ICS Ltd. Management of Percutaneous Devices - Established Percutaneous Lines

Page updated 30 April 2007

Management of Established Percutaneous Lines

Staff managing percutaneous devices must be appropriately trained.
Effective handwashing and a meticulous no-touch aseptic technique is vital when handling percutaneous devices. Gloves should be worn but these need not be sterile except where intra-arterial or intra-thecal devices are concerned. Non-sterile gloves can be decontaminated by alcohol gel before touching a site.
Interruptions to the closed system should be kept to a minimum.
Use membranes to deliver injections if possible rather than stopcocks.
Clean membranes, stopcocks and taps with alcohol (eg Sterets) before breaking a connection. (Aqueous or alcoholic chlorhexidine or alcoholic betadine may also be used.)
Change administration sets as follows:
Blood products: immediately on completion of each transfusion or every 24 hours, whichever is the sooner.
TPN: immediately on completion of each bag of infusion or every 24 hours, whichever is the sooner.
Clear IV fluids/drugs: no more frequently than every 72 hours unless clinically indicated.
Consider the use of filters in regularly accessed lines.
If an administration set is disconnected it must always be replaced with a new line and never re-connected.
Percutaneous sites must be inspected regularly - see below for frequency.
Signs of local infection at exit sites as well as systemic infection must be taken seriously and referred to medical staff. Management depends on the device used: see below.

Use a separate, dedicated administration set and do not use this for anything other than the blood product in question.
Change administration set on completion of each transfusion or every 24 hours, whichever is the sooner.

Use a dedicated lumen and do not use this lumen to give anything other than TPN.
Do not attach three-way taps.
Change administration set immediately on completion of each bag of infusion or every 24 hours, whichever is the sooner.
Type of device depends on the duration of therapy and the concentration of TPN given. Peripheral cannulas may be used for short term nutritional support but the cannula must be changed every 24 hours. A midline catheter may be used for up to 4 weeks. Longer periods of nutritional support require a central venous catheter.