Central Venous Access Devices

General principles for all central lines: What type of Syringe size is used and why?

use only 10-mL or larger syringes and avoid excessive force when flushing the lines or administering medications. Flushing with larger syringes creates less pressure; smaller syringes create more pressure.

Complications of central lines: Catheter lumen occlusion: What is deep vein thrombosis? What is the a nontrhombotic occlusion?

(DVT) is a blood clot (thrombus) in a deep vein, usually in the legs. While this isn't the same as a blood clot which clots inside or around the catheter tip, a DVT is related to lack of movement. -excessive physical activity, such as heavy lifting, which could cause catheter dislodgement, should be avoided for patients with a PICC line, routine movement and performance of activities of daily living should be continued to prevent the development of deep vein thrombosis. something caused by something other than a clot. An example is a mechanical obstruction or impedance of the passage of fluid or medication through the catheter.

What is one advance of using a central venous access device and one disadvantage?

1. Central venous access devices can be used to avoid repeated venipunctures for patients who need frequent drawing of blood samples. 2.increase the risk of bacterial growth, which is one factor that contributes to catheter-related bloodstream infection

What are the four types of central lines?

1. Nontunneled 2. Tunneled 3.Implanted port 4.Perioherally inserted central catheter(PICC)

What is recommended for blood sampling? For additional assurance that the laboratory results won't be altered by the solutions infusing through the central access device, it is recommended to?

1. 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. You might have to use a different port for blood sampling if the distal port is already accessed for an infusion or if it is nonfunctional. 2. temporarily stop all other infusions until blood drawing has been completed. The amount of time in which infusions should be stopped prior to blood sampling may vary according to facility policy. Then resume after it is completed.

Explain how the negative displacement technique is done?

1. 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, 2. maintain pressure on the syringe plunger, clamp the tubing between the catheter hub and the patient, then disconnect the syringe.

what kind of location is a implanted central access device insertion performed? What is the most common site on the body for the port? What are advantages of implanted ports?

The most common site for implanted port placement is the anterior chest, just below the clavicle. Other less common sites for implanted port placement include the upper arm, the abdomen, and the back. Cosmetically appealing, they have the lowest risk of infection of all chest-accessed central lines, they allow patients to carry on virtually all activities including bathing and swimming when it is not in use, and they do not require exit-site care.

What are power-injectable implanted ports?

can handle 5 mL/second infusions at high pressure, which is needed during contrast enhanced computed tomography. The patient with this type of implanted port 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.

How long can a CVAD stay in place? What type of clients are they beneficial for?

can remain in place for several weeks to years. Central lines are especially beneficial for patients who have chronic diseases and require long-term intravenous therapy.

What is a lumen? are they single or multiple?

hollow channel within a tube. Some central catheters have just one lumen while others have multiple lumens.

Complications of central lines: What is a dysrhythmia? When may it occur? What are nursing interventions used?

1. A dysrhythmia is an abnormal heart pattern indicated on the electrocardiogram 2. malposition or dislodgement. This could occur during the insertion procedure or later during the dwell time. The patient may not experience any clinical manifestations. This is why a chest x-ray is performed upon initial insertion to confirm the catheter tip is located in the correct area. Nursing intervention: 1. The nurse should confirm that radiologic results reveal accurate catheter tip location. 2. In addition to assessing heart rate and rhythm. 3. the patient should be assessed for ear, neck, or back pain, which could also indicate catheter malposition and subsequently dysrhythmia.

Care of the insertion site: Recommendations for antiseptic techniques? What type of ointment and topical antibiotics are no longer recommended? What is the appropriate way to use chlorhexidine?

1. Chlorhexidine gluconate is the preferred agent to clean the insertion site, but some use alcohol and povidone-iodine. The age of the patient is also a consideration when choosing an antiseptic.( alcohol and chlorhexidine are not used for neonates and povidone-iodine must be cleaned with water or saline. Povidone-iodine b/c of fungi infection. use a back and forth motion, 30 secs, and also with P-I it must also be used to clean skin for 2 mins

Nontunneled central line: They are sometimes called? Where is it usually inserted? Single or multiple lumens? Uses? At site may be used but is not preferred? In order to prevent the high risk of infection what should be done as soon as possible? What is the time frame for these? Does this require sedation and where is it usually inserted? Where is a common place for complication?

1. Subclavian percutaneous, acute-care, or short-term catheters. 2. This type of catheter is usually inserted into the internal jugular or subclavian vein, with the catheter tip resting in the superior vena cava just above the right atrium. 3. most often have multiple lumens. 4. Indications for placement of this type of catheter include intravenous therapy, blood sampling, and central venous pressure monitoring. 5. The femoral vein may be used if necessary. This site is not preferred, 6.The catheter should be removed as soon as possible due to high risk of infection. 7. Not commonly used for long-term, less than 6 weeks. 8.The insertion method is percutaneous venipuncture and does not require sedation. The provider may insert the catheter at the patient's bedside or, if necessary, in an emergency setting. 9.venipuncture directly above the lungs increases the risk of pneumothorax.

Complications of central lines: Catheter lumen occlusion: What is a thrombosis? What CVAD is it common in? What are signs of thrombosis? Nursing interventions?

1. Thrombotic occlusions are caused by clotting inside the lumen or outside around the catheter tip that blocks the catheter's lumen. This can make it impossible to draw blood from the catheter, to flush it, or to use it for infusion. This causes impaired blood return as the vessel with the thrombosis is at least partially occluded. This results in swelling of the forearm. 2. PICC 3. The lack of blood return or sluggish flow may indicate a catheter lumen occlusion or a malpositioned tip Nursing interventions: 1. Proper catheter care and flushing the central venous access device before and after medication administration and after blood draws will help to maintain catheter patency. 2. If, despite preventive measures, a thrombotic occlusion occurs, a thrombolytic enzyme may be needed to clear the blockage. When those measures do not help, the catheter must be replaced. 3. If you cannot flush the catheter, 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. 4.Try these strategies: 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. 5. It may be that the sutures securing the vascular access device are constricting the catheter. If so, obtain an order to remove the sutures and apply a stabilizing device. 6. 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.

What is involved with the assessment during a PICC insertion?

1. Your assessment includes measuring the patient's upper arm circumference to establish baseline data. For standardization, it is best to measure at the level of the top of the axilla. This serves as a reference point to determine with later measurements the presence of swelling or edema. 2. measure and document the length of the external portion of the catheter from the insertion site to the hub of the access cap. Later, you'll compare the length of the external catheter to the previously documented length to detect catheter dislodgement from the insertion site. If the new measurement differs, contact the provider. 3.Ongoing care includes a dressing change (usually with a transparent semi-permeable dressing) 24 hours post insertion and then on a weekly basis. Assess the site for redness, drainage, swelling, and pain. 4. Follow your facility's policies for flushing. A typical schedule for flushing is every 12 hours when medications or fluids are not being administered. The Infusion Nursing Society's 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. Also, keep scissors, razors, and other sharp objects away from the PICC to prevent damage. Patient education should 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.

Complications of central lines: What are common infection that can occur? What are signs of infection? What are nursing interventions for a infection?

1. bacteria (such as Staphylococcus aureus), yeast, and fungi. 2. fever, chills, swelling tenderness, redness or drainage at the insertion/exit site. Nursing interventions: 1. requires 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. 2. 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. 3.Needless connectors should be cleaned with chlorhexidine- some may use disinfection caps instead. Replacing with a new cap each time. 4. Strict aseptic technique should be used when hanging solutions and with dressing changes. 5. Additionally, the site should be assessed daily for redness, drainage, swelling, or discomfort at the insertion site. Since Chlorhexidine has been found to reduce the number of CR-BSI, it is the recommended skin disinfectant.

Distinguishing the ports: What are the three ports of the multi-lumen catheter? What are each used for?

1. distal lumen: Used for the administration of blood or other viscous fluids - 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) 2. middle lumen: Used for parenteral nutrition 3. proximal lumen: Used for the administration of medications or blood -The first hole that sits inside the patient's vein is the proximal port (closest to the entry and farthest from the right atrium). *Blood samples can be taken from any port not being used for fluid administration.

Peripherally inserted central cather (PICC): Where is it usually inserted into the body? Single or multiple lumen? Intended time of usage? Medical uses are? What location site can it be inserted? Are PICC sutures recommended? What are they usually secured with?

1. inserted into the basilic (preferred) or cephalic vein in the arm (thus the term peripheral). The end of the catheter rests in the superior vena cava just above the right atrium. 2.A PICC can have single or multiple lumens. 3. PICC lines are intended for patients who require therapy for several days to months. 4. PICCs are indicated for administering fluids, blood, and medications, as well as for blood sampling, although blood sampling through a PICC can be difficult, especially with smaller lumen PICCs. After blood sampling, the line is flushed with 20 mL sterile saline. A 10-mL syringe is always used for flushing to avoid the dangers posed by increased pressures from smaller syringes. - Depending on its size, 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. 5. PICC placement can be done at the bedside by a physician or, in some facilities, by a specially certified RN. If the PICC is not placed under fluoroscopy, an x-ray must verify the position of the distal tip. 6. Can be done but not recommended because of risk of breaks in skin and bacteria infection 7.secured with wound closure strips (such as Steri-strips) or a securing device (such as StatLock) to prevent catheter migration and damage.

1. Where are CVADs usually instead? 2. Where is the tip usually inserted?

1. into the veins of the hand or forearm, central access devices are inserted into large veins in the central circulation. 2. The tip of a central venous catheter is generally threaded into the internal or external jugular veins or into the lower third of the vena cava (superior or inferior) that leads to an area just above the right atrium.

Blood collection methods: What two ways should blood be collected?

1. syringe method 2. the evacuated collection tube system (trade name, Vacutainer) method - Follow the recommendations of the manufacturer of the central access device and your facility's policy to determine the method to use.

Blood collection methods: What is the syringe method? What is the evacuated collection tube system method?

1. vigorously clean the needleless connector and attach a small syringe to the appropriate port. 2.Unclamp the line and then slowly aspirate the appropriate amount of blood from the central line. Only the amount of blood needed for testing should be obtained. 1. vigorously clean the needleless connector and attach the Vacutainer holder. 2. When you unclamp the line and push the evacuated blood tube inside the tube holder, blood will begin to flow into the tube. 3. Fill the number of tubes of the correct color stopper as required by the laboratory for the prescribed tests.

Complications of central lines: How can Catheter malposition occur? Nursing interventions?

A central catheter can become dislodged as a result of improper technique when removing a dressing, inadequate securing of a catheter, and physical activity. -A central catheter migrates when the tip of the catheter changes without the external catheter changing length. For example, 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. With catheter migration, fluids flow against the direction of blood flow. Nursing interventions: 1. Remove the dressing from the insertion site carefully to prevent inadvertent dislodgment. 2. instruct your patient about physical activity that could contribute to catheter dislodgment. 3. If the line is pulled out, cover the site with an air-occlusive dressing. Place the patient on his left side in Trendelenburg position. Be sure to stay with the patient while a colleague contacts the provider. 3. To prevent migration, most catheters are sutured in place. If present, the Dacron cuff also serves as an anchor. When you assess the line and the insertion site, measure the external catheter length and check for any discomfort and edema of the chest, neck, shoulder, or accessed extremity.

What are the advantages of the multi-lumen vs the single-lumen catheter?

A multi-lumen catheter (MLC) increases the advantages of a single-lumen catheter. 1. An MLC has separate color-coded ports to identify the different lumens. 2. Each lumen opens separately from the other lumens at the distal end of the catheter or along various areas of the catheter. This means that solutions do not mix as they travel through the catheter. 3. With a multi-lumen catheter in place, several treatments can be performed via a single central line insertion site. The number of lumens within an MLC varies from two to four. The multiple ports 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.

What does a single lumen catheter consist of ?

A single-lumen catheter consists of a tube or lumen ending in a hub that can either be connected to tubing for a continuous infusion of fluid or medication or capped and used for intermittent infusions.

Complications of central lines: What is Air embolism, when can it occur? What are signs? Nursing interventions? What should you do if you suspect a air embolism?

Air can enter the circulatory system when a central venous catheter is open to the environment, thus causing air embolism. This can occur during inadvertent disconnection of the central line tubing, catheter rupture, and catheter removal. dyspnea, chest pain, , hypotension, anxiety, nausea, dizziness Nursing intervention: 1. Frequently check that the catheter is intact and patent. -A cracked catheter allows air to enter. -Closed/valve-tip catheters, such as the Groshong, can be open to air without risking an embolism. 2. Be sure to keep other catheters clamped Other: During assessment and auscultation over the pericardium, the nurse hears a churning noise. 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.

Central venous catheters are also known as(CVADS)?

Central lines

What are open-ended catheters?

Examples are hickman and Broviac catheters. -Hickman has 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. -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. 9.6-French Hickman catheter is 1.6 mm. Broviac: 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.

General principles for all central lines: What is a second type of flush that may be used? What is a valve-tip or close-end valve catheter?

Heparin flushing. Volume will depend on type of central line and agancy. Examples are Groshong. incorporate a valve that opens from positive or negative pressure, as is generated by flushing or aspirating. Otherwise, the valve remains closed to keep blood from entering the catheter. These types of valves require only saline flushes. Trying to avoid systemic anticoagulation. -the patient is protected from air emboli because the tip does not transfer the negative pressure in the chest to the catheter's lumen. -does not require clamping or heparin

General principles for all central lines: What is the important with clamping a central line? What types of catheter does not have to be clamped?

If central lines are not clamped, air might enter the patient's central circulation, causing an air embolus. Keep central catheters clamped when not in use. This includes the time in between syringe changes. Use the small plastic clamp attached to the central line for clamping. A catheter with a valved or closed tip such as a Groshong does not require clamping.

What happens if you were to use a positive pressure flushing technique with a needle-free positive fluid displacement injection cap?

It causes blood reflux.

Tunneled Central line: Typically are for how long? What is associated with it? What are the medical usages? Site?

Names: Hickman, Broviac, Leonard, and Groshong. 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, and parenteral nutrition, as well as for central venous pressure monitoring and blood sampling. The 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.

Are all multi-lumen catheters the same?

No, 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). And, follow your facility's procedures for labeling each lumen according to how it is used (for drawing blood samples, infusing fluids, infusing parenteral nutrition). you cannot tell by glancing at the external portion of the catheter which is the proximal, medial, or distal lumen. You have to depend on how the manufacturer labels the lumens.

What is the difference between opened end implanted ports and valved? When an implanted port is not accessed, what is usually sufficient?

Open-ended ports require heparin flushing while valved ports do not require heparin. monthly flushing is usually sufficient.

Complications of central lines: What is a Pneumothorax and Hemothorax? What are the usual manifestations? What are nursing interventions?

Pneumothorax: air in the pleural space, that is, outside the lung. Hemothorax: blood in the pleural space. dyspnea, hypoxia, tachycardia, restlessness, cyanosis, chest pain, and decreased breath sounds on the affected side. The likelihood of hemothorax and pneumothorax during insertion is less with PICCs, however. - Identification of these complications may be delayed for hours or days, sometimes because of minimal symptoms. Nursing interventions: Monitor the patient's vital signs, administer oxygen, and notify the provider. It might be necessary for the patient to have a chest tube inserted and the central line removed.

Flushing practices for implanted port: (IVADS)

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

Complications of central lines: What is Sepsis? What are common manifestations? What are nursing interventions?

Sepsis is a severe blood infection caused by bacteria, viruses, and fungi. Sepsis is extremely serious and can be life-threatening. Common manifestations include fever, chills, hypotension, tachycardia, and confusion. Nursing interventions: 1. Follow all precautions for preventing infection. These will help prevent the progression of infection to sepsis.

Discarding blood: What is blood discard? What is the purpose of getting blood before gaining a sample?

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.

Complications of central lines: What is pinch-off syndrome? What are warning signs? What are nursing interventions?

When a central catheter is inserted into the subclavian vein, the clavicle and rib can move together and compress the central line catheter, causing pinch-off syndrome. Warning signs include difficulty drawing blood samples and resistance to the infusion of IV fluids. Nursing interventions: 1. obtain a brisk blood return and to be able to flush the catheter easily before infusing fluids or medications through the catheter. If you cannot flush the catheter or aspirate blood, 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).

Complications of central lines: What are Drug precipitates? What can be done? Nursing interventions?

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. Follow your facility's policies for the frequency and volume of flushes.

Fluid displacement needleless connectors: What is the important technique to use with negative displacement devices? Why is this important?

When using a negative displacement device, it is important to use a positive-pressure flushing technique. Negative displacement devices let blood flow back into the catheter's lumen when you disconnect the syringe or administration set. Blood reflux can lead to occlusions.

Once the CVAD is inserted( full tip and everything) what is usually done and why?

a chest x-ray is done to confirm proper tip location and catheter position and to make sure that there is no pneumothorax.

Care of the insertion site: What is the purpose of a dressing at the insertion site? What does the CDC recommend you change a dressing? How about the Infusion Nurses Society? What type of dressings are preferred and why?

acts as a protective covering to prevent infection and also helps stabilize the catheter to prevent migration. How often you change the dressing varies with the type of dressing (gauze versus transparent) and the appearance of the dressing (soiled or damp versus clean and dry). Always use surgical asepsis (sterile technique) when changing the dressing. When its damp, loosened, or soiled. 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 b/c it allows for easy visualization of the insertion site. Guaze isn't unless there is drainage. Also a chlorhexidine match may be considered.

A single-lumen central venous catheter is used for patients who need? When a single-lumen catheter is in place for infusing parenteral nutrition, can it be used to sample blood or to transfuse blood?

an infusion into a large, central vein. no because blood cells tend to adhere to the lumen and impede the flow of the nutrition solution.

How are the type of CVADs usually picked?

the provider will work with the patient to decide to use a central catheter and then decide which type of catheter to use, depending on the type of therapy the patient needs and the length of time it will continue. It is important to know the type of catheter you are accessing so that you can manage the patient's intravenous therapy correctly.

Complications of central lines: What is one way to reduce the risk of infection?

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

Complications of central lines: Catheter ruptures occur when? What are signs? How can it be avoided? Nursing interventions?

could occur: 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). - It could also 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 or swelling during an infusion, or the inability to aspirate blood. avoidance: 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 interventions: if catheter rupture is suspected, clamp the catheter above the break if it is visible. Also notify the provider, as the catheter may need to be repaired or replaced.

What are IVADS( Implanted vascular access devices)? What does it consist of? What are the uses? To access the port use what type of needle? How many days are the needle used?

often referred to as an 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. single or double injection port with a self-sealing silicone septum(allowing for multiple access) 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. 3. used to administer medication including chemotherapy, to deliver fluids, and to draw blood samples. 4. 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. Usually 7 day usage.

Implanted port central line

picture

General principles for all central lines: What type of flush solution is sometimes used and how should it be flushed? What happens if you meet resistance or cannot aspirate blood?

sterile 0.9% sodium chloride solution helps ensure and maintain patency of all types of central venous access devices. -our facility's policies will specify flushing procedures to perform after catheter placement, before fluid infusion, and before and after blood sampling and drug, blood-product, and parenteral nutrition infusions. 2. use a pulsing (push - stop - push - stop) flush to create turbulence that helps clear blood and medications from the line. 3. take further steps to assess the catheter's patency before you administer medications and solutions. Do not flush the catheter forcefully.

Care of the insertion site: Central venous catheters have a special cap on the end where IV tubing or syringes connect into the line. This cap is called the ? What other cap/connector is available and how is this more beneficial? What other assessment things should you be doing?

the injection or access cap/needleless connector.. They should also be changed if blood or debris is visible, upon contamination, or prior to drawing a blood culture. Before attaching the new needleless connector, it should be primed with 0.9% sodium chloride and applied using aseptic technique. also available is Single-use Luer-lok access cap/connector. 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. The single use cap (Swab Cap) contains isopropyl alcohol and is twisted over and onto the needleless connector prior to each use and left in place until the next use. At the time of the next use, the single use cap is removed and replaced with a new one. In addition to site care and cap changes, your ongoing care includes assessing the insertion site for redness, drainage, inflammation, swelling, tenderness, and 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.

Cleaning the needless connector: It is important to remember? What are ways to clean them?

they are recognized sites for microbial contamination and a source for developing catheter-related bloodstream infections. 1. One way is the use of 70% alcohol,chlorhexidine 2. 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. Once the disinfection cap is in place, the line is ready to use. The disinfection cap remains in place until the next use. When it is time to access the needleless connector again, the existing disinfection cap is removed and replaced with a new sterile disinfection cap.