Care of bundles for Critical Nursing Staff

1. Care of patient with PICC line
and central line.

2. Central venous line
A catheter (tube) that is
passed through a vein to
end up in the thoracic
(chest) portion of the
vena cava (the large vein
returning blood to the
heart) or in the right
atrium of the heart

3. Types
 Central venous catheter
 Porta cath
 PICC line (peripherally
inserted central catheter)
 Joe cath

4. Indication for insertion
 Administration of inotropes
 Hemodialysis
 Use of long term antibiotics
 Difficult IV cannulation
 Hemodynamic instability

5. Requirements before insertion
 Hemoglobin
 PT
 APTT
 INR
 Platelets

6. Policy
 Consent
 Sterile technique
 Vitals must be monitored for insertion of this line.

7. Site
 For CVC Subclavian is first choice then internal
jugular then Femoral. As subclavian has lowest
rate of infection than femoral.
 For dialysis the preferred site is internal jugular
then femoral then sub clavian. subclavian vein is
avoided due to risk of subclavian vein stenosis.

8. Post insertion care of line
 Central line insertion site must be examined daily.
 Hand hyiene must be done before handling the port.
 Tropical antibiotic and creams are not allowed
around the catheter site
 Decontaminating all needleless injection sites and/or
sampling ports with an alcohol/ Chlorhexidine swab
before and after use

9. Dressing
 Guaze dressing ------- 48 hours (2 days)
 Transparent dressing ------ 7 days
However the dressing should be changed if it becomes
damp, loose, soiled or has been lifted to inspect the site
Only certified Registered nurses and physicians will do
dressing of central line.

10. PICC line assessment
For PICCs, if limb swelling is
suspected, compare the mid-
upper limb circumference with
the initial value recorded on
the Central Line Insertion
Record to quantify this. If a
significant increase in
circumference is confirmed,
venous thrombosis should be
considered.

11. Hemodialysis assessment
 If Hemodialysis is judged to be required for more
than 3 weeks then a permanent dialysis
catheter/fistula should be placed and the patient
should be discharged with a permanent dialysis
catheter/fistula.

12. Heparinized flush
 0.1 ml of heparine and 9.9 ml 0.9%NS ( both for
peads and adults)