Peripheral venous catheter (PVC)

NHS Ayrshire & Arran guidelines
NHS Ayrshire and Arran

PVC patency assessment and flush (using a standard ANTT® approach)

Statement The PVC site and patency must be assessed for signs of complications to reduce patient harm.
Equipment requirements
  • PPE (minimal consideration disposable apron and gloves)
  • Clean tray
  • 10ml luer lock syringe (x1 per lumen)
  • IV 0.9% sodium chloride (NaCl) (appropriate volume for patient and VAD)
  • 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)
  • Clinical waste bag
  • Sharps bin.
Timing

The continuing need for a PVC should be reviewed daily. 

PVC check is done once daily and documented on the PVC bundle.

The flush should be a minimum of once per day; before and after medicine administration.
Procedure
  • Explain the process to the child and parent and gain consent.
  • 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 and protect tip of syringe by placing in Micro Critical Field (sterile syringe packet).
  • Perform hand hygiene.
  • Apply PPE.
  • ‘Scrub the hub’ of the NFAD for at least 30 seconds using 2% chlorhexidine and 70% alcohol and allow to dry.
  • Using ANTT, access PVC via the NFAD using prepared syringe. Unclamp NFAD and flush the PVC using a turbulent push/pause technique, clamp NFAD whilst maintaining positive pressure.
  • The flush should be administered with ease. If there are signs of resistance, infiltration, extravasation or inflammation discontinue flushing process and consider replacing the PVC.
  • Repeat for each lumen if required.
  • Discard all disposable equipment.
  • Remove PPE and discard as healthcare waste.
  • Perform hand hygiene.
The PVC top port should only be used in emergency situations as it cannot be adequately decontaminated due to the design of the device.  Immediately following PVC insertion, the top port is sterile and can be used to administer time critical medications. Top ports should never be used for administration of systemic anti-cancer therapies (SACT). 
Aftercare

Record procedure and complete PVC bundle.

Ensure VAD is positioned correctly to ensure skin health is maintained.

PVC dressing change (using a standard ANTT® approach)

Statement The PVC is secured with an appropriate sterile dressing, whilst allowing for inspection of the insertion point.
Requirements
  • PPE (minimal consideration disposable apron and gloves)
  • Clean tray
  • 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)
  • Appropriate sterile semi permeable transparent dressing
  • Medical adhesive remover (if required)
  • Sterile swab for culture (only if signs of infection)
  • Clinical waste bag.
Timing

As required, if dressing is visibly loose or soiled.

Every 7 days if it is clinically indicated that PVC is required to remain in situ and no signs of phlebitis or infection.
Procedure
  • Explain the process to the child and parent and gain consent.
  • Perform hand hygiene.
  • Apply PPE.
  • Loosen and carefully remove the old dressing in an upward direction towards the puncture site, taking care not to pull or dislodge the PVC. 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.
  • Replace gloves if heavily contaminated with body fluids.
  • Using ANTT, cleanse area, starting at the entry site, using 2% chlorhexidine and 70% isopropyl alcohol in a ‘circular’ pattern and allow to dry for at least 30 seconds.
  • Inspect entry point and surrounding skin for signs of phlebitis or infection.
  • Apply sterile device stabilising strips and dressing ensuring adherence.
  • Discard all disposable equipment.
  • Remove PPE and discard as healthcare waste.
  • Perform hand hygiene.
Aftercare

Record procedure and complete PVC bundle.

Ensure VAD is positioned correctly to ensure skin health is maintained.

PVC removal (using a standard ANTT® approach)

Statement The need for a PVC is assessed on a daily basis and should be removed as soon as it is no longer required.
Requirements
  • PPE (minimal consideration disposable apron and gloves)
  • Clean tray
  • Sterile gauze swabs
  • Sterile adhesive dressing (check allergies)
  • Medical adhesive remover (if required)
  • Clinical waste bag.
Procedure
  • Explain the process to the child and parent and gain consent.
  • Perform hand hygiene.
  • Stop all fluids being infused via the PVC and disconnect administration set (if applicable).
  • Perform hand hygiene.
  • Apply PPE.
  • Carefully remove the PVC dressing. Medical adhesive remover can be used here to aid in the removal of the dressing.
  • Hold a piece of sterile, dry cotton gauze over the insertion site and remove the PVC.
  • Apply firm pressure immediately to insertion site for approximately 2-3 minutes or long enough to ensure that there is no bleeding.
  • After removal, the PVC should be inspected for integrity and damage.
  • Apply a sterile adhesive dressing to the insertion site, checking for any allergies.
  • Discard all disposable equipment.
  • Remove PPE and discard as healthcare waste.
  • Perform hand hygiene.
Aftercare Record procedure and complete PVC bundle.