Central lines Flashcards
purpose of central lines
his osmolarity IV therapy, prolonged therapy, frequent blood work and transfusions, pressure monitoring, incompatible meds
high osmolarity therapy percentage requiring central line
more than 10% dextrose, 5% protein electrolytes, TPN, hypertonic solutions
hypertonic solutions
D5 NS
D5 LR
D10 W
D5 1/2 NS
3% NaCl
25% albumin
PICC
peripheral inserted central catheter
- good for up to a year
- can be inserted at bedside or surgically
- X-ray required prior to use
best location site for PICC
basilic
- on upper arm; ulnar side
open picc line
“power picc” “arrow”
- has clamps
closed picc line
“groshong” “power picc solo”
- has valve
- no clamps
locations for central lines
basilic, brachial, cephalic, peripheral, internal jugular, subclavian
- all rest in superior vena cava
non-tunneled central line
short term
- multiple lumens
- highest risk of infection
non-tunneled central line use
urgent and short term
non-tunneled central line insertion
inserted at bedside but require x-ray prior to use
tunneled central line
secured via dacron cuff and fibrous tissues grows into it
- lowest risk of infection
- named as “broviac” or “hickman”
tunneled central line use
long term (1-3 years)
tunneled central line placement
requires surgical placement and removal
IVAD
inserted in the OR and is placed under the skin
- long term (1-3) years
accessing IVAD
only access using huber point needle
needle change for IVAD if accessed
needle must be changed every 7 days
needle change for IVAD if not accessed
needle must be changed every 30 days
dressing change
measure to make sure line dosent move
- change every 7 days using tegaderm and 24 hours post insertion
- sterile technique
site assessment frequency for central line
assess every 4 hours when inserted and after that every shift
indications for flushing
before infusions, prior to meds, blood sampling, after disconnection, prior to locking
- flush with 20ml
locking frequency for non tunneled
every 24 hours
locking frequency for tunneled
every 7 days
locking frequency for picc
every 24 hours
locking frequency for IVAD
every 30 days
flushing solution for closed PICC and tunneled
NS 10ml
flushing solution for non valved
NS 10ml, heparin 5ml, sodium citrate 3ml
cap connector change
no more than 4 days and at least every 7 days
- prior to collection of blood culture from CVAD
pinch off syndrome
get stuck between clavicle and first rib
S&S of pinch off syndrome
positional occlusion, difficulty flushing/aspirating
treatment for pinch off syndrome
raise arm and forceful flush
catheter valves
reduce risk of blood reflux and occlusion
distal port of multilumen CVAD
longest tube; 18 gauge
- CVP monitoring
medial port of multilumen CVAD
18 gauge; “meals”
- where we put TPN
- or medication if not on TPN
proximal port of multilumen CVAD
shortest tube; 16 gauge; “poke”
- blood sampling
- put medication in
- blood administration
