Connecting an infusion to a central line, PICC line or Hickman line

NHS Ayrshire & Arran guidelines
NHS Ayrshire and Arran

An aseptic technique must be adhered to when commencing an infusion. A trolley should be set up in the same way as to do the dressing change and flushing the line with the required equipment. The giving set must be primed using an aseptic technique on the dressing trolley and must not be run over a sink (This would significantly increase the risk of infection from sink organisms from splash back).

Do not prime giving sets prior to starting the procedure.

Equipment required

  • sterile dressing pack
  • one pair of sterile gloves
  • plastic apron
  • disposal bag and sharps bin
  • antiseptic hand hygiene product
  • chlorhexidine gluconate BP 2% & isopropyl alcohol 70% wipes
  • 0.9% sodium chloride (10mls per lumen). 10ml PosiFlush XS may be used – ensure the packaging stipulates XS as only these syringes are externally sterile
  • 10ml Luer-Lok syringes
  • blunt needle
  • sterile infusion giving set
  • sterile prescribed infusion product for administration
  • infusion pump to deliver the product – Infusion devices must always be used when delivering treatment or fluids via a CVAD to reduce the risk of CVAD complications.

Procedure for connecting an infusion to a CVAD

Please note: if your hands are not socially clean and you need to wash your hands with soap and water (rather than alcohol gel), this must be carried out a minimum of 2 meters away from the working surface/dressing trolley and any CVAD equipment.

  1. Clean your hands with alcohol gel as per the WHO 5 moments for hand hygiene. Put on sterile gloves using an aseptic technique.
  2. Draw up 0.9% sodium chloride solution for flushing (10mls per lumen) or 10ml PosiFlush XS may be used – ensure the packaging stipulates XS as only these syringes are externally sterile.
  3. Aseptically run through the sterile giving with 0.9% saline and place on the sterile field ready for connection.
  4. Remove the port protector using sterile swabs. Clean the needle free device thoroughly with chlorhexidine gluconate BP 2% & isopropyl alcohol 70% wipe for 30 seconds and allow to dry completely for 30 seconds.
  5. Attach a 10ml syringe, open clamp (if applicable) and withdraw 5-10ml stagnant blood, close clamp and discard stagnant blood appropriately. Remember when withdrawing blood from a CVAD without clamps (valved CVAD), gently pull back 1-2mls wait 2-5 seconds for the valve to open and blood to start gently flowing through, prior to aspirating the full amount.
  6. Attach syringe with 10mls of 0.9% sodium chloride (open clamp if applicable) and flush using a brisk push/pause action, closing the clamp on the last push.
  7. Aseptically attach the sterile giving set to the patients CVAD.
  8. Load giving set into the infusion device and then open clamps on CVAD (if applicable) and clamp on the giving set. Start the infusion.
  9. Dispose of all waste appropriately as per waste management guideline
    1. NHS Ayrshire & Arran segregation of waste policy
    2. NHS Ayrshire & Arran waste disposal policy.
  10. Remove PPE and perform hand hygiene as per the WHO 5 moments for hand hygiene.
  11. Document procedure including any problems, action taken and review date in the care bundle DRS 6104 (Appendix 5) and appropriate notes.

Do not remove stagnant blood from CVADs insitu for TPN feeding.

Following this all equipment should be appropriately disposed of, the contents of this trolley should never be kept to be used for disconnecting the infusion, no matter how short the infusion as this significantly increases the chance of infection.