Indwelling Subcutaneous Catheter Flashcards
What is a sub cut line
-Catheter that gets inserted into the subcutaneous tissue (instead of a vein)
-For the purpose of rehydration or med admin
-May be used when oral route cannot be used, when multiple subcutaneous injections are required, or when establishing an IV is difficult or impractical
Another term for sub cut line
Subcutaneous butterfly catheters
Inserting Subcut Line
-Easy to insert, easier than IV as you do not need to be as precise
-An order is required, cannot decide to insert
-Small gauge needle is inserted into sub cut tissue (yellow gauge = 24 gauge)
Sites for Subcut insertion
-Abdomen, upper outer arm, upper thigh preferred sites
-Subclavicular area and upper back could also be used when the preferred sites are not suitable
-Upper back may be used for a confused patient who is grabbing at the line
-When selecting site, avoid rashes, bruising, scar, inflammation, edema, masses, tenderness, and bony prominences
How to Insert Sub Cut Line
-Cleanse site with CHG/alcohol swab using friction
-Rotate white safety barrel to loosen needle inside catheter
-NO NEED TO PRIME DEVICE PRIOR TO INSERTION (small amount of air is fine)
-Remove protective shield, then using thumb and index finger, pinch skin and tissue around insertion site
-Grasp pebbled side of wings with bevel up and insert entire length of catheter at 30-45 degree angle
-Remove catheter if flashback of blood noted
-Stabilize wings and grasp safety barrel and oil in a straight continuous motion to remove needle
-Replace existing injection cap with a needle less connector, prime needless connector first
-Instill 0.5ml saline flush into tubing
-apply special label indicating sc line to ensure sc line is not mistaken for an IV catheter
SC line and blood flash back
-Because the catheter is supposed to be in the SC tissue, there should not be flashback in the catheter at any time
-Remove the catheter if blood flashback noted as that means the catheter has migrated into a vessel
Medication Admin into Subcut Line
-Max volume for meds is 2mL followed by 0.5mL flush (optimizes absorption and comfort)
-Once administered elevate for effect in 10-15 minutes
-Site should be assessed q8h and can dwell as clinically indicated up to 7 days
-When meds are incompatible use separate Subcut lines
-Sometimes a Subcut line will be dedicated to one type of med and will be labelled as such
-Both heparin and insulin cannot be administered into a Subcut line because these drugs require rotation sites
Maximum rate for continuous med admin for SC lines
10ml/hr
Assessment of SC line
-Assess for edema, redness, pain/tenderness, induration/hardness, bruising, blood flashback, heat, necrosis, and blanching
Hypodermoclysis
-Subcutaneous infusion of fluids for purpose of rehydration
-Used for patients with limited IV access, palliative care patients, and patients with mild dehydration (moderate to severe would be treated with IV)
-Mostly used in older adults, palliative and peds environments
-Can give up to 1.5L in 24 hours
-Maximum rate of infusion is 50ml/hr
-Rotate sites every 24-48 hours or after 1.5L has infused
Sub cut line VS IV catheter
-SC line is in fat tissue, IV is in the vein = different site selection & infusion volumes
-Never should see flashback in Subcut, must see in IV
-Subcut lines require special labelling
-Do not need to prime Subcut lines prior to insertion
-Both have same skin prep, needleless connector and dressing
-Do not need to check patency in SC lines, only flush after using
