Central Line care - exam 3 Flashcards
What to report to MD immediately with central lines
o CVP outside ordered parameters
o Inability to correct a dampened waveform
o Impaired circulation
o Catheter dislodgement
o Bleeding or swelling at insertion site
o s/s of infection
How can a central lines patency be maintained?
- NS flush
- Heparin Flush
- Cont IV fluids
- Pressurized flush solution
When monitoring a patients CVP, what can dampened waveforms indicate?
a sign of line malfunction or air or blood in transducer.
What position should a patient be placed in when removing a central line? Why?
Trendelenburg or supine to prevent air embolism
What needs to be done immediately after removing a central line?
immediately cover area with sterile gauze and apply pressure.
After removal of a central line what should the nurse observe for?
- Excessive bleeding
- air embolism
- infection at site
Pre-procedure interventions for central line insertion
- Obtain informed consent
- Position using a towel under the scapula to make insertion site more prominent. Pt should be in Trendelenburg
Intraprocedure interventions for central line insertion
- Experienced provider inserting a line or providing supervision
- Perform a time-out
- Use proper hand hygiene
- Don appropriate attire during insertion to include cap, mask, a sterile gown and gloves, and eye protection
- Prep site with chlorhexidine antiseptic skin prep and let air dry
- Drape patient utilizing sterile technique
- Insert line; maintain sterile technique
- Clean site with chlorhexidine and cover with sterile occlusive dressing
- Optimal catheter site selection (attempting to avoid use of the femoral vein)
- Daily review of the necessity of the line and prompt removal when unnecessary
PPE required for line placement
- cap
- mask
- a sterile gown and gloves
- eye protection
When inserting a central line, what is the insertion site cleaned with?
Chlorhexidine
What vein should be avoided when inserting a central line?
Femoral vein
Post procedure nursing interventions for central line insertion
- Catheter secured by a suture and a occlusive dressing
- Central line position must be verified by CHXR prior to use
Ways to minimize risk of infection for a patient with a central line
- Use aseptic technique with any line care,
- Minimize line handling
- Maintain an occlusive dressing
- Daily evaluation of line necessity and prompt removal when not necessary decreases infection risk
Correct procedure to draw blood specimens for a central line
- Wash hands
- Put on gloves
- Identify patient
- Mask on
- Assess port (draining , bleeding or pain)
- Unclamp port line
- Wipe hub for 15 seconds w/cholerhexine or alcohol pads
- Connect flush
- Aspirate for blood return
- Push 10 ml of NS using push/pause method
- Aspirate 5ml then discard
- Wipe hub for 15 seconds
- Connect 10 ml empty syringe / draw back blood 5-6ml
- Wipe hub for 15 seconds
- Flush with 20ml of NS
- Wipe hub for 15 seconds
- Flush last 10 ml of NS
- Wipe hub for 15 seconds
- Clamp port line
