Proper Handling and Maintenance of Vascular Access Devices (VAD)
By Candy Finley, RN, IgCN - July 28, 2023

As children, if a piece of candy fell on the ground, some would bend down, pick it up, say, "God made dirt and dirt don't hurt," and shove it in their mouths. As people age, some continue with "the five-second" rule, never stopping to consider how many germs they are ingesting!

As nurses, the above scenarios are no longer practices we should live by, not only in our personal lives, but more so in our professional roles. We are educated and trained about the importance of utilizing standard precautions for administering care to patients to prevent illness, injury, or death to patients and ourselves. More importantly, nurse training includes understanding the differences between aseptic and sterile techniques and the consequences when there is a break in these techniques.

According to the Infusion Nurses Society (INS), Aseptic Non-Touch Technique (ANTT) is used during clinical procedures to identify and prevent microbial contamination of aseptic parts and sites by ensuring that they are not touched either directly or indirectly.

The 5 Practice Terms for Using ANTT:

1. Key-Site: Any portal of entry into the patient.
2. Key-Part: The part of the procedure equipment that, if contaminated, is likely to contaminate the patient.
3. General Aseptic Field: A decontaminated and disinfected procedure tray or single-use procedure kit/barrier. They are used to promote but not ensure asepsis.
4. Critical Aseptic Field: A sterile drape/barrier used to ensure asepsis; all procedure equipment is placed on the drape and managed collectively.
5. Micro Critical Aseptic Field: A small protective sterile surface/housing and recently opened sterile equipment packaging that protects Key-Parts individually.

Proper handling and maintenance of venous access devices (VADs) in the home requires the practice of Standard ANTT. This technique combines Standard Precautions and an approach of protecting Key-Parts and Key-Sites individually, using a non-touch technique and Micro Critical Aseptic Fields within a General Aseptic Field. Standard ANTT is used for clinical procedures where achieving asepsis and protecting Key-Parts and Key-Sites is straightforward and short in duration, such as VAD flushing and locking, administration set preparation and change, intravenous medication administration, and simple wound care. If Key-Parts or Key-Sites require direct touch, then sterile gloves must be worn.

Nufactor Policy States:

• • Upon entering a patient's home, you must don an N-95 mask and may only remove it for food and drink. Nufactor provides proper personal protective equipment (PPE) for all cases that require it.
• • Inspect the work area before placing supplies on it. If unclean, clean the surface with a disinfectant or with soap and water before proceeding. Then wash your hands using soap and water for 20 seconds, gather your supplies, and rewash your hands.
• • After everything is set up, all vial stoppers, access devices, and medication ports should be sanitized (scrub the hub) with an alcohol prep pad and allowed to air dry without fanning or blowing, as that could add microbes to the surface.
• Note: Vial stoppers are not sterile and must be sanitized after the vial lid is removed.
• Once you have selected the vein for venipuncture, you must don clean gloves and wear them for the entire procedure. If gloves are soiled, torn, or ripped, replace them. Intact gloves are to be worn at all times. A glove must never intentionally be pierced in order to palpate a vein with a bare finger. It is also unacceptable to touch the peripheral intravenous (PIV) site after it is cleaned, even with gloves, or it must be cleansed again.
• Once you have selected the vein for venipuncture, you must don clean gloves and wear them for the entire procedure. If gloves are soiled, torn, or ripped, replace them. Intact gloves are to be worn at all times. A glove must never intentionally be pierced in order to palpate a vein with a bare finger. It is also unacceptable to touch the peripheral intravenous (PIV) site after it is cleaned, even with gloves, or it must be cleansed again.
• When cleansing the site with the chlorhexidine prep swab, begin in the location of the site and swab the area in a circular motion moving outward. Remember no fanning or blowing on the site is allowed.
• Once the PIV is in place, clean the clave if the patient is disconnected for any reason.
• After the infusion begins, you do not have to wear gloves when changing vials, but your hands must be clean; hand sanitizer is recommended.
• When accessing central lines, remember it is mandatory to maintain sterility throughout the process. Make sure the work area stays clean and dry.
• When handling supplies, you can only handle the outside wrappers with your bare hands.
• The nurse must wear a sterile mask, and the patient is required to turn their head away to avoid breathing on the VAD site.
• Keep supplies within reach and never drop anything below your sterile field. Nufactor dispenses sterile saline separately, and it must be dropped onto your sterile field.
• For Port-A-Caths (PACs), do not attempt to access it more than three times. Remember to hold the port in place when accessing it to prevent movement and/or de-accessing. Once accessed, the clave must be cleansed vigorously with alcohol for 15 seconds and allowed to air-dry. Flush per protocol daily.
• The Huber needle must be changed every five days according to Nufactor policy, and every 72 hours if a gauze/split gauze is used between the skin and the Huber needle.

In summary, best practices are to follow the INS standards and Nufactor pharmacy policies to prevent infection and reduce complications to ensure patient safety. These techniques/practices are further illustrated in our IVIG and SCIG Administration Guides.

Always remember, our top priority is always the patient.

References:
Gorski, L., Hadaway, L. C., Hagle, M., Broadhurst, D., Clare, S., Kleidon, T., Meyer, B. M., Nickel, B., Rowley, S., Sharpe, E. D., & Alexander, M. (2021). Infusion Therapy Standards of Practice, 8th Edition. Journal of Infusion Nursing, 44(1S), S1–S224. https://doi.org/10.1097/nan.0000000000000396