central venous catheters (cvc)

• percutaneous line
• most commonly used central line in hospital
• single, double, triple, or quad lumen
• typically <60 day use (shorter term use)

what veins are used for central venous catheter?

internal jugular vein or subclavian veins are most commonly used

sutured in place

tunnel catheters

• percutaneous, tunnled under the skin
• single, double, or triple lumen
• long term use- 1 year
• placed surgically in OR, cannot be placed at bedside

tunnel catheters placement

• 2 surgical wounds- tunnel is made from surgical site near the subclavian area to an exit wound further down the chest
• a cuff will form a barrier under the skin- stabilizes the catheter & prevents bacterial migration into the blood stream

peripherally interred central catheters

(PICC)

• place peripherally but are considered a central line- threaded to the superior vena cava (SVC)
• can be 20x longer than a peripheral catheter- fed up the arm
• often inserted through the basilic vein
• MUST BE CONFIRMED BY X-RAY PRIOR
• commonly used for long term antibiotics; TPN
• can be used for 6 weeks

PICC line flush

requires daily flush

can be NS or NS and heparin

when flushing you MUST use a 10ml syringe due to pressure

can be inserted at bedside

implantable ports: port-a-cath (PAC/POC)

• a port is placed in a surgically made "pocket" and sutured in place
• a catheter extends into a vein from this port
• requires a huber needle to access
• can be single or double port/lumen
• needle should be changed every 5-7 days
• can be used for 1 year
• commonly used for chemotherapy

tesio catheters

• for hemodialysis use ONLY
• do NOT access, flush, aspirate or administer medications via a tesio
• for dialysis staff only
• often used while an AV fistula is being place
• requires heparin

caring for central lines

• scrub the hub for at least 15-20 seconds
• can use scrub caps, alcohol, chlorohexidine
• antibacterial caps should be applied to each port between
• do not reuse cap

systemic complications

• problem involving the entire body related to IV therapy
• ex: circulatory overload, infection, sepsis

local complications

• adverse reaction or trauma to the surrounding site
• ex: phlebitis, hematoma

hypersensitvity complications

can be systemic or local

more in depth -

systemic complications

• circulatory overload
• usually infused too fast, or with hepatic, cardiac, renal disease
• dyspnea, cough, edema, wt gain, rales or crackles
• infection (sepsis/septicemia)

systemic complications

-more in depth

• venous air embolism (rare, lethal)
• air gets trapped in R ventricle and lodges against the pulmonary valve

s/s of systemic complications

• tachycardia
• SOB
• shoulder pain
• JVD
• hypotension
• weak pulse
• dizziness

venous air embolism, what would you do if your patient has this?

immediately place patient on left side- trendelenburg- this will cause air to disperse back to the right atrium and prevent air from entering the pulmonary artery

• apply oxygen
• obtain vitas, pusle oximetry
• notify HCP

speed shock

associated with systemic complications

• medication is rapidly introduced into circulation
• usually results in hypertension
• slow the infusion rate, notify HCP
• ex: vancomycin- red man syndrome

local complications

phlebitis

• inflammation of vein
• s/s- redness, pain, swelling, induration
• remove IV &relocate
• stop infusion
• warm compress

local complications

infiltration

• seeping of fluid into surrounding tissue
• site will be cool to touch with dependent edema; painful
• discontinue IVFS, remove IV, apply cold compress and elevate the extremity
• check site hourly

local compllciaitons

extravasation

• infiltration of a vesicant medication
• can cause blistering and sloughing of tissues
• chemo
• potassium
• dopamine
• flagyl
• stop infusion
• aspirate medication if possible
• apply old compress

local complications

hematoma

• infiltration of blood into extravascular tissues
• may see discoloration of skin
• usually related to nursing skills
• higher risk of patients on anti-coagulants
• higher risk in elderly

prevent complications

• handwashing
• use sterile technique
• inspect all equipment before use
• anchor IV tubing and cannulas to prevent motion and pulling
• do not use veins over areas of joint flexion if possible
• be alert to sings of circulatory overload
• JVD, elevated BP, elevated RR, crackles, edema, weight gain

LPN scope of practice

• guidlines are provided by state board of nursing
• always follow your facility policy as well
• may insert, flush and discontinue any peripheral iv line
• check facility policy when working with any central line in order to follow your scope
• cannot discount or insert any central line
• cannot access or flush ports