include a description of timed inspiration and breath holding.
• Patient MUST BE in bed lying flat in a Trendelenburg (head-down-tilt) position unless contraindicated – seek advice.
• Open dressing pack. Using ANTT, assemble sterile field and open all equipment onto sterile field.
• Perform hand hygiene.
• Apply PPE.
• Loosen and carefully remove the old dressing in an upward direction towards the exit site, taking care not to pull or dislodge the catheter. Medical adhesive remover can be used here to aid in the removal of the dressing.
• Cleanse the exit site and surrounding skin with the 2% chlorhexidine in 70% isopropyl alcohol wipe/wand starting at the exit site, in a ‘circular’ pattern for 30 seconds before working outward to the periphery (an area slightly larger than the new dressing). Allow to dry for at least 30 seconds.
• Remove the securing sutures.
• Ask patient to hold their breath and perform a Valsalva Manoeuvre. If Valsalva cannot be performed, the catheter should be removed on expiration.
• ** Increasing the intra thoracic pressure is different in a spontaneous breathing patient and a patient receiving positive pressure ventilation. (please see specific instructions below).
• As the ntCVC is being withdrawn/removed, cover insertion site with a sterile swab from the dressing pack, applying gentle pressure at the insertion site as the catheter is being removed.
• Apply firm pressure immediately to insertion site until haemostasis is achieved.
• Cover the site with a hydrocolloid dressing, ensuring a good adherence of the dressing to the skin.
• After removal the ntCVC should be inspected for integrity, length and damage.
• Discard all disposable equipment.
• Remove PPE and discard as healthcare waste.
• Perform hand hygiene.
• Patients may then be returned to a comfortable position.

• Minimise activity for at least one hour post removal.
• Observe the patient’s PEWS/vital signs and observe limb closest to insertion site for signs of swelling and or pain.
• Dressing must remain in situ for a minimum of 24 hours following ntCVC removal and then dressed as required until site has healed.
• Record procedure and complete CVAD bundle.
• For femoral venous catheters: Nurse patient flat for 2 hours when possible. Apply pressure for at least 15 minutes. Ensure complete cessation of bleeding ensured prior to applying dressing. Do not allow hip flexion during this period.

Air embolism is a significant risk if procedure not followed. If suspected, turn patient left side, head down (Trendelenburg position), administer 100% oxygen via non rebreathing mask and call 2222.

** Spontaneous Breathing/Non-Ventilated Patients/Continuous Positive Airway Pressure (CPAP) only/Pressure Support Ventilation (PSV) or Non-Invasive Ventilation (when Pressure Support (PS) set at zero): In these situations, the removal must be timed with expiration (because the intra thoracic pressure is at its highest). Instruct the patient to hold their breath and where possible perform a Valsalva Manoeuvre. If Valsalva cannot be performed, the catheter should be removed on expiration.

** Patient receiving Positive Pressure Ventilation (fully ventilated) PSV or NIV (when PS is set higher than zero): In these situations, the removal must be timed with inspiration (because the intra thoracic pressure is at its highest).