Central Lines & TPN

Question 1

A central venous device is placed into the venous system and threaded into a ___ ___.
Is it usually superior or anterior?

Answer 1

• vena cava

- superior

Question 2

When is the inferior vena cava used?

Answer 2

when access is gained through the femoral vein –> emergency

Question 3

What are 5 indications for placement of a central venous catheter?
What should be considered for this therapy?

Answer 3

• IV fluids : long/short term, poor venous access, emergency
• Chemotherapy / irritating drugs
• hemodynamic monitoring
• venous blood sampling : poor venous access
• parenteral nutrition
• you should consider if the benefits out weight the risks, and continue to assess this frequently

Question 4

What are the 4 types of central lines?

Can you go home with them?

Answer 4

• non tunneled catheter : short term –> cannot go home with this
• tunneled catheter : can go home
• PICC line : can go home
• implanted port : can go home

Question 5

More lumens = __ (larger or smaller) line = __ (inc or dec) risk fo infection

Answer 5

more lumens = larger line = inc risk for infection

Question 6

Can you give medications that are not compatible is separate lumens of the same line?

Answer 6

Yes - each lumen has its own individual line

–> should not give at the same time

Question 7

PICC line

• __ (inc or dec) risk form pneumothorax? Why?
• __ (inc or dec) risk fo SVT / DVT?

Answer 7

• dec risk for pneumothorax b/c inserted into the arm

- inc risk for SVT/DVT in the arm where the line is placed

Question 8

When can a PICC line be uncovered?

Are dressing changes for PICC lines clear or sterile? How often should we change the dressing?

Answer 8

• should always be covered, will immediately replace dressing during dressing change
• sterile dressing change
• change dressing every 7 days or PRN

Question 9

What type of central line has the highest risk for infection?

Answer 9

non tunneled central line

Question 10

Where can a non tunneled central line be inserted?

Answer 10

• into the jugular vein

- into the subclavian vein

Question 11

Describe the placement of a tunneled central line

Why is this type of placement beneficial?

Answer 11

entry site is further from the venous system, it is threaded through Sub Q tissue and then enters the subclavian vein, and is threaded to the superior vena cava
- this is beneficial because the line does not directly enter the blood –> dec risk of infection

Question 12

When is a non tunneled central line typically placed?
large or small bore?
How long can it remain in place?
Is care for the insertions site clean or sterile?

Answer 12

• emergency
• large bore –> increases the risk for infection
• no standard for how long it can stay in but should be removed ASAP bc of high infection risk
• STERILE

Question 13

Describe the dressing care for a tunneled CL

Answer 13

• dressing for the first 10 days after placement
• after 10 days can wash with soap and water
• should inspect daily for s/s of infection

Question 14

Describe the placement of an implanted port

Answer 14

lumen(s) is placed in a subQ pocket under the skin in the chest, the catheter then enters the vein and is threaded into the vena cava

Question 15

How is the lumen of an implanted port accessed?

What should be done for infection control after the lumen has been accessed?

Answer 15

• need a special needle to puncture the reservoir and install the medication
• the port should be covered after it has been accessed

Question 16

What are 9 risks of having a central line?

Answer 16

1. CLABSI : central line associated blood stream infection
2. bleeding : after insertion (not during)
3. arrhythmias : typically the catheter is too far and tickling the atria
4. occlusion
5. dislodgment
6. migration
7. air emboli : esp when taking out
8. pneumothorax : esp subclavian non tunneled
9. thrombosis : mc with PICC lines

Question 17

What is the max lbs/in^2 a central line can tolerate?

B/c of this we should use a __ (large or small) syringe?

Answer 17

• max is 25 lbs / in^2

- should use a large syringe –> never less than 10 mL

Question 18

What if pharmacy sends a medication to be administered via central line in a 5 mL syringe?

Answer 18

Ensure the line is flushing REALLY well, give the medication, flush with an appropriate size syringe after med administration

Question 19

What is TPN?
What is the mixture made of?
What needs to be added in addition to TPN to have total parenteral nutrition?

Answer 19

• TPN = parenteral nutrition
• mix of : amino acids, electrolytes, and dextrose
• total parenteral nutrition = TPN + lipids

Question 20

What type of line is required for TPN?

Can it be administered though a line that is also being used for medication administration?

Answer 20

• only administered through a central line

- needs to have its own lumen : the only thing it can be infused with is lipids

Question 21

What are the 2 general indications for TPN?

Who decides how much for how ling and content?

Answer 21

• indications : (1) pt does not have a function GI tract, (2) pt needs complete bowel rest
• nutrition decided the content, time, and amount

Question 22

What are the risks associated with TPN? (6)

Answer 22

1. infection : central line AND high dextrose content
2. hyperglycemia : check CBG regularly
3. hypoglycemia : abrupt cessation / come off
4. liver failure : lipids are not given
5. fluid overload
6. referring syndrome : in pts who are severely malnourished –> feed too much too fast (can kill them)

Question 23

You should titrate/wean TPN based on __ __.

Answer 23

institution policy

Question 24

If a pt is on TPN and insulin, and you stop the TPN should you continue or stop the insulin?

Answer 24

you should stop the insulin so the pt does not become hypoglycemic –> TPN has a high dextrose content which may require insulin to control blood glucose

Question 25

How long can you hang TPN?
What size filter does it need?
What else does the line need?

Answer 25

• can hang for 24 hrs
• nees a 0.22 micron filter
• line also needs to be labeled

Question 26

How long can you hang lipids?

What size filter should be used with lipids?

Answer 26

• can be hung for 12 hrs

- need a 1.2 micron filter

Question 27

What types of pts would not receive lipids with TPN? (4)

Answer 27

• obese
• high triglycerides
• acute pancreatitis with hyperlipidemia
• receiving propofol