Central venous catheters

  • 7,174 views
Uploaded on

 

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
No Downloads

Views

Total Views
7,174
On Slideshare
0
From Embeds
0
Number of Embeds
2

Actions

Shares
Downloads
0
Comments
0
Likes
3

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. Central Venous CathetersDuring hospitalization, central venous catheter (CVC) care isoverseen by RNs to ensure safe and effective intravenous therapy Following receipt of physician’s order for placement, arrangements are made as needed by nursing If placing a central venous catheter at the bedside; • Obtain central line cart from OPCC if line is placed on any of the general nursing units • Obtain CVC Tray & Central Line Insertion Drape Kit • Have permit signed • Assist at the bedside as needed • Monitor for quality during placement procedure • Complete CVC Insertion Checklist and place in managers box
  • 2. CVC (continued)CVC insertion is a sterile procedure for which a “Bundle” has been recommended to reduce blood stream infections Optimal Hand Hygiene using chlorhexidine is performed Optimal Site Selection is performed by the physician • (Subclavian as opposed to femoral) Optimal Site Preparation is performed - chlorhexidine prep – 30 second scrub with 30 second dry time or 2 minute scrub with 1 minute dry time for wet areas Optimal Barrier Precautions are performed : For the physician inserting the line and those assisting with the procedure, required proper protective equipment includes: cap, mask with eye shield, sterile gown and gloves
  • 3. CVC (continued) All others in the room must have cap and mask - including patient The patient should be draped completely from head to toe with the exception of a small opening at the site of insertion All participants, (physicians and nursing) are responsible for maintaining all components of optimal line placement. The physician is responsible for site selection, maintenance of sterile field, confirmation of patency, daily observation of line and prompt removal of catheter The assisting nurse is responsible for holding the physician accountable for asepsis during placement
  • 4. CVC (continued) Once the CVC has been placed, nursing awaits a confirming radiology report prior to using the CVC unless otherwise ordered by the physician An order must be obtained from the physician (not the radiologist) prior to using the CVC Intravenous infusions via CVC are initiated by the RN LPN’s may replace primary bags without medication additives and hang piggyback antibiotics - All IV push meds, including flushes, are performed by the RN All unused ports of CVC’s are flushed every 12 hours and as needed following medication administration with at least 10 ml of normal saline (NS)
  • 5. CVC (continued)Blood may be drawn from central venous lines for lab work per physician orders as follows: • Withdraw and waste 5 ml • Withdraw sample (volume determined by lab) • Flush with at least 10 ml NS • Flush with 20 ml NS if a PICC
  • 6. CVC (continued)CVC dressings are changed by RNs weekly or sooner ifcompromised, under aseptic technique. Dressing changes are performed by RN’s with regard for: • Excellent hand hygiene • Proper use of barrier equipment • Thorough cleansing and inspection of the insertion site • Use of the Chloraprep • Use of the Biopatch • Tubing and caps are changed every 96 hours coinciding with fluid changes every 24 hours and dressing changes every 7 days • Date and time all CVC dressing and tubings • Education reinforcement for patient and family • Proper documentation
  • 7. CVC (continued)Removal of CVC Upon receipt of order to discontinue CVC, the RN educates the patient regarding removal While the patient’s face is turned away from the CVC and aseptic technique is in use, the patient is asked to briefly hold their breath while the CVC is removed Firm pressure is held to the site for at least 5 minutes An occlusive, pressure dressing is applied and the patient is instructed to leave in place 24 hours During the pressure holding phase, the patient is encouraged to avoid talking, laughing, or coughing as these activities may lead to risk of an air embolism
  • 8. CVC – Peripherally Inserted Central Venous Catheter PICC is a Peripherally Inserted Central Venous Catheter that is inserted into the peripheral vein and advanced until the catheter tip rests in the superior vena cava next to the right atrium A PICC is similar to a traditionally placed CVC except the complications are fewer and the dwell time is longer A PICC may have a single or multiple lumens. It may also have a “purple port” which is a power port meaning it can be power injected with contrast media by Radiology. Only a power PICC can be power injected
  • 9. CVC – Peripherally Inserted Central Venous CatheterA PICC is not appropriate for all patients and proper selection todetermine the appropriateness of a PICC is necessary. The followingare some indications for a PICC:  Extended IV therapy for antibiotics, chemotherapy, or other medications  Parenteral nutrition with dextrose > 10%  Continuous infusion of vesicant medications or medications with ability to cause necrosis if infiltrated  Lack of vascular access  Patients requiring IV therapy after discharge  IV fluids with a PH less than 5 or greater that 9, or osmolarity greater than 600
  • 10. CVC – Peripherally Inserted Central Venous CatheterProcedure - Once a PICC is ordered by the physician, the PICC nurse isnotified of patient need by calling the operator and having her paged.  A consent form is signed for PICC placement  PICC standing orders are placed on the chart and added to the Med- Act  A CVC checklist is filled out as with all CVC (PICC nurse should fill out the CVC checklist)  The PICC nurse fills out a Patient Assessment Form and this is placed in the chart  A sign is placed at the head of the bed labeled “PICC LINE IN PLACE” the PICC nurse may place the measurements hereOnce the PICC is placed, a CXR is completed for placement  Line confirmation is communicated to the primary physician who gives IV orders  If repositioning of the catheter is needed, the PICC nurse is notified
  • 11. CVC – Peripherally Inserted Central Venous CatheterMaintenance: Sterile dressing changes using the Biopatch and Statlock device are completed every seven days unless the dressing is loose or soiled and needs changing sooner IV tubing and caps are changed every 96 hours Prior to accessing the cap of the PICC “scrub the hub” for 15 – 30 seconds with an alcohol pad to decrease risk of infection Upper arm circumference at the PICC insertion site is measured and compared with the initial insertion measurement and documented daily in CPSI Any retraction of the catheter is also assessed and compared with the length documented at the time of insertion and documented daily in CPSI
  • 12. CVC – Peripherally Inserted Central Venous Catheter These measurements are compared to the measurements documented on the Patient Assessment Form by the PICC nurse on insertion The PICC nurse is notified of any changes in these measurements The appropriate sign is placed at the head of the bed to alert associates of “no needle sticks, tourniquets, or blood pressures to affected arm” If the patient has a temp over 101 degrees F at anytime the physician is notified
  • 13. CVC – Peripherally Inserted Central Venous Catheter The PICC is used for lab draws as ordered on the standing orders The pull/pause technique is used when aspirating blood Always waste at least 10 ml prior to the blood sample If patient has TPN infusing, lab needs to be drawn from a different port not the port in which the TPN is infusing All drug levels are drawn from a different port as well, not the one the antibiotic or other medication was infused in The red lumen needs to be saved/marked for blood draws The PICC is always flushed with 20 ml of normal saline after blood draws or blood transfusions using the push/pause technique
  • 14. CVC – Peripherally Inserted Central Venous Catheter Routine flushes are 10 ml normal saline per shift as with all CVC using a 10-12 ml syringe If a patient is admitted to WCMC with a PICC the PICC nurse is notified The PICC nurse is also notified with any issues related to the PICC such as an occluded line or breakage. The physician is notified and then the PICC nurse
  • 15. CVC – Peripherally Inserted Central Venous Catheter An RN may remove a PICC IF he/she has credentials or a competency check sheet signed by a PICC nurse and this is in their inservice file All paperwork (listed below) related to PICC are located on the intranet attached to the policy in the nursing manual • CVC Checklist • PICC consent • PICC standing orders • PICC Patient Assessment • PICC sign • PICC removal check off form
  • 16. CVC – InfusaportsAccessing Infusaport Upon physician order, infusaports are accessed utilizing aseptic technique using only non-coring access device (Huber needle) During the access process, patency is confirmed by positive blood return during aspiration and flush Blood is not routinely drawn from standard infusaports for lab work unless an order from the physician is received Following accessing the site, a sterile dressing is applied Unlike temporary CVC’s or PICC’s, infusaports require heparinization to maintain patency
  • 17. CVC – Infusaports (continued)Routine Infusaport Use Ports that are accessed, but not in regular use, (i.e. lock), are flushed once daily with 10 ml NS followed by 10ml Heparin flush (10 units/ml) for a total of 100 units Following use of the infusaport for continuous IV administration, the infusaport is flushed with 10 ml NS followed by 10 ml Heparin (10 units/ml) flush The infusaport is flushed with 10 ml NS between IV meds If at any time the site becomes edematous, painful, or will not flush, infusions are stopped immediately and the physician is notified
  • 18. CVC – Infusaports (continued) Sterile dressing changes are performed by the RN weekly and at any time that the dressing is compromised All infusaports are re-accessed weekly with dressing change, tubing change, and fluid change - date and time all dressings and tubings All fluid bags are changed every 24 hours All tubing and caps are changed every 72-96 hours in conjunction with tubing change and with re-accessing the port on day 7 LPN’s may replace primary fluid bags (without medication additives), and hang piggyback antibiotics All IV push meds (including flushes) administered via infusaport are given by RN’s
  • 19. CVC – Infusaports (continued) De-accessing Infusaport Prior to de-accessing, the Infusaport is flushed vigorously with 10 ml NS followed by 10 ml Heparin flush Once the non-coring needle device is removed, observe the site for adverse signs No dressing is required following removal Instruct the patient regarding follow-up as ordered by physician
  • 20. CVC – Infusaports (continued) De-access with two fingers on base: To de-access the port, approach the safety needle from behind - Place fingers on the base to stabilize it With the other hand, place a finger on the tip of the safety arm Lift the safety arm straight back Notice that the needle comes out perfectly straight “Click” needle into lock position: Continue lifting until the needle “clicks” into the lock position The safety needle is now ready for disposal into a sharps container
  • 21. CVC – Power Ports Power Ports differ from standard infusaports in both shape and function The hub of a power port is triangular in shape Power Ports have three palpation points on the septum arranged in a triangle The patient may also provide a card or keychain identifying their port as a Power Port Power Ports are identifiable by x-ray Recently placed Power ports at WCMC will have a placement sticker located in the chart
  • 22. CVC – Power Ports Power Ports must be positively identified by two means before being used for power injection In contrast to standard ports, Power Ports can be used to power inject contrast dyes needed for radiology exams Power Ports may be accessed with standard Huber needle devices, but a PowerLoc Safety Infusion Set is required if the port is to be used for power injection of contrast dye PowerLoc Safety Infusion Sets are kept in Radiology Blood may be drawn from Power ports with physician order All other routine care is the same for both types of ports
  • 23. CVC – Use of HD cath for IVCatheters used for hemodialysis should be reserved for HD useonly unless extenuating circumstances exist Following failed peripheral IV insertion per the protocol for difficult IV starts, the attending physician may give orders to utilize the HD catheter for intravenous therapy An order set Utilization of Hemodialysis Catheters for Intermittent Intravenous Infusion standardizing the access procedure is found in the CVC policy in the Nursing Manual #6000.0208 Nephrology must be contacted prior to accessing the device
  • 24. CVC- Use of HD cath for IVKey points related to this procedure are as follows: Ensure sterility Use only the blue “venous” port Use only Betadine - no alcohol based products including chlorhexidine are used Aspirate previously instilled heparin prior to use After successful aspiration, flush with 10 ml NS RN’s assume responsibility for all aspects of care Upon completion, flush with saline and re-heparinize with 2.5 ml of heparin, noting that the concentration is 1000 units/ml. Dressing changes to be completed during dialysis