Weekly changing of a bung and administering factor via a Hickman line

This information is for parents and patients who are learning to perform a weekly bung change and administer clotting factor.

Equipment required

• 1x sterile dressing pack
• 6x Clinell 2% alcohol wipes
• 1x bionnector
• 2x pre-filled sterile saline syringes
• Clotting factor
• 1x Hepsal
• 2x blunt fill needle
• 1x filter needle
• 3x Clinell 2% alcohol wipe
• 2x 10 ml syringes

Method

Changing of bung

1. Wash hands.
2. Wipe tray.
3. Clean all tops of Hepsal and vials of factor with alcohol wipe and allow to dry for 30 seconds.
4. Break off ampoule tops of Hepsal, leave on side but not on tray.
5. Make up factor as previously shown.
6. Open dressing pack and place onto clean tray (flat base facing down) and using only the outside edges open up.
7. Without touching any other part of the dressing pack pick up the orange bag (bin) using the edge and shake it open.
8. Without touching the outside of the bag, place dominant hand inside bag like a glove.
9. Using the gloved hand, from the plastic tray inside the dressing pack move the gloves and place them on the side and move the dressing towel to the edge of the dressing pack.
10. Open 5 Clinell 2% alcohol wipes and without touching any of the wipes, drop them onto the dressing pack.
11. Open 2x pre-filled saline syringes and bionnector and drop onto the dressing pack.
12. Wash hands.
13. Put on sterile gloves ensuring that your bare hand only touches the inside of the glove.
14. Unwrap the Clinell 2% alcohol wipe and place them on top of each other
15. Ensure that the bung is accessible in the tray.
16. Open up the dressing towel and without touching the line, slide dressing towel underneath the lumen so that the bung is on the towel.
17. Take a Clinell 2% alcohol wipe in your non-dominant hand and only touching the wipe, hold the line close to the bung.
18. Using another wipe in dominant hand, cover the existing bung and remove, then discard the wipe. Continue holding the line in the non-dominant hand.
19. Take a Clinell wipe and clean the open Hickman line in a circular motion, then discard that wipe. Repeat previous step 2 more times.
20. Whilst keeping hold of the line, pick up new bung from tray and then attach to line.

Administering factor

1. Connect filter needle to syringe and draw up Hepsal. Remove the needle and place back on tray.
2. Draw up factor with syringe and place back on tray.
3. Remove gloves.
4. Wash hands.
5. Put on clean gloves.
6. Clean needleless connector at end of lumen with Clinell alcohol wipe and wait for 30 seconds to dry.
7. Hold Hickman line in non-dominant hand. Insert empty syringe into the end of bionnector
8. Unclamp the lumen and draw back gently until a flashback of blood is obtained.
9. Remove syringe.
10. Insert one saline syringe, and flush approx. 3 to 5ml.
11. Remove syringe.
12. Insert factor into line and administer factor then remove syringe.
13. Insert saline syringe into line and unclamp, administer saline using a pulsating technique, then remove syringe.
14. Insert 3ml of Hepsal into line using a pulsating technique. Finish with a Hepsal flush under positive pressure.
15. Bung change should take place weekly.

Benefits

Parents / patients will be able to perform a bung change and administer clotting factor via a newly inserted Hickman line in their home environment, reducing the need for prolonged hospital admission or the need for paediatric community nurse visits on a weekly basis.

For further information please contact the haemophilia nurse specialists on 01223 257039.