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Trainer Lesson Plan

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This is a detailed lesson plan, including key points, for the central venous access device competency training.

Publié dans : Santé, Business, Santé & Médecine
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Trainer Lesson Plan

  1. 1. Trainer Lesson Plan: CVAD Competency Training Page 1 of 1 What Key Points Program Intro – 10 minutes Introduce yourselves as the trainers. If necessary, give a little information about your history and experience in working with VADs. Ask learners to introduce themselves. Ask them to tell you about their previous experience in working with CVADs. Ask if they have any specific information that they came to learn. Write their questions and concerns on the white board. Point out the ones that will be covered in the training. Tell learners how you will address the other issues. Ask learners to look at the program objectives with you and go over them. Call attention to the competencies in the program materials. Tell learners that they will need to successfully demonstrate the skills to be certified as competent. Show Deltec video: Before the video, tell participants the following: “The Best Choice for You: • It is easiest to first classify CVADs by whether they Understanding CVADs” are external catheters or are implanted ports. Most video: 15 min. implanted ports have the port located in the chest; some are located in the arm, however. discussion: 5 min. • This video will show CVADs with implanted ports in the chest and arm and external catheters that protrude from the chest and arm. The video will not show non-tunneled subclavian or jugular catheters. It also will not show dialysis catheters. • Besides the fact that the video illustrates four types of CVAD placements, it also provides some good talking points for patient education. After the video, tell learners the following: • Non-tunneled and jugular catheters are inserted via percutaneous stick into the internal or external Vascular Access Team 11/04
  2. 2. Trainer Lesson Plan: CVAD Competency Training Page 2 of 2 What Key Points jugular vein. Non-tunneled subclavian catheters are inserted via percutaneous stick into the subclavian vein. Dialysis catheters may be tunneled or not. Show Bard video: Queue up the video to where it shows how the Groshong valve works. Let the video run through were “Insertion Groshong® PICC” it shows the difference between open-end and Groshong video: 2 minutes catheter tips. discussion: 2 minutes Tell learners that the video shows how the Groshong valve works and compares it to an open-end catheter. After the learners complete the exercises, go over the correct answers. Try to identify and correct learner misconceptions. In-class exercise – 5 minutes Give each learner a copy of the VENOUS ACCESS DEVICE ORDERS and a set of in-class exercises: Self-grading and discussion – 10 minutes • Peripherally Inserted Central Catheter • Subclavian Hickman Catheter • Tunneled Catheter • Tunneled Dialysis Catheter • Implanted Vascular Access Device Instruct learners to do the exercises. They should be guided by the VENOUS ACCESS DEVICE ORDERS – just as they would in clinical practice. Show Deltec video: Before the video: tell learners that the video will show how to palpate, assess, access, and deaccess the “Clinician Information for the implanted port. Care and Maintenance of PORT- A-CATH® AND P.A.S. PORT® Implantable Venous Access After the video, stress that sterile technique must be Systems” used when accessing implanted ports. This necessitates use of the Central Line Dressing Tray. Show the tray to video: 15 min. learners. discussion: 2 min. Show Deltec video: Before the video, tell learners that the video will show them how the Gripper Plus safety needle works. “Gripper Plus Safety Needle: Vascular Access Team 11/04
  3. 3. Trainer Lesson Plan: CVAD Competency Training Page 3 of 3 What Key Points Training Video” After the video, tell learners the following: video: 2 minutes • The non-coring needle must be inserted at a right discussion: 2 minutes angle to the bottom of the implanted port. At times the port may lie at a slight angle in the chest. Either rotate the port so that the septum is parallel to the skin, or angle the needle to accommodate the angled port. • If the port is upside-down under the skin, meaning the bottom is closest to the skin, DO NOT attempt to rotate it. Doing so can twist the catheter or break it. Instead, notify the primary MD. You will not be able to use the implanted port until it has been surgically revised. • If unsure about port placement, always call the Vascular Access Team for help. They are the experts and are here help. • Show learners the different Gripper Plus non-coring needles that are available for arm- and chest- placed implanted ports. Listed below are all the Gripper Plus Safety Needles that are available at FSH. 1.1mm (19G) X 32mm (1 ¼ in.) – MATCOM 130004* 1.1mm (19G) X 25mm (1 in.) – MATCOM 194630* (used most) 0.9mm (20G) X 25mm (1 in.) – MATCOM 150464 0.9mm (20G) X 16mm (5/8 in.) – MATCOM 193369 1.1mm (19G) X 19mm (3/4 in.) – MATCOM 194629* (for arm) 0.9mm (20G) X 19mm (3/4 in.) – MATCOM 168438 *Asterisk indicates minimum needles to have on hand. Sterile Gloves Demonstration and return demonstration 10 minutes Give everyone a pack of sterile gloves and have them show you how they don the gloves. Vascular Access Team 11/04
  4. 4. Trainer Lesson Plan: CVAD Competency Training Page 4 of 4 What Key Points Sterile Technique Review Review these points: • Nurse dons mask and sterile gloves for procedure. • Patient wears mask if concern about respiratory infection. • The drape in the sterile dressing kit is permeable. Do not allow it to get wet. (Do not squirt saline or lay swab sticks on it.) If it gets wet, it is contaminated and you need to set up another sterile field. • The outer inch margin of the sterile field drape is not considered sterile. • The pre-filled syringes are not sterile. (The solution inside the syringes is sterile.) You will need to put empty sterile syringes in your field and fill them. • Tell learners that there are a few ways to hold the non sterile NS vial without contaminating the sterile field. Some nurses place a sterile 4X4 in the field and use it to hold the vial with the sterile gloved hand. Other nurses turn the vial on its side and hold it in place with an elbow. Some nurses wait to put on the second sterile glove. It is up to the learner to decide what works best – but the sterile field must not be compromised. Competency review and Go over the required supplies. Review the two demonstration – 20 minutes competencies with learners. Drawing Blood, Administering Fluid, and Flushing External-Port Central Venous Access Devices (CVADs) Jugular and Subclavian Catheters, Tunneled Catheters, and Percutaneously Inserted Central Catheters (PICCs), Dialysis Catheters Accessing, Drawing Blood, Administering Fluid, Vascular Access Team 11/04
  5. 5. Trainer Lesson Plan: CVAD Competency Training Page 5 of 5 What Key Points Flushing, and Deaccessing Implanted Central Venous Access Devices (CVADs) Chest and Arm Placement • Emphasize that after drawing blood all blood must be cleared from the catheter for two reasons. Blood in the catheter and/or cap is a great medium for bacteria and remaining blood can clot in the catheter. • Use intermittent flush technique and as much sterile NS flush as necessary to clear the catheter lumens of blood. If unable to clear the cap of blood, simply prime and change it. Learner practice – 15 minutes Instruct learners to use the competencies as a guide for skill practice. Observe, guide practice, and be available to answer questions. Competency demonstration – 10 The competencies are divided into parts, designated in minutes per person. bold, with a YES or NO to the far right. For each part that is completed successfully, simply circle YES. For each part that is not completed successfully, circle NO. Also, check the step/s that were not completed correctly. At the end of the competency are a few questions for you to ask the learner. Indicate on the competency if they were correctly answered. At the very end, certify whether the learner met the criteria for the competency by checking MET or NOT MET. If NOT MET, write your action plan in the space below. It may be something as simple as, “attend the next class and redo the competency.” Total time: 105 minutes plus 10 minutes per person. Vascular Access Team 11/04