central venous catheters

NUR 140:

NUR 140 Central and Peripherally placed vascular access devices and advanced medication delivery systems Karen Larson, MBA/TM, MSN, RN

Reasons For Inserting Central Venous Catheters:

Reasons For Inserting Central Venous Catheters Limited vascular access Administration of highly osmotic or caustic fluids or medications Frequent administration of blood and blood products Frequent blood sampling Measurement of CVP Hemodialysis

Types Of Central Venous Catheters:

Types Of Central Venous Catheters Nontunneled central catheters Tunneled central catheters Peripherally inserted central catheters (PICC) Implantable ports

CVC –LINE PLACEMENT:

CVC –LINE PLACEMENT Large vein in the neck (internal jugular vein) Chest ( subclavian vein) Groin (femoral vein)

Nontunneled Central Venous Catheters:

Nontunneled Central Venous Catheters Used for short-term therapy Inserted percutaneously Subclavian vein- preferred vein, easier to access, less risk for infection Internal/external jugular vein- difficult to secure dressing increase risk for infection Femoral vein- risk for bleeding, risk for infection, thrombosis, phlebitis Has from 1 to 4 lumens or ports Usually from 6 to 8 inches in length

Potential complications line placement:

Potential complications line placement Air embolism- in adult lethal dose of air 70 to 150 ml, can be as little as 10 ML. -teach patient valsalva maneuver if not contraindicated. Pneumothorax Arterial laceration Catheter Embolism Cardiac Tamponade Local Infection Sepsis Thrombosis

CVC:

CVC When central line is not in use be sure to clamp pigtail. The ports of multilumen CVCs should be labeled. -distal port- CVP monitoring (largest lumen, closet to the heart. -proximal Port- Blood sampling (medications and blood compoinent administration) -medial- TPN (prevention of catheter related infections) - Fourth lumen- infusion of fluids/medications

CVC:

CVC CVC dressing is changed every 7 days if you are using a transparent dressing. Change it every 48 hours if you are using gauze or Telfa island dressing and tape. If the dressing becomes wet or loose, change it even if it is not the normal time to change it.

CVCs:

CVCs Administer fluids using an electronic infusion pump. Never use a syringe less than 10 ml to flush line, use push-pause method when flushing, administers 1 to 2 ml with each push If institution allows heparin flush the heparin solution used is 100units/1ml Drawing blood from CVC- usually done by RN, Flush with 10 ml saline, fluids containing glucose or electrolytes off at least one full minute, after drawing blood flush with at least 20ml saline to remove blood from pigtail or the cap. Remember to discard the first 5 to 10 ml.

Removal and Discontinuation of CVC:

Removal and Discontinuation of CVC RN may take out once physician has written the order Position bed in trendelenburg or flat- to raise intrathoraicc pressure, which reduces chance for air entry into system and embolism Prevent air embolism- place 4X4 gauze over exit site, instruct patient to perform the valsalva maneuver. Hold pressure over the exit site for 1-5 minutes after the catheter is out

Discontinuing A CVC:

Discontinuing A CVC Follow the institution’s policy and procedure For percutaneous internal jugular or subclavian insertion sites, place patient in trendlenburg position and have him perform the Valsalva maneuver Remove cath and apply pressure with an occlusive dressing over a petroleum gauze Check cath to ensure tip is intact Document how patient tolerated procedure, placement of dressing and cath tip intact

Central Venous Tunneled Catheters:

Central Venous Tunneled Catheters Surgically inserted via percutaneous cutdown under local or general anesthesia Catheter advance into the vessel and is placed in the superior vena cava, subcutaneously tunneled to an incisional exit site on the anterior or posterior trunk of the body Insertion and removal are surgical procedures performed by a physician

Different Types Of Tunneled CVC:

Different Types Of Tunneled CVC Hickman catheter Groshong catheter- pressure sensitive valves allow to stay closed when not in use no reason to use a clamp. (When not in use only needs to be flushed with saline every 7 days) Broviac catheter- mainly used pediatric patient

Hickman catheter:

Hickman catheter

Groshong- three-position, pressure-sensitive valve or valves, which allows fluids in or out, but stays closed when not in use:

Groshong - three-position, pressure-sensitive valve or valves, which allows fluids in or out, but stays closed when not in use

Broviac Catheter:

Broviac Catheter

peripherally inserted central catheter (PICC) :

peripherally inserted central catheter (PICC) A special type of catheter used in a vascular access procedure that is inserted inside a major vein for a period of weeks, or months so that blood can be repeatedly drawn or medication and nutrients can be injected into the patient’s bloodstream on regular basis. Unlike a standard intravenous catheter (IV) which is for short term use, a vascular access catheter is more durable and does not easily become blocked or infected. The peripherally inserted central catheter (PICC) typically provides access for 4-12 weeks but may remain in place months to years. Basilic vein is the vein of choice for PICC insertion

Implantable Vascular Access Devices (Port-A-Cath):

Implantable Vascular Access Devices (Port-A- Cath ) Implantable Ports are catheters which are inserted completely under the skin. The distal end of the catheter is formed by a small metal "drum" or reservoir, which has on one side a membrane for needle access. This drum is surgically placed under the skin, just below the clavicle, with the membrane immediately below the skin. The catheter runs from the drum into the subclavian vein. Access is always with a special needle that is pushed through the skin and the membrane into the reservoir inside the drum. Such ports come in different sizes, and can have either one or two lumens. Since the entire catheter is under the skin, the risk of infection is smaller than with external catheter