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Questions and Answers
What is the recommended maximum time for assessing and changing the dressing on a central venous line (CVL)?
What is the recommended maximum time for assessing and changing the dressing on a central venous line (CVL)?
What should be done if patency of a central venous line is compromised?
What should be done if patency of a central venous line is compromised?
Why must a biopatch be used on a central line?
Why must a biopatch be used on a central line?
Which of the following methods is recommended when flushing a central venous line?
Which of the following methods is recommended when flushing a central venous line?
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What should be done if a catheter is found to have a fibrin sheath or tail?
What should be done if a catheter is found to have a fibrin sheath or tail?
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What is a potential consequence of excessive force while flushing a catheter?
What is a potential consequence of excessive force while flushing a catheter?
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What should be done if resistance is met during catheter flushing?
What should be done if resistance is met during catheter flushing?
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What is the proper angle for inserting a needle during a blood draw?
What is the proper angle for inserting a needle during a blood draw?
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During a dressing change, which solution should be used to scrub the site?
During a dressing change, which solution should be used to scrub the site?
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What positioning should be utilized when removing a 'short' non-tunneled catheter?
What positioning should be utilized when removing a 'short' non-tunneled catheter?
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What is the immediate step after removing a catheter to control any bleeding?
What is the immediate step after removing a catheter to control any bleeding?
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What should be done after finishing the administration of medication via IVP?
What should be done after finishing the administration of medication via IVP?
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Which type of central venous line is primarily used for long-term infusion therapy and can last up to 12 months?
Which type of central venous line is primarily used for long-term infusion therapy and can last up to 12 months?
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What is a significant risk associated with the insertion of a Short Non-tunneled Catheter?
What is a significant risk associated with the insertion of a Short Non-tunneled Catheter?
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Which method of insertion is used for Tunneled Central Catheters?
Which method of insertion is used for Tunneled Central Catheters?
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What technique should be applied if a patient experiences an air embolism during catheter insertion?
What technique should be applied if a patient experiences an air embolism during catheter insertion?
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Which category of central venous line allows for a dacron cuff and is intended for permanent access?
Which category of central venous line allows for a dacron cuff and is intended for permanent access?
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What is a recommended nursing role during the insertion of a Short Non-tunneled Catheter?
What is a recommended nursing role during the insertion of a Short Non-tunneled Catheter?
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Which of the following complications is associated with the improper placement of a central venous catheter?
Which of the following complications is associated with the improper placement of a central venous catheter?
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Which type of central venous line is typically implanted in a subcutaneous pocket?
Which type of central venous line is typically implanted in a subcutaneous pocket?
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Study Notes
Central Venous Lines
- Central Venous Lines (CVLs) are catheters inserted into a large vein near the heart, providing access for various medical interventions.
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Uses:
- When peripheral IV access is unobtainable
- Long-term infusion therapy
- Hemodynamic monitoring (monitoring blood pressure)
- Administering large volumes of fluids or blood
- Administering caustic agents (agents that damage tissue)
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Types:
Short Non-tunneled Catheter
- Inserted bedside by a physician or specially trained nurse using a needle and guidewire.
- Common insertion sites: Internal jugular vein (neck) or subclavian vein (chest).
- Used for immediate access in emergencies and can have multiple lumens for different uses.
- Higher infection and complication risk.
- Short-term use, usually 1-2 weeks.
Non-tunneled Peripherally Inserted Central Catheter (PICC)
- Inserted bedside using a needle and guidewire.
- Common insertion site: Basilic or cephalic vein in the arm.
- Can have multiple lumens.
- Increased risk of neurovascular compromise of the extremity, thrombosis, and catheter shearing.
- Longer-term use, potentially lasting 12 months.
Tunneled Central Catheter
- Inserted in the operating room or an interventional radiology suite.
- Has a dacron cuff embedded in the skin to prevent migration.
- Can have multiple lumens. - Requires clamping when not in use and daily flushing. - Long-term use, lasting months to years. ### Implanted Port - Surgically implanted into a subcutaneous pocket. - Can have one or two lumens. - Composed of a dense silicone septum with a steel reservoir. - Requires the use of a non-coring needle (Huber needle) for access. - Requires flushing every four weeks when not in use. - Long-term use, lasting months to years.
Insertion Protocol for Short Non-tunneled Catheter:
- Positioning: Trendelenburg position, high bed position, towel between shoulder blades, and head turned to the side.
- Nursing role: Prepare sterile supplies, position the patient's head, provide comfort, and talk the patient through the procedure.
- Complications:
- Pneumothorax (collapsed lung)
- Nerve injury
- Cannulation of the wrong vessel
- Catheter dislodgement
- Phlebitis (inflammation of a vein)
- Thrombosis (blood clot)
- Catheter mispositioning:
- Advance the catheter further or pull it back.
- Air embolism:
- Position the patient on their left side with their feet elevated.
- Administer oxygen.
- Monitor the patient's status.
- Arterial puncture:
- Remove the catheter.
- Apply pressure to the puncture site for 10-15 minutes.
- Attempt insertion on the other side.
- Bright red, pulsating blood is a sign of arterial puncture.
- Infection:
- Non-occlusive dressing, poor technique with dressing changes, poor hand washing, and secretions are all risk factors.
- Discontinue the catheter, cut off the catheter tip, and culture the tip.
- Catheter rupture:
- Excessive force during flushing or catheter compression (pinch-off syndrome) are common causes.
- If resistance is encountered, pull the catheter back and check for blood return.
Blood Draw Protocol:
- Apply a tourniquet.
- Palpate the vein.
- Clean the insertion site.
- Hold the skin taut and insert the needle bevel up at a 15-30 degree angle.
- Feel a pop or see a flash of blood.
- Hold the syringe securely and pull back gently on the plunger or allow the vacutainer to draw blood.
- For vacutainers, rotate each tube 8-10 times to mix blood with additives in the tube.
- Release the tourniquet.
- Apply pressure with a 2x2 gauze pad and withdraw the needle.
Medication Administration IVP Protocol:
- Prime a new IV cap with normal saline.
- Scrub the area where the cap detaches from the catheter.
- Attach a new cap to the catheter (connected to a normal saline syringe).
- Assess for blood return.
- Administer a normal saline flush (5-10mL) with the push-pause method.
- Administer the medication with the push-pause method.
- Administer another normal saline flush (5-10mL) with the push-pause method.
- Clamp and remove the saline syringe.
- Scrub the hub and administer a heparin flush.
- Clamp the end and remove the heparin syringe.
Dressing Change:
- Position the patient with their head turning away from the insertion site.
- Perform hand hygiene and mask use for both the nurse and patient.
- Clean gloves should be used, assessing the site. Remove clean gloves and open the CVAD kit, then apply sterile gloves.
- Scrub the site with chlorhexidine solution for 2 minutes (horizontal, vertical, and circular scrubs).
- Use skin prep and apply a new stabilization device.
- Apply a transparent, semi-permeable membrane dressing with a label.
Removal Protocol for "Short" Non-tunneled Catheters:
- Clip the suture or remove the stat-lock.
- Positioning: HOB flat or Trendelenburg position. Have the patient perform the Valsalva maneuver (holding their breath, humming, or bearing down) to prevent air embolism.
- Remove the catheter steadily.
- Hold pressure for 10 minutes. If bleeding continues, apply pressure for 5 minutes and recheck.
- Apply a dressing.
- Inspect the removed catheter, measure its length, and document.
Removal Protocol for PICCs:
- Apply a hot pack to the area for 10-15 minutes (dilates vessels and minimizes venous spasms).
- Use clean gloves to remove the dressing and stat-lock.
- Positioning: Supine with the HOB at a stop position.
- Ask the patient to relax. Use a hot pack for 1-2 minutes.
- Remove the catheter steadily.
- Hold pressure for 10 minutes and apply a dressing.
- Inspect the removed catheter, measure its length, and document.
Central Line Bundle:
- Chlorhexidine bath every 24 hours to decrease infection risk.
- Assess the dressing every 24 hours: ensure it is dry and intact or change it.
- Change dressing every 7 days (or 24 hours after insertion) or when soiled.
- Disinfectant caps on the catheter hub create a closed system with alcohol:
- Change caps every 72-96 hours.
- Assess the label on tubing, dressing, and bags and replace them as needed:
- IV solutions changed every 24 hours.
- IV tubing changed every 72-96 hours.
- Review the need for a CVL every 24 hours.
- Apply a biopatch to keep antiseptic near the port.
De-clotting CVLs
- t-PA (tissue plasminogen activator) or low dose alteplase (recombinant tissue plasminogen activator) can be used to break up clots:
- After 2 hours, 75% patency (openness) is restored.
- A second dose restores 85% patency.
Fibrin Sheath and Tails:
- If a CVL is improperly maintained, a clot can form at the end of the catheter, forming a fibrin sheath or tail.
- This sheath can cover the exit ports and render the catheter unusable.
- It prevents blood from returning but the catheter may flush easily because the tail can lift up.
Nursing Considerations:
- Only use syringes 10mL or larger. Smaller syringes have too much pressure.
- Use the push-pause method when flushing. This allows blood to flush out and prevents clots.
- Scrub the hub for 15-30 seconds.
- Keep disinfection caps on when the ports are not in use.
- Avoid taking blood pressure or venipuncture on the arm with a PICC.
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Description
This quiz covers the essential aspects of Central Venous Lines (CVLs), including their uses, types, and insertion techniques. Understand the differences between short non-tunneled catheters and PICC lines, along with their applications in medical settings. Test your knowledge on this critical medical intervention.
