This document discusses central venous catheters. It describes central lines as flexible tubes inserted into large veins near the heart to deliver fluids, medications, blood products, and monitor central venous pressure. It outlines different types of central lines including non-tunneled, tunneled, and implanted ports. The document discusses indications, contraindications, complications, and proper insertion and maintenance techniques to prevent infections like chlorhexidine skin antisepsis and dressing changes. The goal is to promote infection prevention best practices for central lines.

1. PRESENTED BY,
Ahmed Abdullah

2.  A central line (or central venous catheter) is like
an intravenous iv line, But it is much longer than a
regular IV and goes all the way up to a vein near
the heart or just inside the heart.
 A patient can get,
 Fluids, Medicine
 Blood
 It also can be used to draw blood.
 It may stay in place for weeks or months and helps
avoid the need for repeated needle sticks.

3. A central venous catheter is a thin, flexible tube
that is inserted into a vein, usually below the right
collarbone, and guided (threaded) into a large
vein above the right side of the heart called the
superior vena cava.

4. Fluid
resuscitation,
Blood
transfusion &
drug
administration.
TVP
insertion
Central venous
pressure
monitoring,&
pulmonary artery
catheterization.
Emergency venous
access for patients
with failed
peripheral access.

5. Coagulopathy
Local infection, Skin
trauma
Avoid in raised
intracranial pressure-
aim for a femoral
approach if required
Patient non-
compliance

6. Peripherally
inserted central
catheter(PICC)
Non-Tunneled
CVC
Tunneled CVC
Totally
implantable
device
Pulmonary
artery
catheters.

7. Provides an alternative to subclavian or
jugular vein catheterization. Inserted via the
peripheral vein into the superior vena cava,
usually by way of cephalic or basilic veins.
Preffered if iv therapy is expected to exceed 6
days.

9.  Surgically implanted CVC with the tunneled
portion under the skin and a Dacron cuff just
inside the exit site.
 The cuff inhibits migration of organisms into
the catheter tract by stimulating growth of
surrounding tissue,thus sealing the catheter
tract used to provide vascular access to patients
who require prolonged iv therapy,home
infusion therapy or hemodialysis.(eg.Hickman,
Quinton catheter).

11.  A non-tunneled central line is a type of short-
term IV catheter& most common type of CVC
also it is accountable for 90% of CLABSI.
 The risk of infection depends on the site of
insertion femoral>internal jugular>subclavian
veins.
 Examples are PICC line, Sheaths ,Triple lumen
etc.

15.  A subcutaneous port or reservoir with self-
sealing septum is tunneled beneath the skin
and is accessed by a needle through intact
skin(eg. Port-a-cath).
 It has a low rate of infection. Preferred for
patients who require long term, intermittent
vascular access.

17.  Inserted through a Teflon introducer and
typically remains in place for an average
duration of only 3 days.
 Most catheters are heparin bonded to reduce
catheter thrombosis and microbial adherence to
the catheter.

20.  Ultrasound
 Sterile trolley
 Sterile field, gloves, gown and mask
 Puncture needle.
 Saline flush
 Chlorhexidine 2% with 70% alcohol
 Lignocaine
 Suture
 Scalpel
 Sterile dressing
 Pressure bag to attach to monitoring
 Transducer

21. Pre-procedure
 Consent the patient if conscious and it should
include complications.
 Set up sterile trolley
 Position the patient according to site. If it is
neck, head facing away from side of insertion
This ensures maximum venous filling
 Ultrasound if needed.

22.  A central line insertion bundle must be filled up during
insertion and follow asceptic techniques
 Use the bedside ultrasound to identify the target vein.
 Advanced the needle according to the site.
 Once venous blood is aspirated, stop advancing the
needle and insert guide wire.
 Advance the CVL over the guide wire. Make sure the
distal lumen of the central line is uncapped to facilitate
passage of the guide wire.
 Once the CVL is in place, remove the guide wire. Next,
flush and aspirate all ports with the sterile saline.
 Secure the CVL in place with the suture and place a
sterile dressing over the site.

23.  Attach central line to pressure bag to allow
CVP monitoring
 Run a blood gas to ensure a venous sample
 Chest x-ray to confirm placement and to check
for pneumothorax
 Clear documentation(CLABSI BUNDLE) of
date of insertion and monitor for infection

24. Haemothora
x
Pneumothor
ax
Haematoma Inadvertent
arterial
puncture

25. 1. Hand Hygiene
2. Proper Dressing Change
3. Aseptic technique for accessing
and changing needleless connector
4. Standardize tubing change
5. Daily review of catheter necessity

26. Clean hands with soap and water
or alcohol based gels before and
after,
Access the catheter to draw blood
or administer medications
Dressing change
Change IV tubing and devices
Palpating catheter insertion site
Wear either clean or sterile gloves
when changing the dressing on
intravascular catheters

27.  2% chlorhexidine with 70% alcohol based preparation
is the preferred agent
 Scrub for 30 seconds using back and forth motion &
allow to dry completely
 Use either sterile gauze or sterile, transparent, semi
permeable dressing to cover the catheter site
 Dressing shall be replaced every 48 hours for gauze
dressing or earlier when catheter/needle is changed, or
when dressing become damp, loosened or visibly
soiled.
 7 days for transparent dressing

28. Assess the site for redness, tenderness,
pain, swollen, dysfunction, infection or exudate
every shift
 If IV site is judged to be infected,
1.Discontinue the device
2.Swab exudate for culture & sensitivity
3.Notify the physician
4.Document in patient chart
5.Do OVR and refer to IV nurse

29.  Catheter Hubs and Needless Connectors are
Known sources of CLABSI and recognized
sites of bacterial contamination
 Minimize contamination risk by scrubbing the
access port with an appropriate antiseptic
(chlorhexidine 2%with 70% alcohol) and
accessing the port only with sterile devices.

30.  Replace administration sets that are
continuously used, including secondary sets no
more frequently than at 96-hour intervals.
 Replace tubing used to administer blood &
blood products every 4 hours.
 TPN/Intra lipids 24 hours of initiating the
infusions.
 Chemotherapy tubing after each
administration.
 Propofol every 6-12 hours & when vial
changed.

31.  Perform a daily review of the necessity of the
central catheter
 Document that the review has been
performed.
 Remove the catheter if no longer needed

32. So far we have discussed about,
 central line
 Types
 Indications
 Contra indications
 Complications
 Procedure for insertion and
 Maintenence & care.

33.  We have understood the necessity of central
line in hospital especially on critical areas. As
same like maintenance and care of this also
taking a huge part to prevent CLABSI.so lets
hands together to promote a infection less
treatments and improve the wellbeing of the
patients.
“PREVENTION IS BETTER
THAN CURE”

34.  POLICY CODE-IPP-IPC-054
Infection control for intravenous catheters and therapy.