Preparation
- Perform hand hygiene
- Decontaminate and disinfect trolley as per local policy
- Gather equipment
- Prepare flush/lock/intravenous lines protecting Key-Parts using non-touch technique
- Proceed to patient area and perform hand hygiene
- Check patient identification and IV fluids as per local policy
- Explain the procedure, and obtain verbal consent
- Ensure patient is in a comfortable position and TIVAD body is accessible
- Perform hand hygiene
- Palpate the TIVAD body, identifying the septum
- Perform hand hygiene
- Set up equipment
- Perform hand hygiene
- Put on PPE including sterile gloves
- Prime non-coring needle
- if TIVAD is to remain accessed, attach needleless connector to non-coring needle and prime with sterile sodium chloride 0.9%
- if TIVAD is to be flushed, locked and deaccessed – prime non-coring needle with sterile sodium chloride 0.9%, needleless connector not required
Access
- Skin antisepsis: clean the skin over the TIVAD body and all skin under the dressing with 2% chlorhexidine and 70% isopropyl alcohol swabstick using gentle friction for at least 30 seconds and allow to fully air dry
- Place sterile drape from dressing pack near TIVAD body to create clean area and ask patient not to touch
- Locate and stabilise the TIVAD body between the index and middle finger and thumb of non-dominant hand
- Inform patient of needle insertion and ask to hold breath (if possible)
- TIVAD access (see diagram below): hold non coring needle in the dominant hand and
- insert at a 90o angle with a firm and decisive action through the skin into TIVAD septum (Key-Site) until needle tip touches the bottom of TIVAD body
- outlet where the fluid exits the non coring needle faces away from where the catheter enters the TIVAD body
- non coring needle sits flush with skin
Diagram of accessing TIVAD

© K Curtis 2021
- Ensure extension tubing and needleless connector remains on sterile drape and Key-Parts are protected
TIVAD patency and flushing
- Assess patency:
Aspiration - blood return:
- attach empty 10 mL luer lock syringe to needleless connector (Key-Part) on extension tubing of non-coring needle
- unclamp non-coring needle extension tubing and aspirate 5 mL blood and discard return, assessing ease of withdrawal. Discard syringe
Injection - flushing:
- attach syringe with sodium chloride 0.9% and inject while assessing ease of flushing - using a pulsatile technique and complete with the appropriate clamp-disconnection technique for the type of needleless connector:
Type of needleless connector |
Completion of flushing technique |
Negative |
clamp PRIOR to finishing flush and disconnecting the syringe |
Positive |
clamp AFTER finishing flush and disconnecting the syringe |
Neutral |
no specific clamping sequence required |
Anti-reflux |
no specific clamping sequence required |
Adults: 20 mL using x2 10 mL syringes or x1 20 mL syringe
Paediatrics: as clinically appropriate - at least double the volume of the TIVAD and attachments or as per adults
If not using a manufactured prefilled syringe with antireflux features, leave small volume e.g. 0.5 mL in syringe to avoid ‘bottoming out’ the syringe.
Patency assessment requires checking both aspiration and injection ability
- Any alteration to either easy (1) blood return or (2) injection:
- primary strategies: reposition the patient, ask patient to take a deep breath, either hold the breath or cough
- check needle is appropriately inserted – refer to step 20
- secondary strategy: for TIVADs flushed and locked with sodium chloride 0.9% , flush with 10 to 20 mL of sodium chloride 0.9% using pulsatile action
- attempt to aspirate blood again
- if still no blood return, discuss with vascular access specialist nurse and refer to CVAD Patency Algorithm
- Proceed to step 25 if TIVAD is being deaccessed or step 26 if TIVAD is being used for prescribed therapy
Locking
- Repeat step 22 c with second 10 mL syringe of sodium chloride 0.9%or locking solution as per local policy. Alternatively use x1 20 mL syringe with 20 mL sodium chloride 0.9% for flushing and locking
Apply dressing
- If TIVAD is remaining accessed, apply dressing ensuring needle and first part of non-coring needle extension tubing is covered and closed.

© K Curtis 2021
- Add date and time strip to the side of the dressing
Connecting IV administration lines
- Disinfect needleless connector (Key-Part): using non-touch technique, scrub the needleless connector with large 2% chlorhexidine and 70% isopropyl alcohol swab for at least 15 seconds (refer to local policy) using vigorous friction and allow to fully air dry
- Using non-touch technique, connect primed IV administration line to the needleless connector (Key-Part) and commence infusion as ordered
- Anchor tubing
Deaccessing TIVAD
- Perform hand hygiene
- Remove dressing using non-touch technique
- Using non dominant hand, stabilise TIVAD body and base of non coring needle between fingers and thumb
- With dominant hand, withdraw needle in firm decisive action and engage the safety mechanism on the non-coring needle. Discard immediately into sharps container
- Place small, sterile dressing e.g. intravenous pressure dot over site for approximately one hour or if CVAD access required – re-access TIVAD as per Step 15 – 27
Procedure completion and documentation
- Discard waste and clean trolley
- Remove PPE and discard
- Perform hand hygiene
- Document the procedure in the medical records