|
Category 1 - Evaluation of medical prescription and medication label
|
| 1. Identify prescribed medications and infusion solutions and classify them according to their properties: vesicant, irritant, non-vesicant, and non-irritant. |
1.00 |
1.00 |
1.00 |
| 2. Check the order of infusion of medications, prioritizing the infusion of vesicant drugs first whenever possible. |
0.98 |
1.00 |
1.00 |
|
Category 2 - Puncture site assessment and device selection
|
| 3. Select a flexible PIVC of the smallest gauge and cannula that will accommodate the prescribed therapy. |
1.00 |
0,93 |
0.95 |
| 4. Utilize vascular visualization technology (near infrared, ultrasound) to increase first-attempt success in patients with difficult intravenous access. |
0.98 |
0.90 |
0.98 |
| 5. Discuss preference for site selection with the patient and/or caregiver, including recommendations for using sites on the nondominant side. |
1.00 |
0.95 |
0.98 |
| 6. Prefer veins from the dorsal and ventral surfaces of the forearms, such as the cephalic, basilic, median forearm and elbow. |
1.00 |
0.93 |
1.00 |
| 7. Do not puncture: painful areas, areas with compromised skin, open wounds and/or with inflammatory signs. |
1.00 |
1.00 |
0.95 |
| 8. Do not use the external jugular vein, veins in the lower extremities, visible veins in the chest, breast, abdomen or other locations on the trunk of the body. |
1.00 |
1.00 |
1.00 |
| 9. Perform venipuncture in upper limbs contralateral to lymphadenectomy or radiotherapy. |
1.00 |
1.00 |
1.00 |
| 10. Avoid venipuncture in an extremity with paralysis or hemiparesis and do not puncture the vessels of limbs with a functioning arteriovenous fistula. |
1.00 |
1.00 |
1.00 |
| 11. Use an appropriate method to promote vasodilation: use of controlled heating, gravity and prevention of venous flow with the use of a tourniquet. |
1.00 |
1.00 |
1.00 |
|
Category 3 - Procedure
|
| 12. Do not use an established PIVC punctured more than 24 hours before. |
1.00 |
0.98 |
0.98 |
| 13. Perform hand hygiene and maintain proper aseptic technique at all times when handling the PIVC. |
1.00 |
1.00 |
1.00 |
| 14. Perform skin antisepsis with an alcoholic antiseptic agent and wait for it to dry spontaneously before proceeding with the puncture. |
1.00 |
1.00 |
1.00 |
| 15. Remove with soap and water or 2 % chlorhexidine degerming agent if visible dirt is identified at the puncture site. |
1.00 |
0.98 |
0.98 |
| 16. Employ fear-reducing techniques whenever possible, which may include distraction. |
1.00 |
0.98 |
1.00 |
| 17. Provide a new PIVC device for each puncture attempt on the same patient. |
1.00 |
1.00 |
1.00 |
| 18. Use a pair of non-sterile gloves to insert the PIVC. |
1.00 |
1.00 |
1.00 |
| 19. Do not touch or palpate the insertion site after skin antisepsis. |
1.00 |
1.00 |
1.00 |
| 20. Restrict two puncture attempts per professional and four in total per patient. |
1.00 |
1.00 |
1.00 |
| 21. Use tourniquets that can be cleaned between patients. |
1.00 |
0.95 |
0.98 |
|
Category 4 - Fixation and stabilization
|
| 22. Apply a transparent, semipermeable sterile dressing that allows visual inspection and evaluation of the vascular access insertion site and does not exert pressure on or under the device. |
1.00 |
0.95 |
0.98 |
| 23. Assess the skin for potential risk of injury associated with fixation and due to age, joint movement, and presence of edema. |
1.00 |
0.98 |
0.98 |
| 24. Do not reintroduce a displaced PIVC into the vein. |
1.00 |
1.00 |
1.00 |
| 25. Replace dressing when damp, loose or visibly soiled. |
1.00 |
1.00 |
1.00 |
| 26. Record on the chart the catheter gauge, number of attempts, and the name of the professional responsible for insertion. |
1.00 |
1.00 |
1.00 |
|
Category 5 - Maintenance
|
| 27. Inspect the PIVC site regularly at each bedside visit by visual inspection and palpation to determine tenderness and identify potential complications early. |
1.00 |
1.00 |
1.00 |
| 28. Flush and aspirate to check blood return before each infusion. |
1.00 |
0.98 |
0.98 |
| 29. Infuse 20ml of 0.9 % saline solution before each medication administration. |
1.00 |
1.00 |
1.00 |
| 30. Use commercially available single-dose vials or pre-filled syringes for flushing and lock of the catheter. |
1.00 |
0.90 |
1.00 |
| 31. Disinfect the connection of each route, side injector and occluders with 70 % alcohol before administering the medication through the catheter. |
1.00 |
1.00 |
1.00 |
| 32. Use 10ml syringes for flushing. In case of resistance, evaluate possible factors (such as, for example, closed clamps or kinked extenders and infusion lines). |
1.00 |
1.00 |
1.00 |
| 33. Use positive pressure technique to minimize blood return to the PIVC lumen. |
1.00 |
0.98 |
1.00 |
| 34. Instruct the patient and/or companion on catheter maintenance care and warning signs that should be reported. |
1.00 |
1.00 |
1.00 |
| 35. Do not use an infusion pump to administer vesicant drugs. |
1.00 |
1.00 |
1.00 |
|
Category 6 - Removal and disposal
|
| 36. Remove the PIVC if contamination is suspected, or if complications or malfunctions occur. |
1.00 |
1.00 |
1.00 |
| 37. Apply firm pressure to the site after removing the cannula until hemostasis is achieved. |
1.00 |
1.00 |
1.00 |
| 38. Examine PIVC for integrity after removal and before disposal. |
1.00 |
1.00 |
1.00 |
| 39. Discard sharps immediately after puncture in a specific collector and discard flexible catheters along with the infusion circuit, without disconnecting them, in waste collector B. |
1.00 |
1.00 |
1.00 |
CONSTRUCTION AND VALIDATION OF CHECKLIST FOR SAFE MANAGEMENT OF PERIPHERAL INTRAVENOUS CATHETERS IN OUTPATIENT ANTINEOPLASTIC THERAPY