7104NRS Assignment 1: Critical Analysis of Vascular Access Policy

This essay critically analyzes vascular access device (VAD) policies and guidelines, focusing on selection and insertion practices. It emphasizes the importance of aseptic techniques in preventing healthcare-associated infections, particularly bloodstream infections, associated with VADs. The essay discusses the principles of aseptic non-touch technique (ANTT), including hand hygiene, personal protective equipment, and creating a safe environment. It highlights the need for trained healthcare professionals, proper site decontamination, and adherence to manufacturer's guidelines to minimize infection risks and ensure patient safety. The analysis underscores the role of standardized policies in improving patient care and reducing morbidity and mortality associated with VAD use. Desklib provides a platform for students to access this document and other study resources.

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Introduction
Vascular Access Devices are he devices commonly inserted through veins or arteries for
the purpose of administering fluids into or from the body through peripheral or central vascular
location(McGuire, 2015). Vascular access devices are used for therapeutic reasons like
administration of medication, blood sampling, total parenteral nutrition, reading central venous
pressure, blood transfusions and intake of fluids(Harrington, 2014). Vascular access devices can be
inserted centrally or peripherally. The choice of the device depends on the patient’s needs, its
requirement reasons, the duration for its use and the knowledge and the skills the operator has in
regard to the device (Moureau, 2013). Manufacturer’s guidelines, material and the size of the
device should also be looked into before the device can be put into use(Zhang, Keogh & Rickard,
2013). There are many devices available. Standardizing them will help avoid confusion and
increase their familiarity and consequential competence for their use(Moureau, 2013)(McGuire,
2015). The devices inserted peripherally are midlines and cannulae. Centrally inserted devices are
non-tunnelled central venous catheters, implantable ports, peripherally inserted central catheters,
and tunneled central venous catheters. Handling of any equipment must be met with training and
competency to do so. This is according to Medicines and Healthcare products Regulatory
Agency (Loveday, et al, 2014).
Vascular access devices guidelines are important in ensuring that the devices are
consistently and efficiently used to enable proper patient care(Moureau, 2013). This is because if
they are not handled properly they can be the root cause of infections such as bloodstream
infections which in turn can cause prolonged hospitalization, morbidity and even death (Chopra,
et al, 2013). The longer they are in use the higher the risk of infection. Aseptic non touch
technique as a national policy is used by the healthcare workers to reduce the number of

infections associated with the healthcare(Technique, 2016)(Conley, et al, 2017). This guideline is
part of the nursing skill that encompasses on prevention and control methods as well as
precautionary methods required during clinical procedures to prevent introduction of
microorganisms to sterile body sites of the patient by the health professionals, immediate
environment or the equipment to be used (Austin&Elia, 2013). Aseptic non touch technique is a
standard technique used in accessing all venous access devices whether inserted peripherally or
centrally(Loveday, et al, 2014)(McGuire, 2015). Lack of proper use of the technique is the major
cause of infections acquired in the healthcare(Marschall, et al, 2014). The purpose of the technique
is to lower infection chances of microorganism during preparation, administration and delivery
of intravenous therapy(Loveday, et al, 2014)(Conley, et al, 2017). The technique also reduces
potential contamination through wearing of non-sterile gloves, effective hand washing, use of
alcohol-based solutions in decontamination of key parts of the devices through adequate cleaning
and allowing alcohol to evaporate naturally(Austin &Elia, 2013).
Aseptic non touch technique is the most effective way of reducing healthcare associated
infections through a standardized procedure(Dougherty & Lister, 2015) (Zhang, Keogh &
Rickard, 2013). Healthcare associated infections can cause harm or death to the patients. The
clinical guideline has been backed up by health departments with the aim of preventing infection
to the sites by the pathogens (Loveday, et al, 2014). Asepsis can be medical or surgical. The
main aim of asepsis is sterility. Surgical asepsis aims at eliminating all the pathogenic organisms
on an area or object prior to the surgical procedure(Harrington, 2014). It is a sterile technique.
Medical asepsis is about maintaining cleanliness to prevent and reduce the number of pathogens.
Aseptic non touch technique can be used in achieving medical asepsis(Conley, et al, 2017). Its
principle is that body sites susceptible or sterile should not come into contact with non-sterile

items. During clinical procedures only non-contaminated key parts or sterile fluids should come
into contact with key sites (Moureau, et al, 2013). Key parts should not be in any way directly or
indirectly touched. The principles of aseptic non touch technique are on protection of key parts
and key sites which is now applied to all types of IV therapy. The focus is on the equipment used
and protection of key equipment parts. The equipment parts are those parts that are in direct
contact with the patient with a high potential of pathogens transmission and the parts are also in
direct contact with infusate (Marschall, et al, 2014). Efficiency and safety of aseptic non touch
technique is needed. Hence surgical aseptic non touch technique should be used in complicated
areas while standard aseptic non touch technique should be used in procedures that are
uncomplicated(Harrington, 2014). The choice is determined by the risk assessment of the key parts
and key sites asepsis. Health professionals should assess the risks in every procedure for the level
of aseptic technique and prevention and control measures of infection required to enable
asepsis(Conley, et al, 2017).
Key sites in aseptic non touch technique are insertion sites and wounds(Moureau, et al,
2013).Central Venous Access Devices(CVADs), catheters and veins are the insertion sites.The
parts of the equipment are the key parts needed in the process and have direct contact with the
aseptic parts of the patient, key sites and liquid infusions(Moureau, et al, 2013). Any
contamination of key sites leads to direct transmission of micro-organisms(Megeus, et al, 2015).
When a procedure requires key areas of the equipments to be directly touched,sterilized gloves
can be worn. This reduces contamination risks. Non-sterile gloves can be used during the
procedure if the key parts do not necessarily need to be touched. Principles of carrying out
aseptic technique include; Always wash hands and decontaminate effectively, Never contaminate
key parts of the equipment or the key sites, Touch the non-key parts with confidence, Take

appropriate infection prevention and control measures(Dougherty & Lister, 2015).These
principles remain the same when carrying out an aseptic technique(Conley, et al, 2017). Either
components of the aseptic technique change according to risk assessment. They are; Hand
hygiene, Personal Protective Equipment, Client preparation for clinical processes, Creating and
maintaining a germfree area, Use of safe working technique, Coming up with an adequate
environment, and Proper waste and sharp objects disposal(Megeus, et al, 2015).
Hand hygiene; hand decontamination helps in minimizing the carriage of harmful
pathogens on the hands (Dougherty & Lister, 2015). Hand hygiene is an important component
when it comes to good infection prevention and control precautions in the healthcare set up.
Hand hygiene should be performed in accordance with the Trust Hand Hygiene Policy. Hands
should be washed with clean water and soap and rubbed with a alcohol based sanitizer(Megeus,
et al, 2015). Healthcare staff should use approved antiseptic cleanser before carrying out surgery
procedures.
Personal Protection Equipment; healthcare staff wear the equipment to prevent infections
that are transmitted through body fluids like blood (Chopra, et al, 2013). In aseptic technique it
protects the patient from pathogens that might be carried by the staff at the healthcare. The
equipment depends with the procedure to be carried out and complexity.
Patient preparation for procedure; the skin should be prepared adequately to prevent
bacterial infection chances from the client’s skin from entering the wound(Megeus, et al, 2015).
When preparing for a surgical procedure, the skin should be clean. That is the site can be washed
with soap and clean water followed by decontamination using an antiseptic solution.

Creating and maintaining an aseptic field; in aseptic techniques sterilized items should be used.
Germfree technique is carried to all clinical processes to prevent contamination and keep up
sterileness. This will create a safer environment for the patient free from pathogens.
Use of a safe operative technique; it minimizes infection risk. Contaminations can occur
after procedure due to a tissue being badly damaged during the procedure. If a tissue heals
slowly it is more prone to infection. Excessive bleeding also increases chances for micro-
organisms. Bleeding can be controlled and tissue handled gently during surgical procedures to
minimize infection risks(Harrington, 2014).
Creating safe environment; special rooms should be set aside for surgical procedures and
handling of other items. This prevents collusions and minimizes activities in these areas and
finally minimizing infection risks. Safe environment can be maintained by lowering the clients’
number accessing the rooms, windows and doors should be kept closed amid the processes to
prevent insects and particles of dust from entering the room(Harrington, 2014). The room should
also be cleaned and decontaminated before a new patient is brought in(Megeus, et al, 2015). All
the equipment should pertaining to the room should also be decontaminated. Piercing devices
like needle should be safe for use to keep the staff worker and client from injection injury. IV
trays should also be decontaminated. When disinfecting needleless access devices and catheter
hubs manufacturer’s guidelines should be advocated for (Megeus, et al, 2015). A thirty- second
scrub using the required products.
Conclusion
Vascular access devices allow proper administration of fluids, medication and blood
samples. The devices also have a major lead in healthcare associated infections. That is

bloodstream infections which can be fatal. Prolonged duration with the devices leads to risks of
infection. Aseptic technique should be used when inserting the devices. Insertion of vascular
access devices should be carried out by trained and competent health professionals. Insertion
sites should be decontaminated and allowed to dry prior insertion. Hand hygiene should be
carried out and personal protective equipment worn appropriately before accessing vascular
access devices.

References
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Chopra, V., O'horo, J. C., Rogers, M. A., Maki, D. G., &Safdar, N. (2013). The risk of
bloodstream infection associated with peripherally inserted central catheters compared
with central venous catheters in adults: a systematic review and meta-analysis. Infection
Control & Hospital Epidemiology, 34(9), 908-918.
Conley, S. B., Buckley, P., Magarace, L., Hsieh, C., &Pedulla, L. V. (2017).Standardizing Best Nursing
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Appendix
The policy of Aseptic Non Touch Technique (ANTT) aims at ensuring that harm of healthcare
associated infections to patients, staff and others is reduced to the lowest risk level
achievable. Use of the policy in invasive and non-invasive procedures will help in
keeping healthcare associated infections to a minimum. It outlines a national standardized
methodology of raising the standards of aseptic technique in clinics and in order to
achieve asepsis. In relation to ANTT the policy should be revised with local variations to
prevent infections and control practices and procedures.
The policy aims at supporting the implementation of Aseptic Non Touch Technique
standardization of to enable technique and practice language be standardized. It reduces
the variables in aseptic practice in order to standardize the aseptic technique. The
technique is a core skill in medical and nursing. The policy is also used internationally as
a framework that is safe and effective for practice for aseptic technique for all the clinical
procedures.
Procedure: the policy always begins with getting the consent from the patient and giving
instructions. Curtains should be drawn around a patient or move to an appropriate room.
Hand should be decontaminated. Trays should also be cleaned with an appropriate
detergent. The environment should also be suitable for working. Windows and fans
should be closed. Hands should also be decontaminated. The apron is used ones and
disposed. Dressing should be open. All the equipment should be prepared in the tray and
within their packaging with the key parts identified. Hands should be decontaminated and
kept free from germs and gloves worn if necessary. The procedure should be carried out
using ANTT. When the procedure is through remove gloves, apron and other PPE. Waste

should be disposed and hands decontaminated. The patient should be taken back to the
bedside and kept comfortable. All the equipment: trolley, tray and the operation room
should also be cleaned and hands decontaminated.