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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