T.P.N/C.V.P. PROCEDURAL TRAY  923/16

INSTRUCTIONS FOR USE

 NOTE: Each stage of under-mentioned instructions is in strict chronological (consecutive) order, even when mentioned in the same sentence.

 SET UP/CONNECTION 

1. Prepare the patient for treatment, ensure that all equipment is within easy reach, and in good working order.

2. Check that the CVP kit is complete & undamaged, and that the seal is not torn or open.

3. Put on regular examination gloves (not included in the kit)

4. Remove the existing dressing, and examine the point of entry of the catheter:-

5. If there is a discharge, take a specimen and consult the physician.

6. Examine the stitches, if they have loosened, strengthen the catheter with an adhesive plaster, and inform the doctor.

                          IMPORTANT NOTE:  SOME TYPES OF CATHETER ARE SENSITIVE TO ALCOHOL AND/OR

                          ACETONE. CHECK THE TYPE OF CATHETER, AND TREAT ACCORDINGLY

7. If everything is in order, remove the latex gloves and open the CVP kit.

8. Fit a mask on patient, and then on yourself.

9. Don clean gloves from kit aseptically.

10. Clean the area thoroughly with Hydrogen Peroxide or other suitable cleansing solution, using the pads supplied in the kit.

11. Open the pack marked “ON”  in the kit 

12. Remove the gloves, and fit clean gloves (from kit) aseptically.

13. Secure the catheter by means of the “U-Plaster”

14. Spread the drape, with plastic surface facing downwards, to serve as sterile field.

15. Spread the fenestrated (slit) drape with plastic surface against the patient’s skin, and thread the catheter through the slit.

16. Before removing the existing “Heparin Lock”  clean it in a circular movement with PVP (Povidone Iodine) Prep Pad, then clean the connector, and then remove the existing Heparin Lock.

17. Using alcohol pads, clean, in circular movements, the exposed opening of the catheter to remove clotted/dried blood.

18. Suck up (vacuum) the Heparin in the catheter by means of the 5ml syringes.

19. Using the other 5ml syringes suck up (vacuum) and push to verify free flow in the tube.

20. Connect the catheter to the machine in regular method.

21. Place Gauze pad as a barrier between the skin and the kit.

22. Secure the tubing by means of the 10x2 cm adhesive strips.

REMOVAL

1. After dialysis procedure has been completed, put on regular examination gloves, and remove the pad and the 10x2 cm strips. (DO NOT REMOVE THE U-PLASTER !!)  Open the pack marked “OFF”

2. Fit the patient with mask, fit yourself with mask, remove the gloves you are wearing, and replace them with the sterile gloves supplied in the pack.

3. Replace the old/soiled sterile field from around the catheter with a clean one supplied in the kit, with plastic surface facing the patient’s skin.

4. Spread the new sterile field with plastic surface facing downwards.

5. Connect the needles to the syringes – needle size 18G to 10 cc syringe,

                               needle size 21G to 2 cc syringe.

6. Using a gauze sponge from the kit hold the container and clean the NaCl 0.9% (Saline) cover with the alcohol pad.

7. Using the same gauze sponge hold the container and fill both 10 cc syringes with NaCl 0.9% (Saline) (not included in kit)

8. Using a new gauze sponge from the kit hold the container and clean the Heparin Lock cover with the second Alcohol Pad.

9. Using the same gauze sponge hold the container and fill both 2 cc syringes with Heparin (not included in kit) according to the quantities indicated for the catheter.

10. Change the syringe needles and place them on the sterile field.

11. In circular movements, clean the area around the connection of Dialysis set with alcohol pad.

12. Disconnect the set, and if necessary clean the catheter edges with alcohol pad to remove clotted/dried blood, and connect the Heparin lock and secure it well.

13. Inject NaCl 0.9% (Saline) via the Heparin Lock, and then the Heparin. This procedure must be performed quickly; the catheter valve must be closed whilst there is still positive pressure from the injection, in order to prevent the Heparin from escaping via the inner edge of the catheter.

14. Remove the U-Plaster.

15. Clean & disinfect the skin surrounding the point of entry of the catheter "Exit Site".

16. Clean the skin around the catheter.  TAKE CARE IF THE CATHETER IS SENSITIVE TO ALCOHOL OR ACETONE.

17. If there is redness or infection, or soreness around the “exit” site, disinfect by means suitable medication.

18. Dry the skin around the catheter well. If the area is wet, use the gauze pads to    dry it.

19. Apply the Silvalpad™ around the exit site of the catheter, the brown color facing the skin.

20. Adhere the Eur-A-Fix™ island dressing plaster, placing the island dressing over the Silvalpad™, with the catheter tubes facing downwards. Adhere the tape securely to the skin to prevent penetration of water during washing.

21. Insert the two catheter connectors and the remaining tubes into the Diapouch™, placing the shorter edge of the bag facing the skin with the upper flap of the pouch over the Eur-A-Fix™.

22. Secure the skin color adhesive tape (the longer edge horizontally) with its center over the Diapouch™ flap. Ensure that the adhesive tape covers at least 2 centimeters of the Diapouch™ entrance, at the entry point of tubes. Secure adhesive tape well, to avoid penetration of water during washing.

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