Nonvascular Access
Intraspinal Access
Policy
Any medications administered via an intraspinal route (intrathecal, epidural, ventricular reservoir) must be preservative-free and labeled for “intraspinal infusion only.”
A 0.2-micron surfactant-free, particulate-retentive, and air-eliminating filter will be used for the administration of all intraspinal medications.
Intraspinal access devices, administration sets and, if used, infusion pumps should be clearly labeled to differentiate these from other infusion systems.
The use of alcohol or alcohol-containing solutions, or acetone, will be avoided for site preparation prior to device insertion, site care, and disinfection of the catheter hub/needleless connector.
A dressing should cover the intraspinal access insertion site; routine dressing changes for short-term catheters are not recommended due to the risk for dislodgment and infection. For long-term catheters (eg, tunneled or implanted devices), a transparent semipermeable membrane (TSM) dressing is used to cover the site and changed every 7 days in conjunction with site antisepsis. After the first 24 hours postplacement of a ventricular reservoir, the site is usually not covered with a dressing.
Use of chlorhexidine-impregnated dressings may be considered for short-term intraspinal catheters to reduce the risk of central nervous system-associated infection.
Access of, and administration of medications via a ventricular reservoir or an implanted infusion pump are most often performed by a physician or a specially trained registered nurse (RN) if allowed by the individual’s state Board of Nursing Practice Act.
Long-Term External Intraspinal Catheter Site Care and Dressing Change
Procedure
Obtain and review licensed independent practitioner’s (LIP’s) order.
Verify patient’s identity using 2 independent identifiers, not including patient’s room number or bed number.
Explain procedure to patient.
Place patient in comfortable position.
Perform hand hygiene.
Gather supplies.
Gloves, nonsterile
Gloves, sterile
Mask
Povidone-iodine solution
Antimicrobial dressing (optional)
TSM dressing
Tape
Tape measure, sterile
Assemble supplies on sterile field.
Don mask and nonsterile gloves, and carefully remove existing dressing and discard.
Remove gloves.
Perform hand hygiene.
Don sterile gloves.
Observe insertion site for redness, drainage, swelling, or pain.
Measure external catheter length with tape measure.
Cleanse the skin with povidone-iodine; allow to dry completely.
Place antimicrobial dressing around the insertion site, if used.
Place TSM dressing over entire area, centering it over the catheter insertion site, anchoring catheter with extra tape on skin as needed.
Remove gloves and mask. Discard all used supplies in appropriate receptacles.
Perform hand hygiene.
Label dressing with date, time, and initials of nurse.
Document external length of catheter, site condition, performance of procedure, and patient tolerance in patient’s permanent medical record.
Implanted Epidural/Intrathecal Port Access and Medication Administration
Procedure
Obtain and review LIP’s order.
Verify patient’s identity using 2 independent identifiers, not including patient’s room number or bed number.
Explain procedure to patient.
Place patient in a comfortable position with head turned away from implanted port.
Perform hand hygiene.
Gather supplies.
Gloves, nonsterile
Gloves, sterile
Mask
Noncoring needle with extension set
Povidone-iodine solution
Needleless connector
Preservative-free 0.9% sodium chloride (USP) prefilled syringe
Syringe(s)
Gauze (optional)
Antimicrobial dressing (optional)
TSM dressing
Tape
Assess skin over and around implanted port; palpate port to locate septum.
Assemble supplies on sterile field.
Don mask and sterile gloves.
Cleanse implanted port access site using povidone-iodine; allow to dry completely.
Attach needleless connector to noncoring needle with extension set and prime set with preservative-free 0.9% sodium chloride (USP).
With nondominant hand, palpate and stabilize implanted port.
Insert noncoring needle perpendicular to the skin, through septum of the port until the needle tip comes in contact with the back of the port.
Attach syringe to catheter hub/needleless connector and gently aspirate from the device.
Epidural: observe for the absence of cerebral spinal fluid (CSF) or blood. If either is present, do not inject medication. Notify LIP
Intrathecal: observe for the presence of CSF. If blood is present, do not inject medication. Notify LIP
Place sterile gauze to support wings of noncoring needle if needed, making sure gauze does not obscure needle insertion site.
Apply TSM dressing.
Administer medication/infusion as ordered (see below, Medication Administration Via External Intraspinal Catheter).
Discard used supplies in appropriate receptacle(s).
Remove gloves.
Perform hand hygiene.
Document procedure in patient’s permanent medical record.
Medication Administration Via External Intraspinal Catheter Procedure
Obtain and review LIP’s order.
Verify patient’s identity using 2 independent identifiers, not including patient’s room number or bed number.
Assess patient’s vital signs and neurological status and explain procedure.
Place patient in comfortable position.
Perform hand hygiene.
Gather supplies.
Gloves, nonsterile
Mask
Povidone-iodine solution
Prescribed preservative-free medication in syringe or infusion container attached to primed administration set
Preservative-free 0.9% sodium chloride (USP), prefilled syringe
Don mask and gloves.
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