Invasive device PIVC, CVL & PICC

• Conducted on

  Date

• Prepared by

• Ward

Patient

• Insert NM

• Is the audit for a PIVC?

  Yes

  No

PIVC brand

• Device Type

  Insyte

  Nexiva

  Braun

  Unknown

PIVC Bedside Review

• Is the Date of Insertion marked on the dressing?

  Yes

  No

• Is the PIVC connected to IV therapy on inspection?

  Yes

  No

• Is there a BLUE line label present as per policy?

  Yes

  No

• Is the approved IV occlusive dressing clean, intact and dry?

  Yes

  No

• Is there tape or other non approved dressings securing the PIVC?

  Yes

  No

  N/A

• Has the patient been informed on how to care for the device and when to report concerns?

  Yes

  No

• Is the PIVC in an appropriate anatomical position (should NOT be in Cubical fossa or poor position for patient comfort/safety unless otherwise documented by AP)

  Yes

  No

PIVC documentation review

• PIVC observation chart or theatre records form has correct day of PIVC insertion documented

  Yes

  No

• PIVC observation chart or Theatre Records has the correct anatomical site noted

  Yes

  No

• PIVC observation chart or Theatre records has the correct gauge size documented

  Yes

  No

• PIVC observation chart has insertion personnel documented

  Yes

  No

• PIVC inserted by Ambulance service, during MET call, or by other facility or GP?

  Yes

  No

• PIVC inserted >24 hours

  Yes

  No

  N/A

• Please write the insertion personnel name or location as documented on the form.

• PIVC observation chart has PIVC inspection signed each shift

  Yes

  No

• PIVC observation chart has correct day associated with the PIVC - day 1, 2 or 3

  Yes

  No

• What is the Phlebitis Grading Score (PGS) at the time of audit?

  Select 0 = PIVC Appears Healthy 1 = One of the following is evident: Slight pain near PIVC site OR slight redness near PIVC site. 2 = Two of the following are evident: Pain along path of PIVC, Redness around site, swelling 3 = All of the following are evident: Pain along path of PIVC; Redness around site and swelling 4 = All of the following are evident and extensive; Pain along path of PIVC; Redness around site, swelling , palpable venous cord 5+ All of the following are evident and extensive: Pain along path of PIVC, redness around site, swelling, palpable venous cord, pyrexia

  • 0 = PIVC Appears Healthy
  • 1 = One of the following is evident: Slight pain near PIVC site OR slight redness near PIVC site.
  • 2 = Two of the following are evident: Pain along path of PIVC, Redness around site, swelling
  • 3 = All of the following are evident: Pain along path of PIVC; Redness around site and swelling
  • 4 = All of the following are evident and extensive; Pain along path of PIVC; Redness around site, swelling , palpable venous cord
  • 5+ All of the following are evident and extensive: Pain along path of PIVC, redness around site, swelling, palpable venous cord, pyrexia

• Has the PIVC been used since insertion (such as to give fluid or IV AB)?

  Yes

  No

• Documentation that PIVC flushed every 8hrs (when not in use)

  Yes

  No

• PIVC in-situ > 72 hours

  Yes

  No

• Is the audit for a CVL or PICC?

  Yes

  No

Invasive Device

• Invasive device assessment form completed?

  Yes

  No

• Tegaderm 3000 dressing applied without reinforcement (tape) after day 1

  Yes

  No

• Date of latest dressing change on dressing

  Yes

  No

• Is device line secure to avoid dislodgement

  Yes

  No

• Is device free from kinks on asking patient to move arm?

  Yes

  No

• Does the PICC line have bungs on all lumens?

  Yes

  No

  N/A

• Is there any visible blood/medication in the lumens?

  Yes

  No

  N/A

• Is the dressing clean and intact?

  Yes

  No

• Is there blood present under dressing? If yes please change dressing ASAP

  Yes

  No

• Is the CVC still in use?

  Yes

  No

• Is there documentation to support why the CVC is still insitu and not active?<br>

  Yes

  No

Documentation

• Have the nursing staff caring for the invasive device completed the CVC & PICC competency

  Yes

  No

• Has the site been checked once per shift?

  Yes

  No

• Is there documentation to support device inserted using ANTT

  Yes

  No

• Invasive devices anatomical location documented

  Yes

  No

• Is type and location of device clearly documented?

  Yes

  No

• Is the PICC batch number documented for devices inserted in SCR or ICU/Theatre

  Yes

  No

• Staff member that inserted device has documented their details

  Yes

  No

• Line changes documented as per policy

  Yes

  No

• Patient or family given care information sheet

  Yes

  No