CVC Pre-Op Evaluation and Line Selection Guideline

Line Selection Guide for Appropriate CVC Type Type of therapy PICC/Non-tunneled YesRed medication Frequency oftherapy Duration oftherapy Continuous infusion(or access ≥1 a day) Duration oftherapy≤ 2months > 2months 15 days ≤ infusion≤ 2 months > 2 months Tunneled CVC Patient’sage≥2yo Tunneled CVC<2yoIntermittent Tunneled CVC Yellow or green Duration oftherapyPheresis Percutaneous pheresiscapable CVC (double lumen) Temporary(≤ 2 weeks) Prolonged(> 2 weeks) A A START PIV is an optionConsult VAT teamYes No Midline catheter ≤ 14 days Tunneled pheresis(double lumen)Unique therapy requiring Port Special circumstanceYes NoPort CVC No Port pheresisYes Special circumstances:•Body habitance(e.g. obesity)•Needle phobia v. 2017 .929 Standard Notes•Type “ipstandard” into text box that reads “Insert SmartText”.•Choose appropriate note (tunneled CVC vs mediport)Updated 1/2019 Selection Guide for Single vs. Double LumenV 2017 929 START Special needsDouble lumenYes NoSingle lumen Special circumstances:-Specific infusion aids requiring double lumen (e.g. Cyclosporin, Methotrexate, Leucovorin)-Multiple, incompatible medications are given simultaneously-Multiple/frequent blood drawn is anticipated-Frequent infusion of blood productis anticipated Patient needs CVC placement Care Algorithm forEvaluation of CVCs for Inpatientsv. 2017 .424 PIVor see PICC guideline for NeonatesNo Yes Follow Renal Guideline Yes Review line selection guide as neededAssess risk level(by surgery/VAT) High risk criteria HYes to any IYes to any L No to all No to all High risk placement Intermediate risk placement Low risk placement No High risk criteria:-≥3 prior tunneled lines-History of venous thrombosis-Documented abnormal vascular anatomy-History of congenital hearth disease or cardiac surgery-History of difficult accessIntermediate risk criteria:-HCT≤ 30%-Plt≤ 50k-Abnormal skin condition-BMI>35-Abnormal body habitus/anatomy Access ≥ 14 days or Red infusate Intermediateriskcriteria Patient:Renal failure or ESRD Obtain tentative schedule Confirm urgency:•<12 hours•12-48 hours•>48 hours * We are expected to utilize Renal Guideline for renal failure or ESRD patients once it is developed. Renal Guideline*is finalized No Yes Care Algorithm forPre-op Evaluation H Obtain great vessel u/s Discuss w/ surgeon, review with IR as needed and confirm scheduleYes No Yes Obtain MRV NoNormal (w/i last 30 days) Review with IR and surgery Confirm schedule Abnormal LConfirm CVC typeDiscuss case with surgeonConfirm schedule Greatvessel u/s done in the past 30 days IConfirm CVC type LabsDevelop plan w/primary team for pre-op correctionAble to correctNo Discuss w/ surgeon and confirm schedule Yes Abnormal Skin Normal Normal Develop plan w/primary team and wound care team as necessary for periopmanagement Abnormal Review with oncall surgeon, consider discussion with IRConfirm scheduleYes L Abnormal body habitus / elevated BMINo Confirm CVC type Normal u/s Normal MRV Line placement w/ u/s. Confirm plan w/surgery and requesting team v. 2017 .424