Paediatric
Preparing and administering Antimicrobial line locks
- Read the following sections together as collectively they will provide advice about preparing and administering gentamicin and vancomycin line locks.
- Use aseptic non touch techniques (ANTT) throughout the process of preparing and administering antimicrobial line locks.
- Treat each lumen of the central vascular access device (CVAD).
- Ideally the lock should be left in place for 24 hours.
- If the line must be used because alternative access cannot be established, then the line should be locked for at least 12 hours. If there is more than one lumen then lock each lumen for at least 12 hours.
- For renal replacement therapy central venous catheters, the antimicrobial line lock can dwell in the catheter during the interval between sessions, up to 72 hours. Otherwise, dwell times should generally not exceed 48 hours.
- The line should not be used between locks but if necessary, the lock must be removed before infusion of the next dose of antibiotic or other intravenous medicines or solutions.
Preparing Antimicrobial line locks
- The final concentration of the line lock is essential.
- The line locks must be in a 10mL luer syringe irrespective of final volume of the line.
- Treat each lumen of the line. Prepare a separate syringe for each lumen e.g. double lumen lines will need two antimicrobial line locks.
- Use ANTT techniques to prepare and administer.
|
Antimicrobial |
How to make line lock |
Final Concentration of solution to be instilled into line |
|
Vancomycin |
Or
|
5mg/mL |
|
Gentamicin |
Or
|
1mg/mL |
*For the syringe to syringe connector luer lock syringes are required
Lumen volumes of central vascular access devices (CVAD)
- Treat each lumen of the CVAD
- Prepare a separate syringe for each lumen e.g. double lumen lines will need two antimicrobial line locks.
- If the fill (lumen) volume is clearly marked on the lumen, use that volume for the antimicrobial line lock even if the line is known to have been trimmed.
- Where the fill (lumen) volume is not printed on the lumen, review the patient’s medical notes for documentation.
- If no documentation in the medical notes use the guide below for lock volume:
Amount to be instilled:
The amount instilled should be equivalent to the priming volumes printed on the catheter or clamp, but as a guide, the volume of antibiotic line locks prescribed should be:
|
Age |
Volume to be instilled |
|
Children under 2 years |
no more than 1ml |
|
Children 2 years and above |
2ml |
Adminstering antimicrobial line locks
- Prior to administration perform Positive Patient Identification (PPID) and confirm allergy status.
- Review the prescription.
- Use ANTT throughout the process of preparing and administering antimicrobial line locks.
- Check patency of the Central Venous Access Device (CVAD) by aspirating blood from the lumen.
- Flush CVAD with sodium chloride 0.9%.
- Administer the line lock into each lumen.
- Administer the line locks as prescribed until results from blood cultures are negative. Frequency and duration as per Pathogen specific therapy for intravascular catheter related infections
- Ideally the line lock should be left in place for 24 hours
- If the line must be used because alternative access cannot be established, then the line should be locked for at least 12 hours. If there is more than one lumen then lock each lumen for at least 12 hours.
- For each lumen that contains a line lock, complete and attach an injectable label.
- After dwell time is complete aspirate the antibiotic line lock from the lumen
- If unable to aspirate, flush the lumen with 0.9% sodium chloride to check patency.
- Flush lumen with 0.9% sodium chloride.
- Administer next antimicrobial line lock as prescribed.