1. Central line and blood Sampling
For Nurses

2. What is central line..?
In medicine, a central venous catheter ("central line", "CVC",
"central venous line" or "central venous access catheter") is a
intravenous device that is inserted into a vein in the neck
(internal jugular vein), chest (subclavian vein or axillary vein)
or groin (femoral vein).
It is used to administer medication or fluids, obtain blood tests
(specifically the "mixed venous oxygen saturation"), and
directly obtain cardiovascular measurements such as the
central venous pressure.

3. Types
 Short-term (Percutaneous, Non-Tunneled, Non-Cuffed) Short Term
 PICC (Peripherally Inserted Central Catheters) Long Term
 Tunneled Catheters Long Term
 Implanted Venous Access Devices (IVAD)

4. Open–ended
♦ The catheter is open at the distal tip
♦ The catheter requires clamping
before entry into the system
♦ Clamps are usually built into the
catheter
♦ Requires periodic flushing
♦ Any type of CVC can be open-
ended
Center Venous Catheters: Open-ended or Closed-ended
Closed-ended
♦ A valve is present at the tip of the
catheter (eg. Groshong®) or at the
hub of the catheter (eg. PAS-V®)
♦ Clamping is not required as the valve
is closed except during infusion or
aspiration
♦ May be present on Tunneled
Catheters, Implanted Ports and PICCs

5. o Administer intravenous fluids and blood products
o Administer medications
o Administer hypertonic solutions (Total Parental Nutrition [TPN]),
vesicants (i.e.chemotherapy), irritants (i.e.cloxacillin), and solutions
with extreme pH values (i.e.vancomycin).
o Obtain venous blood samples
o Provide long term intravenous therapy
o Administer large volumes of intravenous fluid quickly
o Administer vasopressor or vasodilator therapy (e.g. Dopamine)
Indications for Use

6. o Monitor central venous pressure (CVP)
o Provide access for transvenous pacemaker or pulmonary artery catheters
o Access venous circulation when a patient has difficult or impossible
peripheral access
o Provide hemodialysis access

7.  Type of therapy to be administered
 Length of therapy (i.e. Short term or Long term)
 Complex or unusual vascular anatomy
 Previous devices and complications
 Clinical diagnosis and assessment
 Clinical situation
 Care setting
 Patient/family preference
 What alternatives are there?
 Always advocate for Best Practice!
The type of CVC inserted depends on the:

8. Insertion
The skin is cleaned, and local anesthetic applied if required.
The location of the vein is then identified by landmarks or with the use of
a small ultrasound device.
A hollow needle is advanced through the skin until blood is aspirated; the
color of the blood and the rate of its flow help distinguish it from arterial
blood (suggesting that an artery has been accidentally punctured).

9. The Seldinger technique is a medical procedure to obtain safe
access to blood vessels and other hollow organs
Seldinger technique

10. Blood Sampling
 Explain procedure to patient before starting.
 Aseptic preparation before starting procedure.
 Maintain proper barrier protection to protect nurse against possible
blood contamination. Prepare dressing pack at patients bed side
 Place patient in supine position. Have patient turn head away from
CVC site during procedure.
 Turn off infusion at least one minute before sampling.

11.  After removing 5 mls of blood from CVC pigtail attached syringe
and remove required amount of blood for blood test. Draw off
blood for electrolytes and full blood counts before coagulation
studies. If coagulation studies are the only tests required it may be
necessary to draw up to 10 mls of blood for discard before
drawing sample bloods.
 Re-heparinize CVC port for 'Heparin Lock for Central Venous
Catheter Lines'.
 Record date and time of procedure on flow chart.
 Note in patient's chart procedure carried out and any problems
noted during procedure.

12. Complications
Central line insertion may cause a number of complications. The
benefit expected from their use therefore needs to outweigh the risk
of those complications.
The major complications are
 Pneumothorax (for lung Catheter).
 Central line associated blood stream infections.
 Thrombosis.
 Other complications (like intra thoracic pressure, air embolism, etc. )

13. For the operator
maximal barrier precautions means strict compliance with
handwashing, wearing a cap, mask, sterile gown and gloves.
The cap should cover all hair and the mask should cover the
nose and mouth tightly.
These precautions are the same as for any other surgical
procedure that carries a risk of infection.
Precautions to prevent infections

14. For the patient
maximal barrier precautions means covering the patient from
head to toe with a sterile drape with a small opening for the site of
insertion.
Maximal barrier precautions clearly decrease the odds of
developing catheter-related bloodstream infections.

15. References
1. Central Venous Catheter Guidelines by NHS, Worcestershire.
2. Mermel LA, McCormick RD, Springman SR, Maki DG. The pathogenesis and
epidemiology of catheter-related infection with pulmonary artery Swan-Ganz catheters:
A prospective study utilizing molecular subtyping. American Journal of Medicine. Sep 16
1991;91(3B):197S-205S.
3. Raad, II, Hohn DC, Gilbreath BJ, et al. Prevention of central venous catheter-related
infections by using maximal sterile barrier precautions during insertion. Infection Control
and Hospital Epidemiology. Apr 1994;15(4 Pt 1):231-238.
4. http://en.wikipedia.org/wiki/Central_venous_catheter retrieved on 03/04/13.