Central Venous Catheters Flashcards
Why would someone need a CVC?
When pts are in need for long-term infusion therapy, or because their condition or disease processes require special types of meds or treatments; commonly inserted peripheral IV therapy may not be practical.
Where does the tip of a central venous catheter lie?
Tip lies in the Cavo-Atrial Junction
What are the four devices that can be used for central venous therapy?
Centrally inserted catheters
Peripherally inserted catheters
Centrally inserted ports
Peripherally inserted devices
What are the major indications for central venous therapy?
Inadequate peripheral access
Complex treatment regimes
Hyperosmolar infusions
Infusion of irritating or vesicant drugs
What are some other indications for central venous therapy? (Besides the major indications)
Rapid absorption and rapid blood and tissue perfusion
Long-term IV therapy
Patient preference
What are some considerations when deciding on insertion of a central venous catheter?
These are mainly related to patient condition, underlying disease processes, and/or anatomical structural deviations or pathologies Other considerations IV drug users Confused Potential need for dialysis (permacath)
What are the usual sites for insertion of a central venous catheter?
Subclavian vein
Internal or external jugulars
What is a less frequently used site for central venous catheter?
Femoral access (This is less common because it’s easier to get an infection. It’s usually reserved for emergency situations, and the goal is to re-site within 48 hours).
What are some peripheral access sites for central venous catheters?
Basilic, cephalic & median cubital
What are some characteristics of centrally inserted catheters?
Flexible, single or multiple lumen catheters
Open or closed ended
Valved or non valved
Short term or long-term
What are two types of short term central venous catheters?
Percutaneous (non-tunneled, non-cuffed)
Midline
What are three types of long-term central venous catheters? (and brand examples)
Tunneled (i.e. Hickman, Broviac, Groshong)
Implanted Vascular Access Device (IVAD)
Peripherally Inserted Central Catheters (PICC) (i.e. Groshong, power PICC, Solo)
What are the numbers of lumens available for central venous catheters?
Single, double, triple, or quadruple
Can incompatible meds be infused simultaneously through separate lumens of the same central venous catheter?
Yes. Incompatible meds can be infused simultaneously via separate lumens. Each lumen must be treated as a separate catheter.
What is the suggested use for the proximal lumen (in a triple lumen CVC)?
Medication administration
What are the suggested uses for the medial lumen (in a triple lumen CVC)?
TPN, medication or fluid administration
What are the suggested uses for the distal lumen (in a triple lumen CVC)?
Blood administration, high volume fluids, medication, CVP monitoring, Blood sampling
What are the characteristics of an open-ended CVC?
Catheter is open at the distal end
Requires clamping before entry into the system
Clamps are usually present
Any type of CVC can be open ended
What are the characteristics of a closed-ended CVC?
Valve is present at tip or hub of catheter
Valve stays closed except when aspirating or infusing
Clamping is not required
What do we use to flush open ended CVCs?
Requires SALINE (some still require low dose heparin)
What kind of CVC’s can be open ended?
Any type of CVC can be open ended
What type of CVCs can be closed-ended?
May be present on tunneled CVC’s, IVAD’s, PICC’s
Is clamping required for a closed ended: distal valve CVC?
Clamping is not required
Is clamping required for an open-ended: proximal valve CVC?
Clamping is not required
What are the advantages of short term catheters?
All types of therapies can be administered
Multiple lumens, larger diameter of lumens
Economical
Preserves peripheral veins
What are the disadvantages of short term catheters?
Highest risk of infection and post insertion complications
Not for home therapy use or long term use
Can be easily dislodged
What is a tunneled long term catheter?
Inserted by percutaneous venipuncture or surgical cutdown
Can be open ended or valved (closed)
A portion is tunneled through the subcutaneous tissue from the exit sited to the insertion site
Has a Dacron cuff positioned in the subcutaneous tissue (2-5cms from exit site) to minimize the risk of infection and to promote securement of the catheter
What are some characteristics of long term catheters?
Generally a tunneled or implanted device/port
Made of soft, medical grade silicone
Dracon cuff near the exit site
Surgically inserted via percutaneous cutdown
Can be single or multilumen
Can last months to years
What are some advantages of tunneled long term catheters?
Designed for long term therapy
All types of therapies can be administered
External segments can be repaired
Can be single or multi lumen
Low infection risk
No dressing required once insertion site healed
What are some disadvantages of tunneled long term catheters?
Surgical procedure to insert and remove (IR or OR)
Can impact body image (external device)
Removed by physician/surgical procedure
What are the parts of a long term catheter: implanted port?
Consists of a portal body, septum, reservoir and catheter
Is a implanted port (long term catheter) open ended or closed ended?
Can be open ended or valved (closed) ended
How is an implanted port inserted?
surgically inserted
How is an implanted port accessed?
Accessed aseptically using a non-coring needle (Huber)
How many punctures can the septum of an implanted port withstand?
up to 2000
Where can implanted ports be implanted?
Implanted ports can be implanted into a vessel, organ, or body cavity
What are the advantages of implanted ports? (long term catheters)
All types of therapies can be administered
Can be single or double port
No activity restrictions when not accessed
Body image intact
Monthly flushing when not in use
What are the disadvantages of implanted ports? (long term catheters)
Surgical procedure to insert
Requires weekly needle access when
In use
Where is a PICC line inserted?
Inserted into peripheral vein and threaded into the superior vena cava
How many lumens does a PICC line have?
Can be single, double, or triple lumen
Are PICC lines open or closed ended?
Can be either open or closed (valved)
How is a PICC line kept in situ?
Can be sutured or steri-stripped in situ
Who inserts a PICC line?
Inserted by specially tained RN
What is the life expectancy of the extension tubing of a PICC line? (How long does it stay there)
Extension tubing attached at insertion remains for the life of the catheter, if a repair is needed and the tubing is removed, the extension tubing must be changed weekly with the dressing change
What are the advantages of a PICC line? (long term catheter)
All types of therapies can be administered
Soft, flexible
Less potential for insertion complications
Less expensive
What are the disadvantages of a PICC line? (long term catheter)
Not appropriate for high volume or rapid infusions, preexisting skin conditions, trauma or burns
May not be able to withdraw blood samples
(4fr Gauge)
Some activity restrictions
What should the nurse do before insertion of a PICC line? (Insertion protocol)
Patient preparation
Who’s responsible for what
What is the insertion protocol during a PICC line insertion?
Position Site choice Local anesthetic Insert large bore needle Needle removed-guidewire Catheter threated over guidewire – guidewire removed Sutured and dressed
What are some complications of PICC line insertion?
Insertion procedure related Air embolus Infection Occlusion Migration/dislodgement, device malfunction
What are some insertion procedure related complications of PICC line insertion?
Cardiac dysrhythmias Pneumothorax Bleeding Hematoma Hemothorax Catheter malposition Venous thrombosis
What are three nursing responsibilities for CVC?
Documentation
Care and maintenance
Patient teaching
How often should a Central venous catheter be assessed?
On admission, at the beginning of each shift, and Q4h and PRN
What should be assessed on a central venous catheter?
Dressing secure and dry
Condition of site (inflammation, drainage, edema, bleeding, bruising)
Palpate site (infiltration, subcutaneous emphysema)
Check system (luer locked, catheter intact and secure, correct solution and rate, no migration/rotation of port)
Measurement of external segment minimum daily assessment
How should the nurse prepare the site for a Central Venous Catheter insertion?
Chlorhexidine Gluconate 2% in 70% alcohol used as skin preparation solution, allow to dry completely.
Clean an area larger than the dressing
Cleanse from insertion site outward using friction scrub
Skin prep solution used once CHG dry; avoid area where CHG pad (on dressing) will occupy
What is the purpose of a CVC dressing?
Dressing protects the site and stabilizes the device
What kind of dressing is applied to a CVC, and how often is it changed?
Upon insertion, a CHG impregnated TSM dressing is applied
Change initial dressing in 6-7 days and prn
Subsequent dressings may be non-CHG
Are dressings applied to tunnelled CVCs?
Yes, they are applied to tunneled CVCs while in acute care.
What does a CVC dressing cover?
Dressing must cover the insertion site and extension tubing attachment.
Is a CVC dressing change a clean or sterile procedure?
Sterile
When should a clamp be used on a central venous catheter?
Clamps must be used when accessing and de-accessing an open ended catheter to prevent air embolism or blood back flow
When are open ended catheters clamped?
Open ended catheters are clamped at all times when not in use.
When are clamps not used in central venous catheters?
Clamps are not used on valved CVCs
What kind of clamp should not be used on a central venous catheter?
Do not use a hemostat or sharp edged clamp that may damage the CVC
What should you do if there is no clamp present on an open central venous catheter?
If no clamp is present, have the patient perform the valsalva maneuver whenever the system is open.
How often are commercially prepared IV solutions changed? (Central venous therapy)
Commercially prepared IV solutions and medications (i.e. RL, NS, heparin) are changed minimum of q96 hours
How often are IV solutions and medications prepared by pharmacy changed? (central venous therapy)
IV solutions and medications prepared by pharmacy (i.e. Travesol) will be changed minimum Q24 hours
How often are IV solutions and medications prepared by nursing changed?
IV solutions and medications prepared by nursing (i.e. toradol, pantoprazole) are changed minimum Q24 hours
What are two requirements for infusions through CVC? (Safety requirements/mechanisms)
Infusion control device used for all infusions via a CVC
All connections are to be luer locked.
When should a central venous catheter be flushed?
Prior to each intermittent infusion to access patency
After each infusion to prevent mixing of medication
After blood sampling
Routinely to ensure patency
All lumens post injection of contrast media
Flush all unused lumens at specific intervals.
What method should be used to flush a central venous catheter?
Use a turbulent flush method (push/pause)
What size syringe should be used to flush a central venous catheter?
Always use a 10 mL (or greater) syringe for flushes as the PSI is lower than smaller syringe.
What should the central venous catheter line be flushed with?
Normal saline or heparin depending on CVC
How often should primary IV administration tubing be changed? (Central venous catheters)
Date and change primary tubing every 96 hours
How often should secondary IV administration tubing be changed? (Central Venous Catheters)
Date and change secondary administration tubing every 24 hours.
How often should lipid-based IV solution tubing be changed? (Central Venous Catheters)
Lipid based solutions (i.e. lipids for PN) tubing changed Q6-12 hours
How often should blood infusion IV tubing be changed? (Central Venous Catheters)
Changed after each 4 units of blood or Q4 h (whatever comes first) if administering blood transfusions
When should portless IV tubing be used for a central venous catheter?
Portless IV tubing should be used for any primary medication infusion (antibiotics, pantoprazole)
What kind of injection caps are used for all PIV and CVC?
Neutral displacement caps are used for all PIV and CVC
When are caps not required for a central venous catheter?
Caps are not required for continuous IV infusions.
How often are injection caps changed for central venous catheters?
Changed q96 hours and prn
If removed for any procedure or to administer therapy
With any signs of damage
If any blood or precipitate present
When should we use sterile technique when dealing with central venous catheters?
Masks, sterile gloves, aseptic procedure if site exposed or catheter lumens open
When should we document about the central venous catheter?
Insertion
Daily/ongoing
Catheter removal
