Vascular Access Service (VAS)

We are a nurse led team. Our service provides the insertion of Peripherally Inserted Central Catheters (PICC lines),  Midline Catheters, Non-tunnelled Central Venous Catheters and the insertion and removal of Tunnelled Central Venous Catheters (TCVCs). We also provide advice and support on the care and maintenance of vascular access devices.

• Nicola Wyllie – Senior Charge Nurse
• Maren Hunter – Advanced Clinical Nurse Specialist
• David McGrath – Advanced Clinical Nurse Specialist 
• Niamh Hughes – Clinical Nurse Specialist
• Christian Macdonald – Clinical Nurse Specialist
• Gemma Martin – Clinical Nurse Specialist
• Isabel Soto Martinez – Clinical Nurse Specialist
• Christina Milligan – Clinical Nurse Specialist
• Yumiko Shimokawa – Clinical Nurse Specialist

Vascular Access Contact Details

• Nurse Led Vascular Access Service Email Address:- ggc.nurseled.piccandhickteam@nhs.scot
• Gartnavel General Hospital Telephone: 0141 232 2140 or (32140)
• Queen Elizabeth University Hospital: 0141 452 3587 or (83587)
• Glasgow Royal Infirmary: 0141 956 0587 or (60587)

There is a new corporate led competency package for NHSGGC staff

 If your clinical area requires training on the care and maintenance of vascular access devices –  please identify a device champion(s) and VAS will provide them with a workshop and simulated practice sign off. VAS can then assist with care and maintenance sessions for staff whose competency can then be assessed by the device champion.

Prior to training please ensure staff have completed learnpro modules – 

GGC: 002 Health and Safety, an introduction 

GGC: 007 Standard Infection Control Precautions 

NES: Prevention and Management of Occupational Exposure (within SIPCEP) 

GGC: 329 Vascular Access Devices

For queries regarding support and training on the care and maintenance of vascular access devices please email -ggc.nurseled.piccandhickteam@nhs.scot

• Vascular access devices (VADs), care and maintenance (previously known as ‘VAD Guidelines’)
• RCN Standards for Infusion Therapy
• ANTT® Video

When accessing any vascular access device you must always use ANTT®

Always wash hands effectively

Never contaminate key parts/key areas

Touch non-key parts with confidence

Take appropriate infection control precautions

The key principle to preventing infection is to maintain the asepsis of key parts/sites.

• Key parts – any part of the device which will come into direct contact with the patients bloodstream.
• Key sites – insertion and exit sites
• The key parts can be protected by the use of micro fields such as syringe wrappers.
• There is no need for the use of sterile dressing packs or sterile gloves, unless you are performing a dressing change when it is impossible to apply the new dressings without touching them and sterile gloves are required.

Dressing changes for all central venous vascular access devices must be done weekly (unless visibly contaminated). The dressing, stabilisation device (if PICC line), CHG impregnated foam dressing and needle-free device must all be changed weekly using an adapted ANTT®. Please see page 17 of the NHSGGC ANTT® Clinical Guideline for step by step guidance.

When accessing a vascular access device to flush, aspirate or change the needle-free device you must always ‘scrub the hub’ for 30 seconds. Whilst scrubbing the hub you should concentrate on the flat connective surface but also scrub around the side using wipes that contain Chlorhexidine 2% and Alcohol 70%.

Preventing catheter blockages

Flush immediately after use, use an ANTT® and scrub the hub for 30 seconds before accessing the device.

When flushing a vascular access device, routinely use Nacl 0.9% in a 10ml luer lock syringe and a brisk ‘push/pause’ technique. This creates a turbulent pulsatile flow which clears the lumen of debris. Ensure that you finish the flush by clamping on positive pressure (whilst you are administering the last push) to prevent blood re-entering the device and thus maintaining patency. Flush before, between and immediately after each use.

Please refer to NHSGGC ‘Vascular access device (VADs), care and maintenance‘ document.

Routinely move clamp on PICC and Midline to prevent damage.

Difficultly aspirating catheter

• Valsalva Manoeuvre – ask the patient to take a deep breath, hold and attempt to force out air through closed mouth.
• Change needle-free device using ANTT
• Check the clamp on PICC line, move clamp and massage lumen underneath if crushed. Check to see if the dressing has kinked the catheter near the insertion site.
• Please refer to  Appendix 4: Algorithm for persistent withdrawal occlusion of the RCN Standards for infusion therapy

Please do not remove a blocked PICC until you have spoken to a member of the Vascular Access Team as it may be salvageable.

Peripherally Inserted Central Catheter (PICC)

Suitable for the duration of therapy.

No preparation required, no exclusion criteria (although patient must be able to position arm to enable insertion).

Suitable for all IV medications and short term parenteral nutrition (PN)

CT compatible and Non CT compatible depending on the device.

Tunnelled Central Venous Catheter (TCVC)

Suitable for the duration of therapy.

Not all patients are suitable to attend the Nurse led service as we have an exclusion criteria – (please see referrals section).

The TCVCs we insert are cuffed so they require to be removed by an appropriately trained individual under local anaesthetic.

Midline Catheters

4F 12cm Smart Midline peripheral catheter – last up to 29 days. CT Compatible. Please be aware – blood sampling from midline catheters may result in device failure.

We encourage early referral for a suitable vascular access device to improve patient experience, preserve vessel health and effectively facilitate IV therapy.

Please be aware that this is an extremely busy elective service, covering multiple sites within NHSGGC. We will endeavour to facilitate all referrals as soon as possible. We are not an emergency service, however we will expedite urgent cases if we are able to do so. To discuss referrals please email us on the group email address above.

The Vascular Access Service work Mon-Fri 08:30 – 16:30 and some weekends staff permitting.

Please note : Vascular access is a nurse led service, not all patients are suitable for referral.

Catheter Peripheral Central Venous Catheter (PICC) / Midline Catheter

There is no restrictive exclusion criteria for PICC or midline catheter insertion.

Cuffed Tunnelled Central Venous Catheter (TCVC)

• APTT ratio must be equal to or lower than 1.6
• PT no higher than 16
• Platelets must be above 40 (if platelets between 30-40 VAS will consider placing a catheter with platelets running following discussion with medical staff)
• Low molecular weight heparin (LMWH) must be omitted 24 hours prior to procedure if it is a treatment dose, 12 hours for a prophylactic dose.
• Patient is able to lie flat

Patients not suitable for Nurse led service

• Known venous stenosis, SVC obstruction or central venous stent in situ
• Significant mediastinal disease
• Recent myocardial infarction (within 2 days)
• Pacemaker in situ
• Current pneumothorax

If patient has these symptoms please refer to interventional radiology service.

Patient Referral to the Vascular Access Service

All patient referrals are made via TrakCare.

Please follow the process below:

• Input the patients community health index (CHI) into trak
• Click on Episode Tree
• Select current episode
• Click on ‘New Request’
• Under Imaging:
• For PICC line insertion : Input ‘IPICCI’ into item box
• For TCVC insertion input ‘ITCVCI’
• For TCVC removal ‘ITCVCX’
• For TCVC exchange ‘ITCVCG
• For Haemo-dialysis insertion ‘ ITUNDI’

For insertion of TCVC – all patients must have a recent Coagulation (Coag) and Full Blood Count (FBC) (within 2 weeks provided they have received no treatment)

Patients will be consented by a vascular access nurse. 

All patients must have capacity to consent ( i.e. not given a sedative pre-procedure unless already consented by a member of the vascular access team). 

If the patient has impaired capacity, they must have a separate  Adults with Incapacity (AWI) form specifically for the procedure completed before being transferred to the department.