Download 7 - UI Community HomeCare

Policy # 2.3.1
UNIVERSITY OF IOWA COMMUNITY HOMECARE
SUBJECT:
Central Venous Catheters, Care of
PURPOSE:
To care for central venous catheters utilizing medical asepsis (mechanisms
employed to reduce potential contamination).
To provide guidelines for use of central venous catheters that minimize the
potential for infection and/or complications.
POLICY:
A.
Definitions:
1.
Tunneled cuffed - Catheters that have a dacron cuff which promotes fixation in
the subcutaneous tunnel.
2.
Non tunneled central venous catheter - non-cuffed catheter placed by a cutdown or
percutaneous approach secured by sutures and/or a securement device.
3.
Implanted port - a silicone catheter attached to a reservoir with a self-sealing
septum which is implanted subcutaneously.
B.
The pharmacist may be consulted regarding drug compatibility for simultaneous
administration of two or more drugs through a single lumen of the catheter.
C.
Every attempt should be made to avoid infusing non-nutrition solutions through the
designated parenteral nutrition lumen.
D.
A physician's order is required when attempting to open a malfunctioning central venous
catheter. (See Procedure- Management of Nonfunctioning Central Venous Catheter)
E.
For tunneled and non-tunneled central venous catheters, a syringe size of no less than
10ml is to be used to flush the catheter. Small syringes create a pressure in excess of
25psi in the catheter and can cause catheter damage or clot dislodgment.
F.
Saline only lines are to be flushed using the SAS (saline, antibiotic/TPN, saline) method.
CVC’s requiring heparin will be flushed using SASH (saline, antibiotic/TPN, saline,
Heparin).
G.
When flushing the pulsatile push-pause method should be used.
H.
Valves and extensions are to be changed every 7 days.
Central Venous Single/Multiple Catheters, Care of -1
Policy # 2.3.1
I.
Try to avoid drawing blood from the line used to administer TPN.
LITERATURE REFERENCES:
Baranowski, Leslie. Central Venous Access Devices. Journal of Intravenous Nursing, 16 (3),
May/June 1993, 167 - 194.
Bennet, J.V, Brachman, B. Hospital Infections 2nd. Edition. 567-568.
Intravenous Nursing Standards of Practice, 2006.
Keenlyside, Dorothy. Avoiding an Unnecessary Outcome. Professional Nurse, February 1993, 288-291.
Mald, Dennis G. Improving Catheter Site Care. International Congress and Symposium Series, Number 179.
Rostad, Marcia. Intravenous Access Central Lines: Part III. Urologic Nursing, 12 (4), December, 1992, 130-135.
Speer, E., et al. Central Venous Catheterization: Issues Associated with the Use of Single and Multiple Lumen
Catheters. Journal of Intravenous Nursing, 13 (1), 30-39.
Weinstein, Sharon M. Principles & Practice of Intravenous Therapy 7th Edition. 313, 396-397.
Josephson, Dianne L. Intravenous Infusion Therapy for Nurses Principles & Practice 2nd Edition. 307-311, 345-348
Centers for Disease Control and Prevention. Morbity and Mortality Weekly Report, August 9, 2002/Vol. 51/No.
RR-10
Written: 1/97
Reviewed: 5/01, 5/04, 2/10, 9/15
Revised: 4/04, 01/07, 3/07, 6/09, 6/12, 6/13, 4/15
Approved By:
Central Venous Single/Multiple Catheters, Care of -2