Central Venous Catheters Flashcards
Where do most central lines terminate?
Superior vena cava
What should be monitored once a central line is placed?
arrhythmias, infection, pain
Where are early signs of central line infections seen?
at the site
What are two reasons that patients need a central line put in?
poor peripheral venous access or for long-term IV therapeutics
What are examples of reasons that a patient may have a central line for long-term IV therapy?
high volume fluid administration, medication administration (electrolyte replacement, anti-invectives, chemotherapy), blood transfusions, vasopressors, TPN, plasmapheresis/dialysis
Where is a tunneled CVC placed? Non-tunneled?
OR vs bedside
what is the most common CVC that is placed?
triple lumen catheter: 7 french
What are examples of non-tunneled CVCs?
PICC, IJ, Subclavian, Vascath
What is an example of an implanted CVC?
Port-a-cath (PAC)
What are examples of tunneled CVCs?
Hickman, Broviac, PICC, Subclavian, Permcath
How can CVCs be assessed for patency?
Saline flush and blood return
What can PIVs be used for?
high flow IV fluids, blood products, IV push drugs, and electrolyte replacement
How is a non-tunneled IJ kept in place?
sutured
How are PICC lines anchored?
stitches or StatLock
How are PICC lines flushed?
10mL saline flush
How are PICC lines advanced?
with a guide wire
Before using a CVC, what is important to check?
Chest x-ray has confirmed placement and there is an order by the doctor
What is the biggest complications for CVCs?
DVT
What is a daily assessment for a PICC line in order to ensure a DVT hasn’t formed?
upper arm circumference
When is a femoral catheter used?
In trauma situations and immobile patients
Why do you not need x-ray confirmation to ensure placement of a femoral catheter?
It terminates at the inferior vena cava
What color are the catheters for dialysis?
red and blue
What kind of needles need to be used for an implanted port-a-cath?
non-coring needles (huber)
When are port-a-caths most often used?
for cancer patients
What would a power port be used for?
Rapid injection or CT/MRI with contrast
What is important to place on a central line for infection prevention?
biopatch
How are tunneled central lines anchored?
1-2 cuffs
Who inserts a tunneled central lines?
interventional radiology or operating room
What is a two lumen red and blue line with 1-2 cuffs called?
hickman line (tunneled)
What is the purpose of cuffs on a hickman line?
inhibit microbial growth
What is a triple lumen colored red white and blue called?
VasCath
What influences the selection of CVCs?
Patient characteristics and preferences, patient history and co-morbidities, infusion needs, CVC options (tunneled vs non-tunneled, implanted port)
What can daily site care of a tunneled line increase the chance of?
infection
What should be assessed on a tunneled line daily?
patency, cleanliness, blood return, pain, swelling, integrity of the line
What is included in a CVC assessment?
insertion site, exit site (redness, swelling), patency of each line, integrity of each line, clamps and caps, creates on chest, and pain in arm, shoulder, or neck
What is the common policy for CVC line maintenance if there is no running IV?
SASH (Saline, Administer, Saline, Heparin)
Why is a 10mL syringe always used for CVCs?
it decreases pressure in the catheter
How should IV fluids be administered using a central line?
on a pump
What are the potential complications of CVC insertion?
Pneumothorax, hematoma, infection, air embolism, wrong vein
What is the average cost for each CVC infection?
$46000
What kind of event is a vascular catheter-associated infection?
“never event”
Best practices for preventing CVC infections? (the central line bundle)
Hand hygiene, maximum barrier precautions upon insertion, chlorhexadine, optimal catheter site selection (avoid femoral), daily review of need for a central line
When should a CVC dressing be changed?
when damp, loosened, or soiled
How often should a transparent CVC dressing be changed?
every 7 days
How often should gauze be changed for CVCs?
every 24 hours
What kind of technique is important to use to prevent catheter-related blood stream infections?
sterile technique
What should be used at the exit site?
Biopatch
What should be used for prep for a CVC dressing?
clorhexidine/alcohol prep with friction
How long should the hubs be scrubbed for?
15-30 seconds
4 complications of CVCs
intraluminal occlusion, fibrin formation, venous thrombosis, drug precipitation
