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Care of Vortex® Vascular Access Device when Used for Apheresis (Adult & Pediatric) (1.57)

Care of Vortex® Vascular Access Device when Used for Apheresis (Adult & Pediatric) (1.57) - Policies, Clinical, UWHC Clinical, Department Specific, Nursing Patient Care, Cardiovascular and Infusion

1.57

NURSING PATIENT CARE POLICY & PROCEDURE





Effective Date:
May 31, 2017

Administrative Manual
Nursing Manual (Red)
Other _______________

Policy #: 1.57AP

Original
Revision

Page
1 of 5

Title: Care of Vortex® Vascular Access
Device when Used for Apheresis (Adult &
Pediatric)

I. PURPOSE

To provide instructions for accessing, locking with heparin, and discontinuing the
Vortex® vascular access device when used for apheresis.

II. DEFINITIONS

The Vortex® vascular access device is a port that is implanted subcutaneously. The
port allows access to large blood vessels and maximizes blood flow for therapeutic
apheresis procedures.

III. POLICY

A. Registered Nurses (RNs) in Infusion Center may perform care for Vortex®
vascular access devices when used for apheresis, after completion of a skills
checklist.
B. RNs may perform care for Vortex® vascular access devices when used for blood
draws or medication administration (no apheresis), according to Nursing Patient
Care Policy and Procedure 1.56AP, Central Vascular Access Device Use,
Maintenance and Removal (Adult & Pediatric). Refer to the section on implanted
ports.
C. Sterile technique shall be used when accessing the port.
D. Needle access can be made through the center of the port for the first several
times it is accessed. After the first several times, needle access shall be rotated
randomly around the periphery of the port.
E. Heparin lock should be administered with each port de-access. Standard locking
volume is 3 mL of heparin 1000units/mL, unless otherwise noted by provider.
F. The MaxPlus Clear™ Connector must be cleansed by scrubbing the top and sides
of needless connector with sterile 70% isopropyl alcohol wipe for 15 seconds and
allowed to dry for 15 seconds prior to accessing.
G. If the patient presents with a fever and elevated white blood cell count, discuss
with a provider prior to starting the procedure.

IV. EQUIPMENT

A. (2) - High-Flow, non-coring (Huber) needles - 16 gauge, 1 inch, latex free
(Angiodynamics brand, Catalog # 06520001)
B. (2) - 7 inch kink resistant extension set with removable MaxPlus Clear Connector
(CareFusion brand, REF MP9002-C)

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C. 1- Vortex Port Access Kit (located in Infusion Center)
D. Locking solution as ordered by the provider
E. (2) - bandages to cover the puncture sites after removing the needles (CS Item
#1201066)

V. PROCEDURE

A. Accessing the port
1. Inspect the port site for any signs of infection. Palpate the site to locate the
septum.
a. NOTE: If newly inserted port: Review the placement note and
document location of the catheter tip. The catheter works best when the
tip is located at the cavoatrial junction. Verify it has been at least 2
weeks since port placement.
2. Perform Hand Hygiene according to UWHC Administrative Policy 13.08,
Hand Hygiene.
3. Put on mask and ask the patient and anyone else in the room or treatment
area to wear a mask.
4. Open Vortex Port Access Kit in a sterile fashion.
5. Scrub each port site with ChloraPrep® One Step for 30 seconds using a
bidirectional (back and forth, up and down, diagonally) motion and apply
slight pressure to create friction over the areas. Allow to dry for at least 30
seconds.
6. Aseptically open the Huber needles, extension sets and drop each item on the
sterile field.
7. Perform Hand Hygiene according to UWHC Administrative Policy 13.08,
Hand Hygiene
8. Don sterile gloves.
9. Adhere sterile drape to patient’s chest below the port.
10. Remove the MaxPlus Clear™ Connector from the extension set and attach
the male luer lock end of the stopcock to the set. Attach the MaxPlus
Clear™ Connector to the side port of the stopcock. Attach a syringe to the
open port of the stopcock.
11. Rotate the trocar of the needle clockwise to verify it is tight.
12. Repeat steps 9-10 with the other extension set, stopcock, syringe, and needle.
13. Follow these steps to insert the needle:
a. Stabilize the port with the thumb and index finger of the non-dominant
hand.
b. With the dominant hand, position the needle at a right angle above the
port septum. Insert the needle perpendicular to the port septum.
c. Apply stead pressure until the trocar touches the base of the port
reservoir.
d. While holding the needle, loosen the trocar but do not remove it. Push
down on the needle hub until it touches the base of the port.
14. Repeat step 13 with the other needle.
15. Ask the patient to take a breath and hold it. Remove the trocar from one of
the needles and immediately attach one of the extension sets. Tell the patient
to resume normal breathing.
16. Repeat step 15 for the other needle.

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17. After attaching the extension tubings:
a. Aspirate10 mL of blood to remove the locking heparin and to establish a
good blood flow.
b. Clamp the tubing. If laboratory samples are needed, attach a sterile 10
mL syringe and draw sample according to UW Health Clinical Policy
2.5.1, Use of Containers for Clinical Specimens, UWHC Clinical
Laboratories Departmental Policy 1502.5.06, Acceptance Policy for
Specimen Identification, and UWHC Clinical Laboratories Departmental
Policy 1502.5.07 Specimen Rejection.
c. Rapidly flush the port with 20 mL of 0.9% sodium chloride.
d. Clamp the extension tubing until ready to connect to the apheresis set.
e. Repeat steps A.17. a-d with the other needle.
18. Place several sterile gauze squares around each needle to support the needle
and extension set. Tape in place to hold the needle and extension set at a 90
degree angle to the patient’s chest.
19. Masks can be removed after the dressing is applied.
20. When ready to start the procedure, attach the apheresis access and return line
to the stopcock. Turn the stopcocks so that they are off to the MaxPlus
Clear™ Connector. Open the clamps on the extension set.
21. Document in the clinical record that the port was accessed.

B. Monitoring
1. Monitor the return site throughout the procedure
a. Pause the procedure immediately if the patient complains of pain or
abnormal sensation at the return site.
b. Examine the site for signs of extravasation.
c. Aspirate for good blood return via MaxPlus Clear™ Connector.
d. Notify provider immediately if extravasation is suspected.

C. Troubleshooting
1. If no blood return is obtained after inserting the needle:
a. Push the needle hub downward to ensure it is seated at the base of the
port reservoir.
b. Ensure all connections are secure.
c. Have the patient take a deep breath, cough, or change their position.
d. Remove it and attempt to re-access it using a new needle.
e. If second attempt is unsuccessful, notify the provider and proceed as
directed.
f. If alteplase is ordered:
• Follow recommendations in Flushing/Locking of Venous Access
Devices-Adult/Pediatric-Inpatient/Ambulatory
o If aspiration is successful, then start the procedure.
o If aspiration is unsuccessful, cancel the procedure and
reschedule after catheter is functional.
2. If access pressure alarms occur during the procedure, attempt any of the
below interventions (does not need to be in order):
a. Push down on needle to ensure it is seated at the base of the port
reservoir.
b. Aspirate 5 mL of blood via the MaxPlus Clear™ Connector on the

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stopcock, and then flush with 10 mL 0.9% sodium chloride.
c. Reverse the access and return lines at the connection to the stopcock.
d. Rapidly flush with 10 mL 0.9% sodium chloride via the MaxPlus
Clear™ Connector on the stopcock.
e. Decrease the inlet speed.
f. Replace the stopcock.
g. Ask the patient to take a deep breath, cough, or change their position.
h. Consider using alteplase. Discuss with the provider.

D. Locking and de-accessing
1. Obtain the volume and concentration of heparin ordered for locking each
lumen prior to completing the apheresis procedure.
a. The standard capping solution is 3 mL of 1000units/mL heparin unless
otherwise ordered by the provider.
2. Scrub the end of the MaxPlus Clear™ for 15 seconds with an alcohol pad.
Let it dry. Connect a 10 mL saline syringe to the MaxPlus Clear™ Connector
on the stopcock of one of the ports.
3. Turn the stopcock so it is open to the syringe and the patient and closed to the
apheresis tubing.
4. Draw back slightly on the syringe to aspirate any air in the tubing.
a. Hold the syringe upright and tap it so any air bubbles rise to the top of
the syringe.
5. Rapidly flush the tubing with 20 mL of 0.9% sodium chloride through the
MaxPlus Clear™ Connector on the stopcock.
6. Remove the saline syringe and attach the syringe that contains the prescribed
dose and volume of locking solution.
a. Flush at a slow, steady rate maintaining positive pressure on the syringe
plunger.
7. Remove the locking solution syringe.
8. Repeat steps 1-7 for the second port.
9. Stabilize each port and gently remove the needle from each port. If there is
oozing at the puncture site, hold gentle pressure until the bleeding stops.
Cover puncture site with bandage, if needed.
10. Document in the clinical record that the port was de-accessed

VI. REFERENCES

A. Blood Center of Wisconsin, Inc. (2016). Accessing and discontinuing from a
Vortex® vascular access device.
B. UW Health Clinical Policy 2.5.1, Use of Containers for Clinical Specimens
C. UWHC Clinical Laboratories Departmental Policy 1502.5.06, Acceptance Policy
for Specimen Identification
D. UWHC Clinical Laboratories Departmental Policy 1502.5.07 Specimen
Rejection.
E. UWHC Administrative Policy 13.08, Hand Hygiene
F. Nursing and Patient Care Policy & Procedure 1.56, Central Vascular Access
Device Use, Maintenance and Removal (Adult & Pediatric)
G. Flushing/Locking of Venous Access Devices-Adult/Pediatric-
Inpatient/Ambulatory

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VII. WRITTEN BY

Clinical Nurse Specialist, Oncology Service Line

VIII. REVIEWED BY

Clinical Nurse Specialist, Pediatric Hematology/Oncology
Nurse Manager, Infusion Center
Nursing Patient Care Policy and Procedure Committee, May 2017

SIGNED BY

Beth Houlahan, DNP, RN, CENP
Senior Vice President, Chief Nurse Executive