Clinical governance and supporting information

Clinical governance

Professional accountability

All nurses and doctors are personally accountable for their actions and omissions and are professionally accountable for the child and young person’s assessment and treatment, including the care and maintenance of CVADs.

Continuous professional development

As with any area of practice, every nurse and doctor is responsible for ensuring they maintain their knowledge and skill around their practice. All health professionals are expected to keep themselves up to date with current best practice in the management of CVADs. The line manager/clinical lead should ensure that the healthcare practitioner has access to relevant education and training provision as identified during Personal Development Planning, e.g. the NHS Education for Scotland Template for Continued Personal Development.

Line manager / professional lead

To ensure safe and effective practice, the line manager is responsible for working closely with the registered nurse or doctor caring for a child or young person with a CVAD and ensuring adequate clinical supervision and support is available.

CVAD care and maintenance

Staff accepting responsibility for the care and maintenance of CVADs must ensure that all documentation and records of the care given is accurate and clear and that all entries are timed, dated and signed with name and designation printed.

Equality and diversity impact assessment

Employees are reminded that they may have patients/carers who require communication in an alternative format e.g. other languages or signing. Additionally, some patients/carers may have difficulties with written material. At all times, communication and material should be in the patient/carer’s preferred format. This may also apply to patients with learning difficulties. In some circumstances there may be religious and/or cultural issues which may impact on clinical guidelines e.g. choice of gender of health care professional.

Consideration should be given to these issues when treating/examining patients. Some patients may have a physical disability or impairment that makes it difficult for them to be treated/examined as set out for a particular procedure requiring adaptations to be made. Patients‟ sexual orientation” may or may not be relevant to the implementation of a particular procedure; however, non-sexuality specific language should be used when asking patients about their sexual history. Where sexual orientation may be relevant, tailored advice and information may be given. This guideline has been impact assessed using the NHS Ayrshire and Arran Equality and Diversity Impact Assessment Toolkit.

Related NHS Ayrshire & Arran documents

Infection Control Guidelines
Section 06 Guidelines for Hand Hygiene
Section 10 Safe Handling and Disposal of Needles and Sharps
Section 18 Guidelines on the Care and Maintenance of Intravascular Devices
Obtaining Blood Cultures Guideline.

References

  1. Ares G. and Hunter, C. J. Central venous access in children: Indications, devices, and risks. Current opinion Pediatrics. 2017 29 (3) pp340-346.
  2. Baskin K.M., Mermel L.A., Saad T.F., et al. Evidence-Based Strategies and Recommendations for Preservation of Central Venous Access in Children. Journal of Parentral Nutrition. 2019 43 (5) pp591-614.
  3. Bard Access Systems (2009) PowerPort* Implanted Port System Nursing Guide, USA: Bard Access Systems Inc; Available via www.bardnordic.com.
  4. Greater Glasgow and Clyde Beatson https://www.beatson.scot.nhs.uk/content/mediaassets/doc/VascularAccessGuideline.pdf
  5. www.cancernursing.org
  6. www.chloraprep.com
  7. López-Briz E, Ruiz Garcia V, Cabello JB, Bort-Marti S, Carbonell Sanchis R, Burls A (2014). Heparin versus 0.9% sodium chloride intermittent flushing for prevention of occlusion in central venous catheters in adults. Cochrane Database of Systematic Reviews Issue 1
  8. Mighten, J. Care and management of children with a totally implanted central venous access device: portacath. Nursing children and young people 2019 31 (3) pp38-46.
  9. https://www.nice.org.uk/guidance/mtg34/resources/policy-for-the-insertion-and-care-of-central-venous-access-devices-cvad-in-hospital-royal-marsden-nhs-ft-pdf-4481503169
  10. RCN (2016) Standards for infusion therapy 4th ed London RCN.
  11. www.emc.medicines.org.uk