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IV THERAPY
GBMC does not have an IV therapy team. It is the expectation of
all nurses that they will start peripheral IV’s as well as have the
knowledge to care for central venous access.
 All IV sites are to be changed every 72 hours. If the IV
cannot be changed, a physician order must be obtained to
leave the IV in place another 24 hours. This order must be
obtained daily.
 All IV tubing must be changed every 72 hours.
 All IV bags must be changed at least every 24 hours.
 Adult KVO rates are 30-50cc/hr unless otherwise ordered
by the physician, or as dictated by patient diagnosis.
 Peripheral medicine locks are flushed with 1cc of Normal
Saline every 8 hours.
 Central lines are flushed every 12 hours with the
appropriate flush, as outlined in the attached Central Line
policy/chart.
 For all inpatient areas, IV assessments, starts, and
discontinues are documented on the IV assess / invasive line
status intervention in Meditech.
 For all inpatient areas, all IV fluid volume documentation is
entered on the IV Intake Spreadsheet in Meditech.
GBMC
CLINICAL POLICY AND PROCEDURE MANUAL
SURGICAL SERVICES
CENTRAL VENOUS ACCESS DEVICE
Approval:
Signature on file:
V. P. Nursing, CNE
I.
PURPOSE
To provide guidelines for the care of the patient with a central
venous access device.
II.
POLICY
Types of devices most commonly used at GBMC
a. Non tunneled device—Arrow Triple Lumen Catheter
(TLC), Peripherally Inserted Central Catheter (PICC),
Power PICC** and Power TLC**
b. Tunneled device—Hickman catheter and the Groshong
catheter, and Power Hickman**
c. Implanted device—Port-a-cath, R-port and Power
port** (power port must be accessed with power needle
for CT scans)
d. Vascular Sheaths—used in the insertion of Temporary
Pacemakers and Pulmonary Artery Catheters (Critical
Care only)
e. Hemodialysis Access devices—cared for and flushed
by the Hemodialysis Nurses.
f. **Power venous access devices are used with the power
injector needed for CT scans. They are purple in color
and are cared for the same as their non-power
counterpart.
All fluids running through a central venous access device must be
on an infusion pump.
Registered Nurses and Licensed Practical Nurses who have shown
competency through the orientation process can draw blood from,
flush, dress, access or attach fluids to a central venous access
device.
Anti-reflux valves must be on the ports of all lines or on the port of
the needle for implanted devices. These valves should be changed
every 72 hours at the time the IV tubing is changed.
MICU, SICU, CCU and Emergency Department nurses may
discontinue
a Triple Lumen Catheter or venous vascular sheath with a
physician order—Follow procedure in AACN Procedure
Manual for Critical Care page 498-501.
Upon receipt of a physician order, Registered nurses in the
following department/job category may treat thrombo-occlusions
of central lines with t-Pa: MICU, SICU, CCU, Emergency
Department, U38, U34, Interventional Radiology, Infusion
Therapy, Educators/Clinical Specialists/Nurse Education
Specialist. (See Critical Care policy—Declotting Central
Venous Access Devices)
Dressings on all central venous access devices are to be changed
every 7 days with the application of Biopatch supplied in the
Central line Dressing Kit and the Port Access Kit. Date, time and
initial all central line dressings. Include date of insertion and date
of dressing change.
Non-coring needles (Huber) are changed every 7 days.
Fluids must be changed every 24 hours and tubing every 72 hours
per GBMC Intravenous therapy policy.
III.
CENTRAL LINE PROCEDURES: Follow procedures in
Clinical Nursing Skills and Techniques by Perry and Potter,
Chapter 19 pages 604-613 with these exceptions.
a. Dressing Change-use Central Line Dressing Kits
1. Use Chloroprep supplied in kit in place of
alcohol and providone-iodine
2. Do not use gauze to cover insertion site
3. Use BioPatch dressing over insertion site and
under transparent dressing.
b. Flushing-follow guidelines on Central Catheter Chart
(Appendix A)
ORIGINAL: 7/88
REVIEWED: 3/90, 11/91, 1/93, 11/95, 10/98, 02/03
REVISED: 12/90, 10/93, 03/04, 04/06, 12/06
Appendix A
All catheters should be flushed according to manufacturers guidelines. The
following is a chart containing those catheters most frequently used at GBMC.
Implanted Devices
NAME OF
CENTRAL
CATHETER
R-Port
Peripheral
Infusion
Device
BRAND
VOLUME OF
NAME OF
FLUSH
CATHETER
Medi-Tech
1. Normal Saline 10 cc
Heparin
5 cc of 100 units/cc
2. Normal Saline -20 cc
Heparin
5 cc of 100 units/cc
3. Normal Saline-10 cc
Heparin
5 cc of 100 units/cc
FREQUENCY
OF FLUSH
INDICATIONS
FOR USE
1. After each
medication and
blood draw--use
pulsatile
(start/stop) flush
technique.
The R-port is implanted
peripherally under the skin in the
non-dominant arm and is used for
long-term access. All types of
fluids and medications may be
infused. May be used for blood
sampling. May be used with
gravity infusion or pumping
device. Use only a Huber noncoring needled for accessing or
heparinizing the catheter. Use only
a #20 gauge or #22 gauge 1/2-3/4
inch needle.
Do not allow blood pressures to be
taken or blood to be drawn from
the arm with the port except
through the port.
For care of the fresh post0op
insertion—follow physician orders
The port is implanted under the
skin in a subcutaneous pocket of
the upper chest and is used for
long-term access. All types of
fluids and medications may be
infused. May be used for blood
sampling. Use only a Huber noncoring needled for accessing or
heparinizing the catheter.
2. After each
blood sampling
or infusion.
3. Every 4 weeks
if not being
utilized.
Implantable
Infusion Port
Port-A-Cath
Mediport
Infuse-APort
Power Port
1. Normal Saline
10cc
Heparin
5cc of 10units/cc
2. Normal Saline 10cc
Heparin
5cc of 100units/cc
1. After each
medication and
blood draw.
2. Every 4 weeks
if not being
utilized
For care of the fresh post-op
insertion—follow physician orders
Central Catheters
NAME OF
CENTRAL
CATHETER
BRAND
NAME
OF
CATHETER
VOLUM
E OF
FLUSH
FREQUENCY
OF
FLUSH
Triple Lumen
Arrow Edwards
Abbott
Normal
Saline 5cc in
each lumen
Power TLC
Heparin
1. After each
medication
administration.
2. Every 12 hours if
not being used for
infusion.
Three types of IV solutions can
be given simultaneously without
mixing. Can be used for blood
sampling. Short-term catheter.
Every 12 hours if
not being used for
infusions.
Single IV therapy
Short-term catheter.
1. Every 12 hours if
not being used.
Usually used for therapy that is
less than 6 months in duration.
1cc of
10units/cc
in each
lumen
Single Lumen
Arrow
Cardiosearch
Peripherally
Inserted Central
Catheter (PICC)
Bard
Power PICC
Normal
Saline -5cc
Heparin
1cc of
10units/cc
Normal
Saline -5cc
in each
lumen
Heparin
2cc of
100units/cc
in each
lumen
2. After each
medication
administration or
blood draw.
INDICATIONS
FOR USE
Tunneled Catheters
NAME OF
CENTRAL
CATHETER
Cuffed Tunnel
Central Catheter
Groshong Single
Lumen Dual
Lumen
BRAND
NAME
OF
CATHETER
VOLUME
OF
FLUSH
Hickman
Broviac
He Med
Power
Hickman
Normal
Saline -5cc
each lumen
Groshong
Heparin
5cc of
10units/cc
Heparin
5cc of
100units/cc
Normal
Saline – 5cc
Flush
vigorously
FREQUENCY
OF
FLUSH
INDICATIONS
FOR USE
1. Every 12 hours if
lumen not being used
for infusions.
2. After each
medication
administration or
blood draw.
3. At the end of
therapy
Long-term catheter for drug
and fluid administration.
Available in single or double
lumen
1. After each
medication and/or
solution
administration.
Intended for long-term central
venous access in adults and
children. A two-way valve is
located adjacent to the closed
distal tip of the catheter, which
remains closed when not in
use. The valve eliminates the
need for clamping of the
catheter. Do not clamp the
catheter.
Infusion of highly viscous
fluids is accomplished with
slight pressure causing valve
to open outwards. Simple
syringe aspiration creates a
negative pressure causing the
valve to open inwards to
achieve blood withdrawal.
2. Once every 7 days
when not being used
for medications
and/or solution
administration.
Groshong (cont)
Normal
Saline – 20cc
Flush
vigorously.
1. After blood
sample withdrawal.
2. After blood
transfusions.
3. After infusion of
blood products.
Groshong (cont)
Normal
Saline– 30 cc
Flush
vigorously
1. If blood is
observed in the
catheter.
2. Prior to blood
sampling after
infusion of TPN
solutions.
NOTE: When
irrigating catheter
after blood sampling,
remove injection cap
and connect directly
to catheter connector.
Hemodialysis Catheters
NAME OF
CENTRAL
CATHETER
Hemodialysis
Hemodialysis
with infusion
port
BRAND
NAME
OF
CATHETER
Shiley
Mahurkar
VOLUME
OF
FLUSH
FREQUENCY
OF
FLUSH
INDICATIONS
FOR USE
Hemodialysis
RN will flush
catheter.
The
Hemodialysis
RN will flush
catheter.
Hemodialysis available
in single and double
lumen.
The infusion
port is
flushed with
5cc of NSS
and 1 cc of
10units/cc
Heparin
flush by the
nurse caring
for the
patient.
The infusion
port is flushed
after each
intermittent
infusion or
every 12 hours
if not being
used.
Triple lumen dialysis
catheter with third clear
port used for infusions.
Approved PNC 4/06, 12/06
Approved Nursing Leadership 4/06, 12/06
Approved Critical Care Committee 4/06, 12/06
Reviewed/Revised 12/06