N358 CVAD

Complications

*Dysrhythmia* -may occur with catheter malposition or dislodgement -Occurs during insertion or during dwell time -Xray must be performed at initial insertion to confirm cath tip location --Nursing intervention: -Prior to initial use, the nurse should confirm that radiologic results reveal accurate catheter tip location -assessing heart rate and rhythm, the patient should be assessed for ear, neck, or back pain, which could also indicate catheter malposition and subsequently dysrhythmia. *the health care provider should be informed if the external catheter length has changed.* _______________________________________ *Infection* -can happen at insertion site or along the catheters path -Common pathogens associated with central line infections are bacteria (such as Staphylococcus aureus), yeast, and fungi. --Signs: -fever -chills -swelling tenderness -redness -drainage at the insertion/exit site. --Nursing interventions: Follow: The Institute of Healthcare Improvement has established several interventions to reduce catheter-related bloodstream infections (CR-BSI) -maximal barrier precautions during the insertion procedure. This requires proper sterile draping of the patient, the use of sterile gloves, gown and mask for the person inserting the central venous access device, and donning a face mask for everyone entering the area where the sterile procedure is being performed. -Another intervention is proper hand hygiene, both during the insertion procedure of the central line as well as before any manipulation of a central venous access device. -Needless port = site of contamination = injection ports should be thoroughly cleaned with chlorhexidine (or another facility-approved antiseptic) and allowed to dry prior to accessing the device. Some facilities may use a single-use access valve disinfection cap (SwabCap) instead of chlorhexidine or alcohol. The disinfection cap contains isopropyl alcohol and is twisted onto the needleless connector. Each time the line is accessed, a new disinfection cap is applied. -Strict aseptic technique should be used when hanging solutions and with dressing changes. -*site should be assessed daily for redness, drainage, swelling, or discomfort at the insertion site.* -Chlorhexidine = CR-BSI recommended skin disinfectant. -catheters are often coated with antimicrobial substances: An example is an antimicrobial cuff (trade name, VitaCuff) that works in conjunction with a Dacron cuff. The Dacron cuff is a band around the catheter that anchors the catheter under the skin to reduce the risk of dislodgement. The cuff also creates a barrier that keeps bacteria from entering the bloodstream. The antimicrobial cuff, coated with antibacterial chemicals, sits proximal to the Dacron cuff. The antimicrobial cuff substantially reduces the incidence of catheter-related infection in a newly placed line. Its chemicals dissolve within 3 weeks after placement, however. ____________________________________________ *Sepsis* -severe blood infection caused by bacteria, viruses, and fungi. -can be life-threatening. -Common manifestations: -fever -chills -hypotension -tachycardia -confusion. Nursing intervention: Follow all precautions for preventing infection. These will help prevent the progression of infection to sepsis _______________________________________ *Pneumothorax and Hemothorax* -Pneumothorax (air in the pleural space, that is, outside the lung) - hemothorax (blood in the pleural space) -Causes: by a puncture of the covering of the lung are possible complications of central venous catheterization. *May not show for hours or days sometimes symptoms very minimal Usually symptoms: -dyspnea -hypoxia -tachycardia -restlessness -cyanosis -chest pain -and decreased breath sounds on the affected side. (less likely to occur than with PICC) --Nursing interventions: -Vitals -O2 -notify provider (may need chest tube and line removed) ___________________________________________ *Air embolism* -Air can enter the circulatory system when a central venous catheter is open to the environment, thus causing air embolism. -Can happen during: -inadvertent disconnection of central line tube and catheter removal. Signs: -dyspnea -chest pain -tachycardia -hypotension -anxiety -nausea -dizziness -confusion. -suspected if, during assessment and *auscultation over the pericardium, the nurse hears a churning noise.* --Nursing interventions: -Frequently check that the catheter is intact and patent. Closed/valve-tip catheters, such as the Groshong, can be open to air without risking an embolism. -Be sure to keep catheters clamped (except the closed valve tips), particularly when changing connections and accessing the needleless connector. -Whether the needleless connector is a positive-pressure connector or negative-pressure connector will determine whether the clamping occurs after or the syringe is removed or if clamping occurs while pressure is maintained on the syringe plunger. -If you suspect an air embolism, clamp the catheter, administer oxygen, and place the patient on his *left side in Trendelenburg position*. This position helps trap the air in the apex of the right atrium rather than entering the right ventricle and, from there, moving into the pulmonary arterial system. -Be sure to stay with the patient while a colleague contacts the provider. __________________________________________ *Catheter Lumen Occlusion* __Thrombosis__ Thrombotic occlusions are caused by clotting inside the lumen or outside around the catheter tip that blocks the catheter's lumen. -make it impossible to draw blood from the catheter, to flush it, or to use it for infusion. -One of the most common complications from PICCs is thrombophlebitis-impaired blood return as the vessel with the thrombosis is at least partially occluded. This results in swelling of the forearm-- -The lack of blood return or sluggish flow may indicate a *catheter lumen occlusion or a malpositioned tip*, and further assessment of the line is crucial. --Nursing intervention: Prevention: Proper catheter care and flushing the central venous access device before and after medication administration and after blood draws -- -if everything fails you need to replace catheter- cannot flush = thrombotic occlusion or mechanical obstruction --1. check to make sure it is not clamped or kinked -Sometimes the problem is that the catheter tip rests against the wall of the vein what you can do: - Have the patient turn his head and cough. -Ask the patient to raise his arms over his head. -Place the patient in Trendelenburg position. -Have the patient take a deep breath. -Have the patient stand up. -Have the patient change positions in bed -- the sutures securing the vascular access device can constrict the catheter: -obtain an order to remove the sutures and apply a stabilizing device -If the obstruction is with an implantable port, check to make sure the noncoring needle is correctly placed in the port. -If it is not correctly placed, remove the needle and replace it with a correctly positioned needle. --Include positive-pressure flushing techniques whenever flushing the line. Use a positive-pressure device whenever possible ____________________________________________ *Drug precipitates* When incompatible medications come in contact with one another, a chemical reaction can result and cause precipitate to form. The provider might order a specific agent to help unblock an occlusion cause by precipitates --Nursing interventions: - Designate and label each lumen for a specific infusion and flush the lumen after use ____________________________________________ *Pinch off Syndrome* When a central catheter is inserted into the subclavian vein, the clavicle and rib can move together and compress the central line catheter -Signs: include difficulty drawing blood samples and resistance to the infusion of IV fluids. --Nursing Interventions: -*imperative to obtain a brisk blood return and to be able to flush the catheter easily before infusing fluids or medications through the catheter.* -ask the patient to change the position of his arm on the catheter's side by raising it or by pulling his shoulder backward. If you are able to aspirate blood and flush the catheter after the position change, suspect pinch-off syndrome. Be sure to assess the periclavicular area near the insertion site for redness, swelling, or crepitus (a noise or vibration you can feel). ____________________________________________ *Catheter malposition* A central catheter can become dislodged as a result of: -improper technique when removing a dressing, -inadequate securing of a catheter -physical activity -A central catheter migrates when the tip of the catheter changes without the external catheter changing length. the tip could move from the superior vena cava into the internal jugular vein. -Changes in intrathoracic venous pressure (coughing, sneezing, vomiting, heavy lifting) could cause the tip to move -Problem: With catheter migration, fluids flow against the direction of blood flow. --Nursing Interventions: -Remove dressing from insertion site carefully (prevent inadvertent dislodgment) -instruct your patient about physical activity that could contribute to catheter dislodgment -If the line is pulled out, cover the site with an air-occlusive dressing. Place the patient on his left side in Trendelenburg position. stay with pt Prevention: catheters are sutured in place. the Dacron cuff also serves as an anchor. -when assessing and insertion site, measure the external catheter length and check for any discomfort and edema of the chest, neck, shoulder, or accessed extremity. _________________________________________ *Catheter Rupture* -when the catheter is broken (this could occur when using excessive force with flushing) or separated from the hub or port body (this could inadvertently occur when scissors are used to remove a dressing) OR occur when a subclavian central venous catheter gets compressed between the clavicle and the first rib, otherwise known as pinch-off syndrome. Signs: -fluid leaking around the site -pain -swelling during an infusion or the inability to aspirate blood. Prevention: -avoiding excessive force while flushing. And using the appropriate syringe size with flushing. Remember, a syringe size smaller than 10 mL could exert too much pressure, which could cause the catheter to rupture --Nursing intervention: -clamp the catheter above the break if it is visible. Also notify the provider, as the catheter may need to be repaired or replaced.

Fluid displacement needleless connectors (Negative displacement devices)

Lets blood flow back into the catheters lumen when you disconnect the syringe or admin set -When using a negative displacement device, it is important to use a positive-pressure flushing technique: -Withdraw the syringe from the injection cap as you flush the last 0.5 mL of flush solution into the catheter. Or, flush all fluid into the catheter, maintain pressure on the syringe plunger, clamp the tubing between the catheter hub and the patient, then disconnect the syringe. -Use a pressure flushing technique *unless the device has a positive fluid displacement needleless cap*. Positive displacement =withholds a small amount of fluid to overcome blood reflux. When using a device with a needle-*free positive fluid-displacement injection cap, = do not use positive pressure flushing techniques.* Disconnecting the administration set or syringe forces the reserved fluid into the catheter's lumen. In this case, using a positive pressure flushing technique will cause blood reflux* Positive displacement= Flush these devices only with saline and do not clamp the line.

What is a Non-coring needle

Think about the meaning of the word coring. When you core an apple, you remove the innermost portion of the apple (the core). Or, think of coring as a cookie-cutter action: The cookie cutter cores or cuts a shape from the rolled cookie dough. If you use a coring (standard) needle when you access an implanted port, you'd remove a "core" of silicone from the septum, resulting in leaking and an increased risk of infection. So instead, you use a noncoring (Huber) needle so that you can access the septum repeatedly without damage

Tunneled Catheters

*Tunneled central venous access devices (CVADs) are designed for long-term use (months to years) as they are designed to reduce infection without compromising mobility.* -A Dacron cuff lies within a subcutaneous tunnel created between the insertion site of the dermis and the site where the catheter enters the bloodstream. --->Tissue granulates around the cuff, anchoring the catheter and acting as a barrier to the spread of organisms from the skin to the bloodstream. (Some cuffs contain antibiotics to further prevent infection.) --Used for: -administering fluids, -chemotherapy -antibiotics -blood -parenteral nutrition -as well as for central venous pressure monitoring and blood sampling -Placement: distal catheter tip is advanced into the vessel and is placed in the superior vena cava, while the proximal end is tunneled subcutaneously to an incisional exit site on the patient's trunk. The usual exit sites allow the patient to care for them conveniently, while also making it possible to conceal them under clothing. Tunneled catheters are often referred to by the trade names Hickman, Broviac, Leonard, and Groshong.

Nontunneled Catheters

*called subclavian, percutaneous, acute-care, or short-term catheters.* *usually inserted into the internal jugular or subclavian vein, with the catheter tip resting in the superior vena cava just above the right atrium.* - femoral vein may be used if necessary:not preferred, and the catheter should be removed as soon as possible due to high risk of infection. -usually have multiple lumens -Indications: intravenous therapy, blood sampling, and central venous pressure monitoring. -not commonly used for long-term care (typically less than 6 weeks ) *assessed daily for need and removal when no longer needed to reduce the risk of catheter-associated bloodstream infection* -Insertion does not require sedation. Provider can do it at bedside -nontunneled catheter protrudes externally and because there is no subcutaneous tunneling, the *risk for infection is greater than with other central venous access devices*. Also, venipuncture directly above the lungs *increases the risk of pneumothorax*.

General Principles For ALL central lines

*syringe Size* Excessive pressure from the syringe = rupture the catheter ONLY use 10mL or LARGER *avoid excessive force when flushing the lines or administering medications. Flushing with larger syringes = less pressure; smaller syringes= more pressure. ________________________________________ *Flushing* Flush with preservative-free, sterile 0.9% sodium chloride solution = helps ensure and maintain patency of ALL types of central venous access devices. -before fluid infusion, and before and after blood sampling and drug, blood-product, and parenteral nutrition infusions -When flushing use a pulsing *(push - stop - push - stop)* flush to create turbulence = helps clear blood and medications from the line -Resistance/ cannot aspirate blood = take further steps to assess the catheter's patency before you administer medications and solutions. *Do not flush the catheter forcefully.* ____________________________________________ *Heparin Flushing* --valves that require ONLY saline flushes.-- -Valve-tip or -closed-end valve catheters such as a Groshong incorporate a valve that opens from positive or negative pressure, as is generated by flushing or aspirating. valve remains closed to keep blood from entering the catheter. -Flushing with heparin helps ensure and maintain patency of the central venous access device. Heparin is available in several concentrations. (cleans out the catheter) ______________________________________ *Clamping* Must be CLAMPED b/c air can enter the port causing air embolus even time between syringe = need to be clamped ONLY catheter with a valved or closed tip such as a Groshong does not require clamping

Ports

-Blood samples can be taken from any port NOT being used for fluid administration. -Check the manufacturer's instructions and how the lumens are labeled (color-coded, labeled by size, labeled by their proximal-medial-distal relationship) -first hole that sits inside the patient's vein is the proximal port (closest to the entry and farthest from the right atrium). -The next hole is the medial opening, and the next is the distal (the hole farthest from the site of entry and closest to the right atrium). *YOU CANNOT TELL BY GLANCE* external portion of the catheter which is the proximal, medial, or distal lumen. You have to depend on how the manufacturer labels the lumens.

Open-ended and Valved Catheters:

-catheter tips may be open-ended or closed (valved). -You may not be able to tell at a glance. always review the patient's medical record to be sure *open-ended tips require heparin flushing and valved (valve-ended) tips do not.* __________________________________________ OPEN ENDED: -Hickman and Broviac catheters A Hickman catheter may have single or multiple lumens. It is surgically inserted into the patient's chest and into a central vein. It is tunneled under the chest tissue after it exits from the vein so that the exit site at the skin is a distance from its exit from the vein. Near the exit site, the catheter is surrounded by a Dacron cuff, which allows tissue to grow into the material, forming a seal against microbes and anchoring the catheter to minimize the risk of dislodgment. It takes approximately 3 weeks for the catheter to heal thoroughly into place. The internal diameter of a 9.6-French Hickman catheter is 1.6 mm. This is large enough to allow withdrawal of blood and infusion of fluid into the vein. This type of catheter can be kept open with a continuous infusion or capped and filled with heparin to be used for intermittent access to the vein. A Broviac catheter is a similar single-lumen catheter that is inserted in the same way as a Hickman catheter. The major difference between the two is that a 2.7-French Broviac catheter has a smaller internal diameter of 0.5 mm, so problems with clotting can arise when a catheter this small is used for drawing blood. This type of catheter is usually used for pediatric patients or for adults with small central vessels and generally only for infusing fluids and medications. ______________________________________ Valved (Closed Catheter) Tips Groshong, has a specially designed end. When fluid is introduced, positive pressure pushes the valve open to allow fluid to flow into the bloodstream. The tip also can be opened with the negative pressure created by a syringe. When negative pressure is applied, the valve opens inward, thus allowing the catheter to be used for drawing blood. When no pressure is applied, the valve remains closed. This keeps blood from entering the catheter and forming a clot. In addition, the patient is protected from air emboli because the tip does not transfer the negative pressure in the chest to the catheter's lumen. Unlike open-ended catheters, valved catheters do not require heparin flushes. The catheter is filled with normal saline when not in use. *Because no heparin is administered to keep it open, it is safer for patients who should not receive heparin. Also, valved catheters do not require clamping when not in use.*

Implanted Vascular Access Devices (IVADs)

-implanted port or by the popular brand name Port-A-Cath, is a device placed under the skin without any portion of it exiting the skin. insertion is performed in the surgical suite or in the radiology department. -single or double injection port with a self-sealing silicone septum covering a metal or plastic reservoir called the body. -The catheter connects the port and reservoir to a central vein, typically the superior vena cava. -For chemo, fluids, or blood draws -Access= a noncoring, non-barbed (Huber) needle. -Noncoring needles- have a deflected point that helps avoid septal injury by slicing through the septum without coring out a tiny piece of it each time the port is accessed. -Most facilities' policies allow access to the implanted port with the same needle for 7 days. -the septum is made of self-sealing silicone, which allows it to be accessed many times without damaging the septum -most common site for implanted port placement is the anterior chest, just below the clavicle. less common sites for implanted port placement include the upper arm, the abdomen, and the back. ____________________________________________ Implanted Port: -single or double lumens. A double-lumen port has two noncommunicating reservoirs. -Advantages: -Cosmetically appealing -lowest risk of infection -allow patients to carry on virtually all activities including bathing and swimming when it is not in use -do not require exit-site care. -Some implanted ports are considered power-injectable and can handle 5 mL/second infusions at high pressure, which is needed during contrast enhanced computed tomography. may carry an identification card that includes information regarding power-injection capability of the implanted port. Others may wear a wrist band identifying the presence of the power injection port. Special power-injection rated needles should be used to access the port. -Open-ended (require heparin flush) or valved (do not require heparin) -When an implanted port is not accessed, monthly flushing is usually sufficient.- *Flushing practices: Prior to each use, aspirate for a blood return to confirm device patency. The port must be flushed with 10 mL 0.9% sodium chloride after each use, and when not accessed monthly flushing is usually sufficient.* *Prior to removing the Huber needle (called deaccessing), the port should be "locked" with a heparin solution per facility protocol.*

PICCs

A peripherally inserted central catheter (PICC) is a long central catheter that is inserted into the *basilic (preferred) or cephalic vein* in the arm. -end of the catheter rests in the superior vena cava just above the right atrium. -single or multiple lumens. -For: patients who require therapy for several days to months *Clear lines of communication must be established so that the healthcare team is aware that the PICC is not a peripheral IV line* --Indications: -administering fluids -blood -medications -blood sampling, although blood sampling through a PICC can be difficult, especially with smaller lumen PICCs. -need to flush with 20 mL sterile saline Post blood sampling *A 10-mL syringe is always used for flushing to avoid the dangers posed by increased pressures from smaller syringes* -can be done at bedside by physician or by special nurse -MUST have X-ray confirmation or fluoroscopy placement -can be sutured in place: not recommended suture sites create additional breaks in the skin that can become inflamed, thus increasing the risk of bacterial colonization at the exit site. Most PICCs are secured with wound closure strips (such as Steri-strips) or a securing device (such as StatLock) to prevent catheter migration and damage. *Assessment*: -measuring the patient's upper arm circumference to establish baseline data. -it is best to measure at the level of the top of the axilla (serves as a reference point to determine with later measurements the presence of swelling or edema.) -measure and document the length of the external portion of the catheter from the insertion site to the hub of the access cap. - you'll compare the length of the external catheter to the previously documented length to detect catheter dislodgement from the insertion site --Ongoing care includes -a dressing change (usually with a transparent semi-permeable dressing) 24 hours post insertion---> then on a weekly basis. -Assess the site for redness, drainage, swelling, and pain. *A typical schedule for flushing is every 12 hours when medications or fluids are not being administered* -recommendations include 5 mL of heparin (10 units/mL) flush once daily for a PICC not in use.- *Avoid measuring blood pressure and performing venipuncture in the arm with the PICC* --Patient teaching -- include activity limitations, such as avoiding heavy lifting, which could dislodge the catheter. The catheter and insertion site will also need to be kept dry during bathing and showering. Proper care, such as flushing, precautions for preventing infection, and signs and symptoms of complications, should also be taught. --

Whats the difference between Peripheral IV Line and PICC

A peripherally inserted central catheter (PICC) is much longer than a peripheral line. A PICC is inserted in the upper arm but its tip goes past the shoulder and ends in the superior vena cava. For this reason, a chest x-ray is done to confirm proper placement unless the line is placed under fluoroscopy. Newer imaging systems may be able to validate tip placement. It can stay in place for a year or more, as long as there are no complications with the insertion site or the catheter. The usual recommendation for peripheral IV catheters, on the other hand, is to replace them every 72 to 96 hours. The Infusion Nurses Society advises changing short (3/4 to 1¼ inches long) peripheral catheters every 72 hours and immediately when contamination or complications occur. PICCs (18 to 29 inches long) are commonly used for parenteral nutrition, chemotherapy, and any other intravenous therapies that must continue longer than 4 weeks

Advantages of Implanted Port

An implanted port is an option for patients who require long-term, intermittent vascular access. It is cosmetically appealing as there is no external portion visible when it is not in use. Because it is completely under the skin, there is no need to cover the device while bathing or showering. In fact, patients can swim without any concerns about keeping the device dry. Another advantage is that the implanted port requires less frequent flushing, typically once a month when not in use

Difference between turned and non tunneled catheters

As the terminology indicates, it's the tunneling. A tunneled catheter is inserted into a central vein and the remainder is tunneled subcutaneously to a distant exit site. Tunneling helps secure the catheter in place and reduces the incidence of infection. A nontunneled catheter is inserted directly into a central vein and is associated with a higher risk of infection. The location varies as well: A tunneled catheter is inserted in the chest; a nontunneled in either the chest or the neck. Also, a tunneled catheter is usually placed in a surgical or radiology suite while a nontunneled catheter can be inserted quickly at the bedside (making it a good choice in an emergency situation). Dwell times vary as well: A tunneled catheter may remain in place for several months to years while a nontunneled catheter usually has a dwell time of less than a month.

Care of insertion site

Dressing = protective covering to prevent infection and also helps stabilize the catheter to prevent migration. *Always use surgical asepsis (sterile technique) when changing the dressing * -The Infusion Nurses Society recommends changing gauze dressings every 48 hours and transparent dressings 3 to 7 days or whenever they are no longer intact. -transparent semipermeable membrane dressing is often preferred as it allows easy visualization of the insertion site. -gauze dressings are not recommended unless there is drainage from the site. -Gauze placed under a transparent dressing is not advised as it obscures visualization of the site. -A chlorhexidine patch may be considered at the insertion site to reduce the possibility of infection. -Chlorhexidine gluconate is the preferred agent to clean the insertion site, but some use alcohol and povidone-iodine.(consider age of pt, no alcohol or clorhexidine for neonates, use povidone-iodine removed completely with sterile water or saline) -NOT RECOMMENDEDS- --gauze dressings are not recommended unless there is drainage from the site. -Gauze placed under a transparent dressing is not advised as it obscures visualization of the site. -Povidone-iodine ointment and topical antibiotics are no longer recommended as they can promote the colonization of fungi ________________________________________ be sure to cleanse the skin well beyond the dressing area. chlorhexidine= back-and-forth motion for 30 seconds. Povidone-iodine= contact with the skin for minimum of two minutes in order for it to be effective. -A single-use Luer-Lok access cap/connector is also available. The use of this eliminates the need to change the cap and it also eliminates the need to swab or clean the end of the cap with alcohol or chlorhexidine. * your ongoing care includes assessing the insertion site for: -redness -drainage -inflammation -swelling -tenderness -warmth. As part of the evidenced-based interventions to reduce catheter-related bloodstream infections, documentation should also include criteria supporting the continued need for the central venous access device. *

Why is saline flushing of central line crucial

Flushing helps confirm the catheter's patency, avoid drug incompatibilities, ensure that the entire drug dose is delivered, and prevent thrombus formation

What should I do when I am unable to obtain blood return from CVAD?

If you cannot aspirate a brisk blood return or flush the line, try some troubleshooting strategies before assuming that there is a blood clot. Have the patient cough, stand up, raise his arms over his head, take a deep breath, change positions in bed, or lie in Trendelenburg position. If these strategies fail and the provider determines that there is a thrombotic inclusion, he might prescribe a thrombolytic agent to dissolve the clot without the need for surgery. The medication dwells in the catheter in direct contact with the clot to break it down.

Can a patient shower with a CVAD

Immediately after a central venous catheter is inserted, the patient should keep any incisions on the chest dry to allow the area to heal (about 7 days). Showering is permitted as long as the site, the catheter, and the connecting devices are covered with an impermeable dressing. An access or injection cap must always be in place at the end of the line, and the dressing should be changed immediately after the shower. The patient should not submerge the exit site in water. That means no immersion in hot tubs, swimming pools, or lakes while the line is in place. With an implanted port, however, the patient is allowed to shower, swim, and soak in a hot tub (if not otherwise contraindicated) when the port is not in use.

Why is positive pressure flushing important?

Positive pressure flushing prevents the aspiration of blood or solution into the lumen, which could occlude the catheter. Positive pressure flushing can be accomplished by: --withdrawing the syringe from the injection cap as you flush the last 0.5 mL of flush solution into the catheter --maintaining pressure on the syringe plunger as you near the end of the flush, clamping the tubing between the catheter hub and the patient, then disconnecting the syringe --using a positive displacement device to do the work for you

Blood Drawing from Central Line

Positive: do not have to stick multiple times Negative: drawing blood from central lines is not ideal, as the additional manipulation of the hub and the possibility of blood adhering to the inner surface of the catheter can increase the risk of bacterial growth, which is one factor that contributes to catheter-related bloodstream infection. You might not be able to obtain a blood sample from a peripherally inserted central catheter (PICC). *A lumen size of 4F or larger is recommended for drawing blood.* Infusion Nurses Society recommends using the *distal port of a multi-lumen catheter for blood sampling* The distal port is largest (16-gauge) and has a greater flow rate. * it is recommended to temporarily stop all other infusions until blood drawing has been completed.* resume infusions after blood sampling is completed. Collection methods: -Syringe Method -Evacuated Collection tube system (vac) *Syringe Method* 1. vigorously clean the needleless connector 2. attach a small syringe to the appropriate port. 3. Unclamp the line and then slowly aspirate the appropriate amount of blood from the central line. *Evacuated collection tube system* 1. vigorously clean the needleless connector 2. attach the Vacutainer holder 3. When you unclamp the line and push the evacuated blood tube inside the tube holder, blood will begin to flow into the tube. *Cleaning* use of 70% alcohol,chlorhexidine or a single-use access valve disinfection cap (SwabCap). The disinfection cap contains isopropyl alcohol. With each use, a new cap gets twisted onto the needleless connector. It replaces the need to clean the connector with an alcohol or chlorhexidine prep pad. - "blood discard" or "waste." =The amount of blood to aspirate or pull from the central catheter and discard before filling the tubes The purpose of withdrawing fluid/blood before obtaining a blood sample is to clear the catheter of any intravenous fluid or medications that could alter the laboratory test results.

How can I be sure I have accessed the implanted port correctly ?

You'll find it easy to aspirate a brisk blood return and flush the extension tube, needle, and cathter with 0.9% (normal) saline solution without any evidence of infiltration.

Lumens

hollow channel within a tube Can have one or multiple lumens in 1 catheter -A single-lumen central venous catheter is used for patients who need an infusion into a large, central vein -When a single-lumen catheter is in place for infusing parenteral nutrition, it cannot be used to sample blood or to transfuse blood. -Multi Lumen Catheter: lumen opens separately from the other lumens at the distal end of the catheter or along various areas of the catheter. -solutions do not mix as they travel through the catheter. - varies from two to four allow - for administration of medications, blood infusions, blood sampling, fluid replacement, and pressure monitoring. -Any one, any two, or all three may be capped and filled with heparinized saline or saline solution for intermittent use. -distal lumen: Used for the administration of blood or other viscous fluids -middle lumen: Used for parenteral nutrition -proximal lumen: Used for the administration of medications or blood

What should I teach a patient going home with a Central line in place

nclude the following in your teaching plan: risk for catheter-related bloodstream infection hand hygiene protecting the device during activities of daily living (keeping line dry, preventing catheter dislodgement) signs/symptoms of complications (catheter dislodgement or rupture; lumen occlusion) special instructions for those receiving home infusions (storage of solution, disposal of equipment) how to flush the line how to secure the device dressing and cap changes necessary supplies inspection of the insertion site and surrounding skin for infection (redness, swelling, drainage, pain, leakage), a break or hole in the line, and difficulty flushing emergency actions (applying pressure to site if the catheter is pulled out and clamping the catheter if punctured and then seeking emergency assistance)

central line is indicated for patients

who need: -parenteral nutrition -chemotherapy or other vesicant or irritating solutions -blood products -antibiotics -IV medications or solutions (when peripheral access is limited) -central venous pressure monitoring -hemodialysis