Indications Long term intravenous antibiotics Chemotherapy Total paranteral nutrition Dialysis Monitoring CVP Limited vascular access Administering large amount of blood & blood products.
Types Of Central Venous Catheters Nontunneled central catheters Tunneled central catheters Peripherally inserted central catheters (PICC) Implantable ports
Nontunneled Central Venous Catheters Used for short-term therapy Inserted percutaneously Subclavian vein Internal jugular vein Femoral vein Has from 1 to 4 lumens or ports Usually from 6 to 8 inches in length
Tunneled Central Venous Catheters Used for long term therapy Inserted surgically Small Dacron cuff sits in subcutaneous tunnel Initially sutured but removed in 7 to 10 days External portion of the cath can be repaired
Peripherally Inserted Central Catheters (PICC) Used for intermediate to long term therapy May be single or double lumen Inserted percutaneously Basalicvein Cephalic vein Threaded into the superior vena cava May be inserted by specially trained RN
Implantable Ports Used for long term therapies Surgically implanted Consists of metal or plastic housing Silicone cath placed in superior vena cava Dressing required until insertion site healed
For intermittent CVP monitoring Disposable CVP manometer set leveling device (such as a rod from a reusable CVP pole holder or a carpenter’s level or rule) , additional stopcock (to attach the CVP manometer to the catheter)
extension tubing (if needed) I.V. Pole, I.V. solution , I.V. drip chamber and tubing dressing materials and tape.
Implementation Gather the necessary equipment. Explain the procedure to the patient to reduce his anxiety. Assist the physician as he inserts the CV catheter.
Complications Infection Phlebitis Septicemia or pyrogenic reaction Air embolism Thrombosis/occlusion Extravasations pneumothorax
CVP monitoring helps to assess cardiac function, to evaluate venous return to the heart, to indirectly know how well the heart is pumping
To measure the patient’s volume status, a disposable plastic water manometer is attached between the I.V. line and the central catheter with a three- or four-way stopcock. CVP is recorded in centimeters of water (cm H2O) or millimeters of mercury (mm Hg) read from manometer markings.
MEASURING CVP WITHA WATER MANOMETERTo ensure accurate (CVP) readings, make surethe manometer base is aligned with the patient’sright atrium (the zero reference point).
The manometer set usually contains aleveling rod to allow you to determine thisquickly.After adjusting the manometer’s position,examine the typical three-way stopcock.
By turning it to any position shown at right,you can control the direction of fluid flow.Four-way stopcocks also are available
I.V. solution bottle Manometer Zero pointThree-way stopcock
Turn the stopcock off to the patient, andslowly fill the manometer with I.V. solution untilthe fluid level is 10 to 20 cm H2O higher thanthe patient’s expected CVP value.Don’t overfill the tube because fluid that spillsover the top can become a source ofcontamination.
Turn the stopcock off to the I.V. solution and open to the patient. The fluid level in the manometer will drop. When the fluid level comes to rest, it will fluctuate slightly with respirations. Expect it to drop during inspiration and to rise during expiration. Record CVP at the end of expiration, when intrathoracic pressure has a negligible effect.
Depending on the type of water manometerused, note the value either at the bottom of themeniscus أسفل السطح المحدبor at the midlineof the small floating ball. After you’ve obtained the CVP value, turn thestopcock to resume the I.V. infusion.Adjust the I.V. drip rate as required.Place the patient in a comfortable position.
General Nursing Care Of Patient With CVC Before insertion, lines are initially flushed with saline During percutaneous insertion of CVC in the subclavian or jugular, place patient in Trendlenberg or have him perform Valsalva maneuver
After insertion, an occlusive gauze or transparent dressing is applied Blood is aspirated through all lumens to verify patency Chest xray must be performed before use
Flushing of lines Each lumen is treated as a separate cath Injection caps are vigorously cleaned with alcohol Use 10cc or larger syringe for administration of meds or flush Turbulent flush technique is recommended
Site assessment and determination of external cath length is performed and documented with each dressing change Tubings are changed per protocol – 72hrs Caps and connections are changed per protocol – 3-7 days
When to call the physician Temp of 100.5F or greater Chills, dyspnea, dizziness Pain, redness, swelling, or drainage at site Unresolved resistance, pain or fluid leaking while flushing Hole or tear in cath Excessive bleeding at site Change in length of external cath Swelling in neck, face, chest, or arm
General safety measures No sharp objects near cath Clamp cath when not in use No pulling or tension on the cath Activity limitations
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 anocclusive dressing over a petroleum gauze•Check cath to ensure tip is intact•Document how patient tolerated procedure,placement of dressing and cath tip intact.
Documentation Document all dressing, tubing, and solution changes. Document the patient’s tolerance of the procedure, the date and time of catheter removal, and the type of dressing applied. Note the condition of the catheter insertion site and whether a culture specimen was collected. Note any complications and actions taken.