1. Nurse Education Workforce Strategy – Gippsland Region Gippsland Oncology Nurses Group (GONG) Management of Central Venous Access Devices 2. HICKMAN CATHETER

2. TUTORIAL Management of Central Venous Access Devices HICKMAN CATHETER This Tutorial Hickman Description AdvantagesAdvantages / DisadvantagesDisadvantages Confirm Placement Principles of Care > AccessingAccessing > Syringe SizeSyringe Size > RemovalRemoval > FlushingFlushing > Heparin LockHeparin Lock > Cap/ Bung DescriptionCap/ Bung Description > Changing a Cap / BungChanging a Cap / Bung > Changing a DressingChanging a Dressing > Changing and IV lineChanging and IV line > Taking BloodTaking Blood > DocumentationDocumentation Complications > Blockage of lumenBlockage of lumen > InfectionInfection > ThrombosisThrombosis > DamageDamage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTIONINTRODUCTION 2. HICKMAN CATHETER 3. PORTPORT 4. PICCPICC Acknowledgements This project is an initiative of : Nurse Education Workforce Strategy –Gippsland Content supplied by: Gippsland Oncology Nurses Group (GONG)- an initiative of Gippsland Region Integrated Cancer Services (GRICS) Special thanks: Anny Byrne (Gippsland Regional Integrated Cancer Services) Anne Maree Day (West Gippsland HealthCare Group) Dianne Fahy (Nurse Education Workforce Strategy) Anne Johnson (Latrobe Regional Hospital) Linda Langskaill (Central Gippsland Health Service) Melanie Regan (Gippsland Regional Integrated Cancer Services) See other sources and references at the end of this presentation. Further reading is encouraged to complement these tutorials.

3. TUTORIAL Management of Central Venous Access Devices HICKMAN CATHETER This Tutorial Hickman Description AdvantagesAdvantages / DisadvantagesDisadvantages Confirm Placement Principles of Care > AccessingAccessing > Syringe SizeSyringe Size > RemovalRemoval > FlushingFlushing > Heparin LockHeparin Lock > Cap/ Bung DescriptionCap/ Bung Description > Changing a Cap / BungChanging a Cap / Bung > Changing a DressingChanging a Dressing > Changing and IV lineChanging and IV line > Taking BloodTaking Blood > DocumentationDocumentation Complications > Blockage of lumenBlockage of lumen > InfectionInfection > ThrombosisThrombosis > DamageDamage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTIONINTRODUCTION 2. HICKMAN CATHETER 3. PORTPORT 4. PICCPICC Scope of Tutorial What is a Hickman Catheter? List the advantages and disadvantages What care should be provided when changing a cap/bung? What is the strength of heparin lock used for a Hickman catheter? Describe how to flush in a ‘pulsatile’ manner What is the minimum size syringe used when accessing a Hickman Catheter? List the essentials for documentation What are the main complications with a Hickman Catheter and how to troubleshoot them?

4. TUTORIAL Management of Central Venous Access Devices HICKMAN CATHETER This Tutorial Hickman Description AdvantagesAdvantages / DisadvantagesDisadvantages Confirm Placement Principles of Care > AccessingAccessing > Syringe SizeSyringe Size > RemovalRemoval > FlushingFlushing > Heparin LockHeparin Lock > Cap/ Bung DescriptionCap/ Bung Description > Changing a Cap / BungChanging a Cap / Bung > Changing a DressingChanging a Dressing > Changing and IV lineChanging and IV line > Taking BloodTaking Blood > DocumentationDocumentation Complications > Blockage of lumenBlockage of lumen > InfectionInfection > ThrombosisThrombosis > DamageDamage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTIONINTRODUCTION 2. HICKMAN CATHETER 3. PORTPORT 4. PICCPICC Hickman Catheter - Description A Hickman Catheter is a tunnelled Central Venous Catheter. The tip of the Hickman Catheter resides in the Superior Vena Cava. The remaining lumen is tunnelled under the skin and exits the chest or abdominal wall. A cuff attached to the lumen adheres to the skin and tissues close to the exit site, which anchors the catheter. A Hickman catheter can consist of single, double or triple lumens. A Hickman catheter is used for intermediate and long term therapies usually in the haematology setting.

5. TUTORIAL Management of Central Venous Access Devices HICKMAN CATHETER This Tutorial Hickman Description AdvantagesAdvantages / DisadvantagesDisadvantages Confirm Placement Principles of Care > AccessingAccessing > Syringe SizeSyringe Size > RemovalRemoval > FlushingFlushing > Heparin LockHeparin Lock > Cap/ Bung DescriptionCap/ Bung Description > Changing a Cap / BungChanging a Cap / Bung > Changing a DressingChanging a Dressing > Changing and IV lineChanging and IV line > Taking BloodTaking Blood > DocumentationDocumentation Complications > Blockage of lumenBlockage of lumen > InfectionInfection > ThrombosisThrombosis > DamageDamage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTIONINTRODUCTION 2. HICKMAN CATHETER 3. PORTPORT 4. PICCPICC Hickman Catheter ADVANTAGES Large bore lumens Pain free when accessed Single, double or triple lumens for multiple infusions DISADVANTAGES High maintenance Altered body image Theatre for insertion / removal Increased risk of infection

6. TUTORIAL Management of Central Venous Access Devices HICKMAN CATHETER This Tutorial Hickman Description AdvantagesAdvantages / DisadvantagesDisadvantages Confirm Placement Principles of Care > AccessingAccessing > Syringe SizeSyringe Size > RemovalRemoval > FlushingFlushing > Heparin LockHeparin Lock > Cap/ Bung DescriptionCap/ Bung Description > Changing a Cap / BungChanging a Cap / Bung > Changing a DressingChanging a Dressing > Changing and IV lineChanging and IV line > Taking BloodTaking Blood > DocumentationDocumentation Complications > Blockage of lumenBlockage of lumen > InfectionInfection > ThrombosisThrombosis > DamageDamage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTIONINTRODUCTION 2. HICKMAN CATHETER 3. PORTPORT 4. PICCPICC Confirmation of placement Every time the Hickman Catheter is accessed, the nurse is responsible for confirming correct placement by: –Aspiration of blood –Ability to easily infuse solutions –Normal appearance of site and patient’s chest –Written x-ray report confirming correct placement of Hickman Catheter available in patient record If unable to confirm correct placement refer to the troubleshooting section of the GONG Cancer Care Guidelines ‘Hickman Catheter Management’ (see Resources)see Resources

7. TUTORIAL Management of Central Venous Access Devices HICKMAN CATHETER This Tutorial Hickman Description AdvantagesAdvantages / DisadvantagesDisadvantages Confirm Placement Principles of Care > AccessingAccessing > Syringe SizeSyringe Size > RemovalRemoval > FlushingFlushing > Heparin LockHeparin Lock > Cap/ Bung DescriptionCap/ Bung Description > Changing a Cap / BungChanging a Cap / Bung > Changing a DressingChanging a Dressing > Changing and IV lineChanging and IV line > Taking BloodTaking Blood > DocumentationDocumentation Complications > Blockage of lumenBlockage of lumen > InfectionInfection > ThrombosisThrombosis > DamageDamage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTIONINTRODUCTION 2. HICKMAN CATHETER 3. PORTPORT 4. PICCPICC Principles of Care Clamps are ESSENTIAL on Hickman catheters Must be left open when a positive pressure bung is in use Must be closed if a non- positive pressure bung is in use Must be closed when the system is opened i.e. cap/bung removed Non Positive Pressure Bung Positive Pressure Bung Note: Above is a sample of one type of bung currently available

8. TUTORIAL Management of Central Venous Access Devices HICKMAN CATHETER This Tutorial Hickman Description AdvantagesAdvantages / DisadvantagesDisadvantages Confirm Placement Principles of Care > AccessingAccessing > Syringe SizeSyringe Size > RemovalRemoval > FlushingFlushing > Heparin LockHeparin Lock > Cap/ Bung DescriptionCap/ Bung Description > Changing a Cap / BungChanging a Cap / Bung > Changing a DressingChanging a Dressing > Changing and IV lineChanging and IV line > Taking BloodTaking Blood > DocumentationDocumentation Complications > Blockage of lumenBlockage of lumen > InfectionInfection > ThrombosisThrombosis > DamageDamage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTIONINTRODUCTION 2. HICKMAN CATHETER 3. PORTPORT 4. PICCPICC Accessing A clean technique* is required for accessing a closed system through a cap/bung Aspirate for blood return to check patency and position Flush with 10 ml normal saline in a pulsatile manner when position confirmed Connect to IV line * Recommended clean technique: clean gloves and clean with 3 alcohol swabs and allow to air dry before proceeding to access a closed system

9. TUTORIAL Management of Central Venous Access Devices HICKMAN CATHETER This Tutorial Hickman Description AdvantagesAdvantages / DisadvantagesDisadvantages Confirm Placement Principles of Care > AccessingAccessing > Syringe SizeSyringe Size > RemovalRemoval > FlushingFlushing > Heparin LockHeparin Lock > Cap/ Bung DescriptionCap/ Bung Description > Changing a Cap / BungChanging a Cap / Bung > Changing a DressingChanging a Dressing > Changing and IV lineChanging and IV line > Taking BloodTaking Blood > DocumentationDocumentation Complications > Blockage of lumenBlockage of lumen > InfectionInfection > ThrombosisThrombosis > DamageDamage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTIONINTRODUCTION 2. HICKMAN CATHETER 3. PORTPORT 4. PICCPICC Syringe Size Syringes no smaller than 10 ml to be used Smaller syringes increase the pressure in the catheter wall and increase the risk of rupture of the catheter

10. TUTORIAL Management of Central Venous Access Devices HICKMAN CATHETER This Tutorial Hickman Description AdvantagesAdvantages / DisadvantagesDisadvantages Confirm Placement Principles of Care > AccessingAccessing > Syringe SizeSyringe Size > RemovalRemoval > FlushingFlushing > Heparin LockHeparin Lock > Cap/ Bung DescriptionCap/ Bung Description > Changing a Cap / BungChanging a Cap / Bung > Changing a DressingChanging a Dressing > Changing and IV lineChanging and IV line > Taking BloodTaking Blood > DocumentationDocumentation Complications > Blockage of lumenBlockage of lumen > InfectionInfection > ThrombosisThrombosis > DamageDamage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTIONINTRODUCTION 2. HICKMAN CATHETER 3. PORTPORT 4. PICCPICC Catheter Removal Only to be performed by a doctor in a hospital setting

11. TUTORIAL Management of Central Venous Access Devices HICKMAN CATHETER This Tutorial Hickman Description AdvantagesAdvantages / DisadvantagesDisadvantages Confirm Placement Principles of Care > AccessingAccessing > Syringe SizeSyringe Size > RemovalRemoval > FlushingFlushing > Heparin LockHeparin Lock > Cap/ Bung DescriptionCap/ Bung Description > Changing a Cap / BungChanging a Cap / Bung > Changing a DressingChanging a Dressing > Changing and IV lineChanging and IV line > Taking BloodTaking Blood > DocumentationDocumentation Complications > Blockage of lumenBlockage of lumen > InfectionInfection > ThrombosisThrombosis > DamageDamage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTIONINTRODUCTION 2. HICKMAN CATHETER 3. PORTPORT 4. PICCPICC Flushing Flush with Normal Saline 10 ml in a pulsatile (stop/start) manner: that is, push then pause the plunger of 10ml syringe continuously in short bursts until syringe empty On accessing the Hickman Catheter to determine patency Before and after drug administration After blood sampling Weekly, when not in use

12. TUTORIAL Management of Central Venous Access Devices HICKMAN CATHETER This Tutorial Hickman Description AdvantagesAdvantages / DisadvantagesDisadvantages Confirm Placement Principles of Care > AccessingAccessing > Syringe SizeSyringe Size > RemovalRemoval > FlushingFlushing > Heparin LockHeparin Lock > Cap/ Bung DescriptionCap/ Bung Description > Changing a Cap / BungChanging a Cap / Bung > Changing a DressingChanging a Dressing > Changing and IV lineChanging and IV line > Taking BloodTaking Blood > DocumentationDocumentation Complications > Blockage of lumenBlockage of lumen > InfectionInfection > ThrombosisThrombosis > DamageDamage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTIONINTRODUCTION 2. HICKMAN CATHETER 3. PORTPORT 4. PICCPICC Heparin Lock Weak heparin lock (heparinization) 50u/s in 5ml is all that is required –After each use, and weekly, when a non-positive pressure bung is in use * Remember never use a syringe smaller than a 10ml

13. TUTORIAL Management of Central Venous Access Devices HICKMAN CATHETER This Tutorial Hickman Description AdvantagesAdvantages / DisadvantagesDisadvantages Confirm Placement Principles of Care > AccessingAccessing > Syringe SizeSyringe Size > RemovalRemoval > FlushingFlushing > Heparin LockHeparin Lock > Cap/ Bung DescriptionCap/ Bung Description > Changing a Cap / BungChanging a Cap / Bung > Changing a DressingChanging a Dressing > Changing and IV lineChanging and IV line > Taking BloodTaking Blood > DocumentationDocumentation Complications > Blockage of lumenBlockage of lumen > InfectionInfection > ThrombosisThrombosis > DamageDamage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTIONINTRODUCTION 2. HICKMAN CATHETER 3. PORTPORT 4. PICCPICC Cap / Bung Description The positive pressure bung maintains a positive pressure in the line to prevent back flow of blood into the end of the catheter. A positive pressure bung should be used with a Hickman Catheter. If a positive pressure bung is unavailable then use a non positive pressure bung and weak heparinization is required. Non Positive Pressure Bung Positive Pressure Bung Note: Above is a sample of one type of bung currently available

14. TUTORIAL Management of Central Venous Access Devices HICKMAN CATHETER This Tutorial Hickman Description AdvantagesAdvantages / DisadvantagesDisadvantages Confirm Placement Principles of Care > AccessingAccessing > Syringe SizeSyringe Size > RemovalRemoval > FlushingFlushing > Heparin LockHeparin Lock > Cap/ Bung DescriptionCap/ Bung Description > Changing a Cap / BungChanging a Cap / Bung > Changing a DressingChanging a Dressing > Changing and IV lineChanging and IV line > Taking BloodTaking Blood > DocumentationDocumentation Complications > Blockage of lumenBlockage of lumen > InfectionInfection > ThrombosisThrombosis > DamageDamage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTIONINTRODUCTION 2. HICKMAN CATHETER 3. PORTPORT 4. PICCPICC Changing a Cap / Bung Aseptic technique required using a sterile tray and sterile gloves Positive pressure cap/bung should always be insitu and must be changed at least every 7 days Clamp line before removing cap/bung

15. TUTORIAL Management of Central Venous Access Devices HICKMAN CATHETER This Tutorial Hickman Description AdvantagesAdvantages / DisadvantagesDisadvantages Confirm Placement Principles of Care > AccessingAccessing > Syringe SizeSyringe Size > RemovalRemoval > FlushingFlushing > Heparin LockHeparin Lock > Cap/ Bung DescriptionCap/ Bung Description > Changing a Cap / BungChanging a Cap / Bung > Changing a DressingChanging a Dressing > Changing and IV lineChanging and IV line > Taking BloodTaking Blood > DocumentationDocumentation Complications > Blockage of lumenBlockage of lumen > InfectionInfection > ThrombosisThrombosis > DamageDamage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTIONINTRODUCTION 2. HICKMAN CATHETER 3. PORTPORT 4. PICCPICC Changing a dressing Always use an aseptic technique Initial dressing should be changed 24 hours post insertion Dressing should be changed every 7 days or earlier if necessary Dressing usually not required 21 days post insertion Entry site may be left uncovered when healed

16. TUTORIAL Management of Central Venous Access Devices HICKMAN CATHETER This Tutorial Hickman Description AdvantagesAdvantages / DisadvantagesDisadvantages Confirm Placement Principles of Care > AccessingAccessing > Syringe SizeSyringe Size > RemovalRemoval > FlushingFlushing > Heparin LockHeparin Lock > Cap/ Bung DescriptionCap/ Bung Description > Changing a Cap / BungChanging a Cap / Bung > Changing a DressingChanging a Dressing > Changing and IV lineChanging and IV line > Taking BloodTaking Blood > DocumentationDocumentation Complications > Blockage of lumenBlockage of lumen > InfectionInfection > ThrombosisThrombosis > DamageDamage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTIONINTRODUCTION 2. HICKMAN CATHETER 3. PORTPORT 4. PICCPICC Changing an IV Line A clean technique* is required when the system is closed ie. bung is in place Continuous IV infusion line is changed every 72 hours For intermittent IV infusion, change line with each infusion Change IV TPN/Lipid line every 24 hours Blood product infusion sets changed to an IV infusion set on completion of the blood product infusion *Recommended clean technique: clean gloves and clean with 3 alcohol swabs and allow to air dry before proceeding to access a closed system

17. TUTORIAL Management of Central Venous Access Devices HICKMAN CATHETER This Tutorial Hickman Description AdvantagesAdvantages / DisadvantagesDisadvantages Confirm Placement Principles of Care > AccessingAccessing > Syringe SizeSyringe Size > RemovalRemoval > FlushingFlushing > Heparin LockHeparin Lock > Cap/ Bung DescriptionCap/ Bung Description > Changing a Cap / BungChanging a Cap / Bung > Changing a DressingChanging a Dressing > Changing and IV lineChanging and IV line > Taking BloodTaking Blood > DocumentationDocumentation Complications > Blockage of lumenBlockage of lumen > InfectionInfection > ThrombosisThrombosis > DamageDamage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTIONINTRODUCTION 2. HICKMAN CATHETER 3. PORTPORT 4. PICCPICC Taking Blood Perform initial flush to determine patency (except for blood cultures) Discard the first 5ml of blood withdrawn before collecting sample When taking blood cultures do not perform initial flush to determine patency, do not discard a sample. Retain initial sample for blood culture Flush Hickman Catheter, in a pulsatile manner, with 20ml of Normal Saline after blood sampling and continue with treatment as ordered and / or heparinization if required

18. TUTORIAL Management of Central Venous Access Devices HICKMAN CATHETER This Tutorial Hickman Description AdvantagesAdvantages / DisadvantagesDisadvantages Confirm Placement Principles of Care > AccessingAccessing > Syringe SizeSyringe Size > RemovalRemoval > FlushingFlushing > Heparin LockHeparin Lock > Cap/ Bung DescriptionCap/ Bung Description > Changing a Cap / BungChanging a Cap / Bung > Changing a DressingChanging a Dressing > Changing and IV lineChanging and IV line > Taking BloodTaking Blood > DocumentationDocumentation Complications > Blockage of lumenBlockage of lumen > InfectionInfection > ThrombosisThrombosis > DamageDamage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTIONINTRODUCTION 2. HICKMAN CATHETER 3. PORTPORT 4. PICCPICC Documentation Clear, consistent documentation is essential after each treatment or shift. This should include: Ability to confirm placement Medications and flushes administered Strength of heparinization (if used) Type of bung/cap used Dressing change Signs and symptoms of infection or thrombosis Troubleshooting *Written x-ray report confirming correct placement at time of insertion should be available in patient documentation

19. TUTORIAL Management of Central Venous Access Devices HICKMAN CATHETER This Tutorial Hickman Description AdvantagesAdvantages / DisadvantagesDisadvantages Confirm Placement Principles of Care > AccessingAccessing > Syringe SizeSyringe Size > RemovalRemoval > FlushingFlushing > Heparin LockHeparin Lock > Cap/ Bung DescriptionCap/ Bung Description > Changing a Cap / BungChanging a Cap / Bung > Changing a DressingChanging a Dressing > Changing and IV lineChanging and IV line > Taking BloodTaking Blood > DocumentationDocumentation Complications > Blockage of lumenBlockage of lumen > InfectionInfection > ThrombosisThrombosis > DamageDamage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTIONINTRODUCTION 2. HICKMAN CATHETER 3. PORTPORT 4. PICCPICC Complications 1.Blockage of lumens 2.Infection at insertion site or in catheter 3.Thrombosis 4.Damage to exposed catheter

20. TUTORIAL Management of Central Venous Access Devices HICKMAN CATHETER This Tutorial Hickman Description AdvantagesAdvantages / DisadvantagesDisadvantages Confirm Placement Principles of Care > AccessingAccessing > Syringe SizeSyringe Size > RemovalRemoval > FlushingFlushing > Heparin LockHeparin Lock > Cap/ Bung DescriptionCap/ Bung Description > Changing a Cap / BungChanging a Cap / Bung > Changing a DressingChanging a Dressing > Changing and IV lineChanging and IV line > Taking BloodTaking Blood > DocumentationDocumentation Complications > Blockage of lumenBlockage of lumen > InfectionInfection > ThrombosisThrombosis > DamageDamage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTIONINTRODUCTION 2. HICKMAN CATHETER 3. PORTPORT 4. PICCPICC 1. Blockage of lumen Difficulty flushing and/or aspirating blood Ensure any clamps are open Change position of patient Change cap or bung

21. TUTORIAL Management of Central Venous Access Devices HICKMAN CATHETER This Tutorial Hickman Description AdvantagesAdvantages / DisadvantagesDisadvantages Confirm Placement Principles of Care > AccessingAccessing > Syringe SizeSyringe Size > RemovalRemoval > FlushingFlushing > Heparin LockHeparin Lock > Cap/ Bung DescriptionCap/ Bung Description > Changing a Cap / BungChanging a Cap / Bung > Changing a DressingChanging a Dressing > Changing and IV lineChanging and IV line > Taking BloodTaking Blood > DocumentationDocumentation Complications > Blockage of lumenBlockage of lumen > InfectionInfection > ThrombosisThrombosis > DamageDamage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTIONINTRODUCTION 2. HICKMAN CATHETER 3. PORTPORT 4. PICCPICC 2. Infection Redness, discharge, tenderness, heat, patient feels unwell, pain and swelling at Hickman Catheter site may be symptoms of infection If signs of infection are present do not access Hickman Catheter and consult physician Septic shower may occur immediately after flushing due to infection in the line. There may be an absence of obvious infection at entry site, however the patient will experience rigors and generally feel unwell. Consult physician

22. TUTORIAL Management of Central Venous Access Devices HICKMAN CATHETER This Tutorial Hickman Description AdvantagesAdvantages / DisadvantagesDisadvantages Confirm Placement Principles of Care > AccessingAccessing > Syringe SizeSyringe Size > RemovalRemoval > FlushingFlushing > Heparin LockHeparin Lock > Cap/ Bung DescriptionCap/ Bung Description > Changing a Cap / BungChanging a Cap / Bung > Changing a DressingChanging a Dressing > Changing and IV lineChanging and IV line > Taking BloodTaking Blood > DocumentationDocumentation Complications > Blockage of lumenBlockage of lumen > InfectionInfection > ThrombosisThrombosis > DamageDamage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTIONINTRODUCTION 2. HICKMAN CATHETER 3. PORTPORT 4. PICCPICC 3. Thrombosis Do not access Hickman Catheter and consult physician

23. TUTORIAL Management of Central Venous Access Devices HICKMAN CATHETER This Tutorial Hickman Description AdvantagesAdvantages / DisadvantagesDisadvantages Confirm Placement Principles of Care > AccessingAccessing > Syringe SizeSyringe Size > RemovalRemoval > FlushingFlushing > Heparin LockHeparin Lock > Cap/ Bung DescriptionCap/ Bung Description > Changing a Cap / BungChanging a Cap / Bung > Changing a DressingChanging a Dressing > Changing and IV lineChanging and IV line > Taking BloodTaking Blood > DocumentationDocumentation Complications > Blockage of lumenBlockage of lumen > InfectionInfection > ThrombosisThrombosis > DamageDamage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTIONINTRODUCTION 2. HICKMAN CATHETER 3. PORTPORT 4. PICCPICC 4. Damage to exposed catheter Check catheter every time it is accessed for: –Perishing, splitting, damage and if the cap is firmly in place –Refer to physician if integrity is compromised –This is more common in children

24. TUTORIAL Management of Central Venous Access Devices HICKMAN CATHETER This Tutorial Hickman Description AdvantagesAdvantages / DisadvantagesDisadvantages Confirm Placement Principles of Care > AccessingAccessing > Syringe SizeSyringe Size > RemovalRemoval > FlushingFlushing > Heparin LockHeparin Lock > Cap/ Bung DescriptionCap/ Bung Description > Changing a Cap / BungChanging a Cap / Bung > Changing a DressingChanging a Dressing > Changing and IV lineChanging and IV line > Taking BloodTaking Blood > DocumentationDocumentation Complications > Blockage of lumenBlockage of lumen > InfectionInfection > ThrombosisThrombosis > DamageDamage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTIONINTRODUCTION 2. HICKMAN CATHETER 3. PORTPORT 4. PICCPICC Resources GONG Cancer Care Guidelines have been accepted to guide the management of all patients with a CVAD in Gippsland and are available at each Gippsland Health Service. Also available on-line at: www.gha.net.au/grics www.gha.net.au/grics

25. TUTORIAL Management of Central Venous Access Devices HICKMAN CATHETER This Tutorial Hickman Description AdvantagesAdvantages / DisadvantagesDisadvantages Confirm Placement Principles of Care > AccessingAccessing > Syringe SizeSyringe Size > RemovalRemoval > FlushingFlushing > Heparin LockHeparin Lock > Cap/ Bung DescriptionCap/ Bung Description > Changing a Cap / BungChanging a Cap / Bung > Changing a DressingChanging a Dressing > Changing and IV lineChanging and IV line > Taking BloodTaking Blood > DocumentationDocumentation Complications > Blockage of lumenBlockage of lumen > InfectionInfection > ThrombosisThrombosis > DamageDamage Resources GONG Products CVAD TUTORIAL SERIES 1. INTRODUCTIONINTRODUCTION 2. HICKMAN CATHETER 3. PORTPORT 4. PICCPICC GONG Products www.gha.net.au/grics