National Neonatal Surgical Benchmarking Group

Care and maintainence of a neonatal central venous line placed in theatre (2012)

Practitioner agreed patient focused outcome:
Optimal care and management of central venous lines will be achieved by utilising an evidence based, family centred collaborative team approach.
Ref: Larson et al (2010) Vascular access, Surgical treatment. Emedicine. http://emedicine.medscape.com/article/1018395-overview
Indicators / information that highlights concerns which may trigger the need for benchmarking activity:
Patient satisfaction surveys.
Complaints figures and analysis.
Critical incident analysis.
Documentation audit. / Research critique / trial.
FACTOR / BENCHMARK OF BEST PRACTICE.
1 / Management of risk & prevention of errors in surgical procedures / All infants will be assessed and care planned to identify and minimise the risks associated with an operative procedure.
2 / Preparation & transfer of patient for a surgical procedure / The infants safety and comfort is maintained throughout the transfer and operative procedure. Trauma / or distress is eliminated or minimised wherever possible
3 / Management of safe recovery from anaesthesia / All infants will have an individualised care plan specific to the surgery undertaken and care will be provided that optimises his / her safe recovery and comfort.
4 / Care and management of a central venous line / The planning of central venous line care is based upon unit guidelines and evidence based practice. The care is individualised, evaluated and documented.
5 / Parental support & information provision / Parents and families have access to a wide range of information sources which are tailored to meet their specific needs .Parents / carers are enabled to fully participate in the decision making process and can give informed consent.
6 / Staff competency & training needs / All nursing and medical staff receives a comprehensive education / training program covering all aspects of the safety in transfer of the vulnerable neonate and attend update sessions to maintain competencies
NAME OF UNIT: / NAME OF PERSON (S)
COMPLETING BENCHMARK

Factor One: Management of risk and prevention of errors in surgical procedures

PROHIBITIVE BARRIERS / BEST PRACTICE
All infants will be assessed and care planned to identify and minimise the risks associated with insertion of a central venous line.

Ref: NATN (1998). Principles of safe practice in the perioperative environment. Harrogate. NATN.

NATN et al (1998) Safeguards for invasive procedures. The management of risks. Harrogate. NATN

King, R. (1998) Anaesthetic Practice. In: Clarke P, Jones J, (eds.) Brigdens Operating Department Practice. Edinburgh. Churchill Livingstone

Taylor, M., Campbell, C (1998) Surgical Practice. In: Clarke P, Jones J, (eds.) Brigdens Operating Department Practice. Edinburgh. Churchill Livingstone

World Health Organisation (2008), Surgery Safety Checklist. NPSA http://www.npsa.nhs.uk/nrls

INDICATORS OF BEST PRACTICE / Yes
2 / Developing
1 / No
0
Are all infants prepared for procedure / theatre using an evidence based checklist as per peri-operative benchmark
There is a communication strategy to advise theatre personnel of relevant infection control issues (MRSA)
All checklists & procedures reviewed on a regular basis to ensure accuracy and relevance. (as per Trust)
The correct site surgery policy been followed correctly.
Score Factor 1
□
0
E / □
1-2
D / □
3-4
C / □
5-6
B / □
7-8
A

Factor Two: Preparation and transfer of a patient for a surgical procedure

PROHIBITIVE BARRIERS / BEST PRACTICE
The infant’s safety and comfort is maintained throughout the transfer and operative procedure. Trauma / or distress is eliminated or minimised wherever possible

Ref: Department of Health. (2007). Maternity Matters, Choice, access and continuity of care in a safe service. London: COI. Available at: www.dh.gov.uk

INDICATORS OF BEST PRACTICE (As per peri-operative benchmark) / Yes
2 / Developing
1 / No
0
There are evidence based transport / transfer guidelines available.
The transfer is undertaken by trained personnel
Essential equipment is available
There is a maintenance program to ensure it functions appropriately
There is a training program to ensure staff competence to use equipment
Theatre personnel are sufficiently prepared / competent to provide care for the very preterm / vulnerable infant.
There are guidelines available to ensure that the theatre environment is safe for the very preterm / vulnerable infant
Score Factor 2
□
0
E / □
1-2
D / □
3-4
C / □
5-6
B / □
7-8
A

Factor three: Management of safe recovery from anaesthesia

PROHIBITIVE BARRIERS / BEST PRACTICE
All infants will have an individualised care plan specific to the surgery undertaken and care will be provided that optimises his / her safe recovery and comfort.

Ref: Crawford and Morris (2nd Ed) (2010) Neonatal Nursing. Chapman and Hall.

Royal College of Anaesthetists Standards for Paediatric Anaesthesia (2005)

INDICATORS OF BEST PRACTICE (As per peri-operative benchmark) / Yes
2 / Developing
1 / No
0
There is a communication strategy to ensure accurate and adequate handover of care between the theatre team and the unit team
There is a documented care plan/checklist accessible to the multidisciplinary health care team
There is an appropriate Pain Management plan / strategy for the gestational age / ventilated / non ventilated patient.
All patients are monitored appropriately post operatively
Score Factor 3
□
0
E / □
1-2
D / □
3-4
C / □
5-6
B /
7-8
A

Factor four: Care and management of a central venous line (CVL)

PROHIBITIVE BARRIERS / BEST PRACTICE
All infants will be assessed and care planned to identify and minimise the risks associated with insertion of a central venous line.

Ref: Royal College of Nursing. 2007. Standards for Infusion Therapy

Bodenham, A. Hamilton, H. 2009. Central Venous Catheters. Wiley-Blackwell.

INDICATORS OF BEST PRACTICE / Yes
2 / Developing
1 / No
0
Aseptic Non Touch technique is used when accessing / handling the CVL.
Evidence based policies / procedures / guidelines /care bundles/ care plans are in place.
Awareness of potential problems and how to manage these; sepsis, occlusion, non- bleeding back, fractured line, line falls out.
Ongoing care of the CVC has three aims:
·  Minimising the opportunity for complications.
·  Prolonging the life of the device.
·  Frequent consideration of the need for the device.
There is clear guidance available on dressings and taping catheter (tubes) into position.
Training is provided on the actual device.
Score Factor 4
□
0
E / □
1-2
D / □
3-4
C / □
5-6
B / □
7-8
A

Factor five: Parental support and information provision

PROHIBITIVE BARRIERS / BEST PRACTICE
Parents and families have access to a wide range of information sources which are tailored to the central venous line.

Ref: Ref: Johnson A, Sandford J, Tyndall J (2008). Written and verbal information versus verbal information only for parents being discharged from acute hospital settings to home. The Cochrane Library

INDICATORS OF BEST PRACTICE / Yes
2 / Developing
1 / No
0
There is a parental information pack available
Parental understanding / acceptability of the information is assessed
The information is:
1)  evidenced based (Specify source and review process)
2)  user friendly & understandable to the family
3)  Is it in a format that the family can access (Fact sheets, leaflets, videos, translated materials)
The information meets the Accessible Communication Standard
Parents have the opportunity to discuss the procedure with the MDT
Score Factor 5
□
0-2
E / □
3-5
D / □
6-8
C /
9-10
B / □
11-12
A

Factor six: Staff competence and training needs

PROHIBITIVE BARRIERS / BEST PRACTICE
Nursing and medical staff receive education / training to maintain competencies.

Ref: Kings College London (2009). Nursing competence: What are we assessing and how should it be

measured? Policy plus evidence, issues and opinions in healthcare. Issue No 18

INDICATORS OF BEST PRACTICE / Yes
2 / Developing
1 / No
0
Staff competence regarding equipment use is assessed and evaluated
Staff competence regarding patient transfer is assessed and evaluated
Staff competence regarding clinical emergencies is assessed and evaluated
How is competence assessed? Competency framework / teaching
There is a database to record staff training & assessment
Education and training resources for staff are evidenced based
How frequently are they reviewed?
Appropriate experts are available within the organisation to provide ongoing education & training
Parents / carers views influence the training program
Score Factor 6
□
0-2
E / □
3-5
D / □
6-8
C / □
9-10
B /
11-12
A

Action planned to move towards best practice statement

Compiled by / Unit: / Date:
Aim:
All infants undergoing insertion of a central venous line will be managed safely by appropriately trained and competent members of the multidisciplinary team in accordance with evidence based guidelines which optimise the benefits of surgery and minimise the risks.
Action required: / By whom: / Date to be completed: /

Reflection / comment

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COMPETENCY FOR: Care & Management of Central Venous Lines

Name / Date shown / Date practiced / Date practiced / Date practiced / Date practiced / Date and sign competent
The participant is able to demonstrate:
Hand hygiene technique
Prepare and clean sterile area
Collect all necessary equipment
Use ANNT correctly to access device
Assess the line and exit site, document findings.
Check cleansing solution and medications as per Trust policy
Take blood samples as per Trust policy
Flush the device with pulsating method
Dispose of syringes, needles, infusion sets, glass into Sharpe’s container
Dressing: as per saving lives bundle CVC (2008)
Use of occlusive dressing, IV 3000, changed weekly
Anchor device with gauze and tape to prevent dislodgement

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