Module 6: Central Catheters Flashcards
Types of Central Catheters
Central catheters are identified by
location, type, indication, and tip
location. Types of central catheters
include:
- PICCs; inserted into the pa-
tient’s arm with the tip termi-
nating in the superior vena
cava, these may be indicated
for both short- and long-
term therapies (up to 1
year or so) - nontunneled catheters
- tunneled catheters
- implantable ports
- dialysis catheters
**May be open ended or valved
**May or may not be power injectable
**Vary in number of lumens (1-4)
**Vary in French Size (Fr 4-14)
**Either a straight or reverse taper on distal portion
-Tapered catheters are wider at insertion site
-Type of catheter used depends on therapy required (TPN, lipids, etc)
Once it is determined that central Cath is needed, then the size is chosen. Using ultrasound allows vein size measurement to ensure appropriate size Cath to allow blood flow around it. Too large = arm swelling and DVT
Nontunneled Catheter
-A nontunneled catheter typically is
inserted in the neck, chest, or groin
using the internal jugular or subcla-
vian vein or, in emergencies, the
femoral vein.
-If the patient is
chronically ill or other veins are
hard to access, the catheter may be
placed in another vein, such as the
translumbar vein.
-Indicated for acute short-term
conditions, nontunneled catheters
come with single, double, triple, or
quadruple lumens and in multiple
sizes (14 to 22 G). The Centers for
Disease Control and Prevention
(CDC) doesn’t recommend their
routine replacement.
-Patients should be assessed daily to determine if they still need the catheter, and remove it if it’s no longer needed
Tunneled Catheter
-A tunneled catheter must be insert-
ed invasively to help secure it and
promote longevity. It has a cuff that
stimulates tissue growth and helps
hold the catheter in place; the
catheter is positioned with the cuff
2 to 4 cm from the insertion site. A
retention suture sometimes is used
to hold the catheter until the tissue
grows around this cuff, which takes
1 to 4 weeks. The remaining
catheter portion is exposed but pro-
vides external access to eliminate
needle sticks. The exposed portion
requires daily to weekly mainte-
nance and must be protected from
being pulled or getting wet
Implantable Port
-An implantable port (also called a
portacath or subcutaneous implant-
ed port) is attached to a reservoir.
The entire catheter and reservoir
are placed surgically or locally be-
neath the skin, allowing the patient to shower and bathe without restrictions.
-Implantable ports come
with single and dual lumens. To ac-
cess the catheter, the skin is pierced
with a special noncoring needle.
Dialysis Catheter
Not used routinely for access, a
dialysis catheter may be used in a
life-threatening emergency if no
other access is available. It’s insert-
ed in the neck or chest through the
internal jugular or subclavian vein
(or in some cases, the femoral
vein).
-It may be tunneled or non-
tunneled, depending on urgency of
need, patient’s diagnosis, and ex-
pected duration of use. Nontun-
neled dialysis catheters are used for
short-term acute treatment or until a
more permanent tunneled catheter
can be placed. Some manufacturers
have added an extra lumen to allow
I.V. medication administration; this
lumen requires the same mainte-
nance as any central-catheter lumen.
A dialysis catheter is accessed,
cleaned, and flushed differently
than other catheters; If your
patient has a dialysis catheter, as-
sess the site carefully to check
whether the dressing is clean, dry,
and intact.
-Be aware that in some
facilities, a dialysis catheter is
packed with a solution, such as
normal saline solution, citric acid,
alteplase, or large heparin doses.
When the catheter is accessed, the
packing solution must be removed
first; afterward, the dialysis team (or
other specialty team) must be
called to repack the catheter.
Care and Maintenance
- Hand hygiene
- maximal barrier precautions, in-
cluding a large sterile drape cov-
ering the patient head to toe
(with a small opening at the in-
sertion site) and head covers,
masks, sterile gowns, and gloves
for all personnel directly in-
volved in line insertion - chlorhexidine skin antisepsis at
the insertion site - optimal site selection; the insert-
ing clinician reviews risks and
benefits of line placement in the
various veins - daily review of the need to con-
tinue the central catheter
Skin Antisepsis
-Skin antisepsis at the insertion site is
crucial to CLABSI prevention.
-Disinfect the skin with an appropriate an-
tiseptic at each dressing change. The
CDC recommends a chlorhexidine
preparation stronger than 0.5% in
70% isopropyl alcohol.
-Scrub back and forth for 30 seconds and let the
site dry completely (which may take
30 seconds to 3 minutes). Don’t ap-
ply the dressing until the prepara-
tion has dried, to avoid skin irrita-
tion and redness under the dressing.
-If the patient can’t tolerate chlorhex-
idine, clean the skin with tincture of
iodine, an iodophor preparation, or
70% isopropyl alcohol
Dressing Changes
-Change a transparent dressing every 7
days; change a gauze dressing
every 48 hours.
-If the dressing is no longer in-
tact, is oozing, or has become
bloody or contaminated, change it
as soon as possible. Apply an im-
permeable cover before the patient
takes a shower or bath to protect it
from direct contact with water.
-Manufacturers make covers specifi-
cally for central catheters to keep
dressings dry in the shower. If the
dressing gets wet and is no longer
intact, change it to prevent infec-
tion
-Chlorhexidine sponges or dress-
ings and silver patches provide
continued antisepsis under the
dressing. If your facility’s central
catheter infection rate hasn’t de-
creased despite adherence to ba-
sic prevention measures, use a
chlorhexidine-impregnated sponge
for temporary short-term catheters
in patients older than 2 months, per
CDC recommendations
Securement-device changes
A central catheter must be stabi-
lized to prevent dislodgment, mi-
gration, damage, and pistoning
(back-and-forth motion within the
vein, which can damage the intima
and cause phlebitis and infection).
Many physicians suture catheters in
place to stabilize them and prevent
malpositioning.
Clean the sutures
when changing the dressing, noting skin redness around them. Reddening may warrant suture replacement with a sutureless-securement device, which can help prevent catheter malpositioning and pistoning. Replace securement devices during
dressing changes
Tubing Changes
For continuous medication or fluid infusions, don’t disconnect the tubing
from the patient; change it every 72
to 96 hours.
Tubing that’s disconnected from
the patient or the main I.V. tubing
is considered intermittent and
should be changed every 24 hours
Red blood cell components expire 4 hours
after the catheter is accessed when
transfused through a 170- to 260-
micron filter. If one unit of blood
takes 4 hours to infuse, change the
tubing before starting the second
unit.
Recommends changing the tubing:
* every 12 hours for lipid products
* every 24 hours for parenteral nu-
trition products with lipids or that
have a Y-connection for lipids
* every 72 to 96 hours for parenteral nutrition without lipids.
Changing IV Cap
CDC says - change with tubing no more than every 72 hours
Always change when clotted/contaminated
Some facilities may require cap changes every 12 to 24 hours, others every 72 to 96 hours, and some with each dressing change
When changing the cap, be sure to prime the new cap with saline solution and clean the catheter hub. Despite the minimal flush volume of I.V. caps, introducing air into the line puts the patient at risk for air embolism.
Flushing of Central Catheters
All central catheters should be
flushed with normal saline solution
before and after medication admin-
istration. Flushing frequency varies
with catheter type. Nonvalved
catheters require more frequent
flushing, with recommendations
varying from every shift to every
day. Follow your facility’s guide-
lines on flushing frequency.
Valved catheters - once weekly flushing when not being used to administer meds/fluids
Failure to flush can cause occlusion
Routine flushing - 10mL Normal Saline
When withdrawing blood - 20mL Normal Saline
Viscous solutions like lipids or parenteral nutrition - 20ML normal saline
Factors Associated with Increased CLABSI Risk
- Prolonged hospitalization before catheterization
- Prolonged duration of catheterization
- Heavy microbial colonization at the insertion site
- Heavy microbial colonization of the catheter hub
- Internal jugular catheterization
- Femoral catheterization in adults
- Neutropenia
- Prematurity (ie, early gestational age)
- Reduced nurse-to-patient ratio in the ICU26,27
- Total parenteral nutrition
- Substandard catheter care (eg, excessive manipula-
tion of the catheter) - Transfusion of blood products (in children)
B. Factors associated with reduced risk. - Female sex
- Antibiotic administration
- Minocycline-rifampin-impregnated catheters
