Fresenius central venous catheter (CVC) skills validation with complete solutions

A: Dressing change step 1 Place a pad under catheter limbs applies appropriate PPE to self staff and care partner A: Dressing change step 2 Inspects in removes the old dressing observes dressing and exit site for visible soiling, exudate, blood or signs or symptoms of infection A: Dressing change step 3 Notifies nurse or physician if signs or symptoms of infection, change in position of catheter, visible soiling with exudate or blood are present A: Dressing change step 4 Discard stressing and removes gloves. Performs hand hygiene and opens dressing supplies. Leaves and package until ready for use B: Cleaning the site step 1 Performs hand hygiene and dons clean gloves. Removes swab stick from package by stick without touching foam applicator. Handles only to stick portion B: Cleaning the site step 2 Starting at the CVC exit site and working outward to the periphery using gentle friction and back-and-forth motion to clean for 30 seconds B: Cleaning the site step 3 If unable to use CHG due to skin sensitivity, uses another approved disinfectant B: Cleaning the site step 4 If ordered, applies perscribed antibiotic ointment to exit site C: Applying the dressing step 1 Using a aseptic technique, applies the catheter dressing over DRY exit site C: Applying the dressing step 2 Removes backing of adhesive dressing or applies tape to edges of gauze dressing C: Applying the dressing step 3 Discards gloves and performs hand hygiene. Documents dressing change and findings D: Initiation of treatment/preparing catheter Part 1 Dons clean gloves and ensures catheter clamps are closed. (HT staff place sterile gauze under catheter lumens) D: Initiation of treatment/preparing catheter step 2 Removes cap from arterial limb. Uses an alcohol pad to scrub the exposed catheter threads with friction and moves from threads up lumen towards body of catheter For 10 to 15 seconds. Discards alcohol pad. Allows alcohol to dry. Attaches 10 ml sterile syringe to catheter lumen. Repeats for Venus limb. D: Initiation of treatment/preparing catheter step 3 Unclamps arterial limb, removes anticoagulant by aspirating 5 ml, reclamps catheter lumen. Repeat with venous limb. Collects pre-treatment blood work if ordered D: Initiation of treatment/ preparing catheter step 4 Aseptically removes syringe from arterial limb, immediately attaches 10 ml saline filled syringe, opens clamp and gently flushes limb, reclamps catheter lumen. Repeats with venous limb D: Initiation of treatment/ preparing catheter step 5 Administers pre-treatment heparin if ordered by physician via the venous catheter limb. Leaves syringe attached and waits 3 to 5 minutes for systematic circulation D: Initiation of treatment/ preparing catheter step 6 Refreshes the prime (50 arterial side, 250 venous side) and ensure system is free of air according to policy double clamp sailing line. Visually inspect system and ensures unused administration lines are clamped. E: Treatment initiation/connecting the bloodlines step 1 Aseptically connects the arterial blood line to the arterial catheter limb and the venous blood line to the venous catheter limb policy E: Treatment initiation/connecting the bloodlines step 2 Attaches approved safety device (hemo clip) as required to venous blood line and venous catheter connection E: Treatment initiation/connecting the bloodlines step 3 Secures bloodlines to patients clothing with tape or plastic occlusion clamp F: Treatment initiation/starting hemodialysis step 1 Opens clamps on arterial and venous blood lines and catheter limbs F: Treatment initiation/starting hemodialysis step 2 Starts the blood pump and increases the blood flow slowly. Observes venous and arterial pressure readings; Increases blood pump speed to the rate prescribed by the physician to achieve optimal clearances F: Initiation of treatment/starting hemodialysis step 3 Activates additional prescribed treatment parameters, i.e. UF profile, heparin pump, etc. F: Treatment initiation starting hemodialysis step 4 Obtains vital signs. Discards gloves and performs hand hygiene G: Treatment termination/ preparation step one Check's volume of each catheter limb, draws a heparin or other locking solution as prescribed G: Treatment termination/preparation step 2 Ensures 300 ml of saline remains in bag H: Treatment termination/returning blood step 1 Stops blood pump H: Treatment termination/returning blood step 2 Moves the hemostat to arterial line above saline "T", opens saline clamps and uses gravity to return blood till pale pink H: Treatment termination/returning blood step 3 Closes arterial bloodline and arterial catheter limb clamps H: Treatment termination/returning blood step 4 Moves the plastic hemostat clamp from above the saline "T" to below the saline "T". Opens clamps on venous line and limb H: Treatment termineation returning blood step 5 Starts the blood pump and increases pump speed to 150-200 ml/min while observing patient and machine carefully H: Treatment Termination/returning blood step 6 Pinches and releases tubing to return venous segment, stops pump and closes venous line and venous catheter limb clamps I: Treatment termination/disinfection of catheter connections step 1 Obtains vital signs, discards gloves, performs hand hygiene, dons clean gloves I: Treatment termination/disinfection of catheter step 2 Verifies bloodlines and catheter lumens are clamped; removes and discards hemaclip from venous catheter limb and bloodline I: Treatment termination/disinfection of catheter step 3 Disconnects the arterial bloodline from the catheter limb and uses an alcohol pad to scrub the exposed catheter threads and end the of hub thoroughly with friction 10-15 seconds. Allows alcohol to dry while holding catheter limb, Attaches hub to 10 ml saline filled sterile syringe to catheter lumen, repeat on venous limb J: Treatment termination/preparing catheter for patient discharge step 1 Opens the arterial catheter limb clamp, and flushes limb with saline. Closes the catheter clamp. Repeat on venous side J: Treatment termination/preparing catheter for patient discharge step 2 Removes empty saline syringe from a catheter limb and immediately attaches the heparin or other prescribe blocking agent filled syringe, repeat on venous side J: Treatment termination/preparing catheter for patient discharge step 3 Opens catheter limb clamp and gently flushes limb with heparin or other prescribe locking agent. Closes the catheter clamp. Repeat on venous side J: Treatment termination/preparing catheter for patient discharge step 4 Applies a sterile cap on the end of the lumen maintaining a aseptic technique. Tightens the ends securely. Repeat on venous side