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33 Cards in this Set
- Front
- Back
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What is the definition of a Central Venous Catheter?
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A venous catheter (tube) with the TIP located in the central venous Circulation, i.e. Superior Vena Cava,Inferior Vena Cava, Right Atrium
(SWAN GANZ) |
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What are the major veins used in a central venous catheter?
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Internal and External Jugular vein (prob. people sweat on their necks, have hair, etc.)
Subclavians (pretty good site, risk for infection) preferred over jugular) Femorals (if subclavian is unavailable, problem is hygiene,close to perineal area.) Antecubital space if PICC |
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Which type of therapies require Central vein catheters?
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Fluids at a high-volume
Total Parental Nutrition (TPN) Vesicant (toxic)chemotherapy Caustic or irritating medications Hemodynamic monitoring (data collection of cardiopulmonary function) Prolonged venous access Inaccessible peripheral veins Blood draws PPN: (Less Dextrose Nutrition; can be given peripherally) thinner substance than TPN |
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What are the two main types of central catheter device insertion techniques?
What must we do before Central Line Insertion? |
"Through the introducer"
"Over the wire" technique- also called "guide wire" or Seldinger technique Central Line Insertion: Informed Consent: VERY IMPORTANT Pateint/Site preparation: Pt. will be on antibiotics. Explain procedure, there may be a drape shielding their view. Also, dressing changes are necessary as these types of central lines may be surgically implanted, however; never assume. Be very careful with ports. Positioning: Somewhat upright, not flat on back. This is an invasive procedure. We cannot just give a Central Line because we are unable to obtain a PICC line, billing is different...must always have another nurse attempt a PICC line before requesting a Central Line. Also DOPAMINE is a vesicant. If someone had major blood loss you would never attempt a PICC line as you would have great difficulty getting a vein. You would need to go straight for the central line. |
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Types of Central venous catheter devices:
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Non-tunneled catheter ("triple lumen"
PICC- peripherally inserted central catheter Tunneled silastic catheter: ex.)Hickman, Broviac, Groshong, Leonard Implanted Infusion Port: ex.) Port-A-Cath, Infus-A-Port, Mediport Short term: Swan Ganz |
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Categories of Central Catheter Devices:
Length of dwell time Short term is: |
swan ganz catheter
SWAN GANZ IS AN EXCELLENT pulonary artery catheter. Gives a VERY accurate temp. |
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Categories of Central Catheter Devices:
Length of dwell time Mid term: |
PICC
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Categories of Central Catheter Devices:
Length of dwell time Long term: |
surgically implanted port or tunneled catheter method of placement
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Central Venous Catheter Care and Maintenance:
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Maintain Patency:CRITICAL. Check your institution's policy for flush protocol. Some may require periodic flushes with NS and heparin, while others may require NS only
Use sterile technique when changing dressing. Check your institution's policy for dressing change protocol |
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Complications of Central Venous Catheters:
INSERTION related: **We risk puncturing a lung when inserting a central line, can be risky. |
Pneumothorax:is a collection of air or gas in the chest or pleural space that causes part or all of a lung to collapse
Hemothorax:is the accumulation of blood between the membranes lining the lungs (the pleura). Chylothorax:An accumulation of chyle ( A milky fluid consisting of lymph and emulsified fat extracted from chyme by the lacteals during digestion and passed to the bloodstream through the thoracic duct) in the thoracic cavity. Intavascular tip malposition: |
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Complications of Central Venous Catheters:
POST INSERTION occurs during catheter dwell time |
Sepsis or blood stream infection-most common, most life-threatening
Thrombosis (blood clot) formation around catheter Tip migration A forward—e.g., into the right atrium—or backward movement of a diagnostic or therapeutic cardiac catheter Danger Fatal or near-fatal arrhythmias Catheter occlusion Air emboli |
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The Swan Ganz Catheter is a short-term use venous catheter inserted for the close monitoring of heart pressures. It is inserted into what?
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the Right Atrium, and can be floated into the Pulmonart Artery, which gives you left side heart pressures.
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Swan Ganz Catheter's are only used in which unit's?
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The critical Care Unit, since it is actually in the heart. It can also have thermometer probes, pacer probes, CVP monitoring, infusion ports, ports for blood draws. It is very useful, but also very dangerous if not handled properly
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Non-tunneled a.k.a "TRIPLE LUMEN" as it often has what?
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3 lumens to use (The pt. cannot go home with this one!! Can be used in critical care units and on Med/Surg Units
Distal : 16 gauge CVP monitoring infusing blood infusing medications Medial 18 gauge infusing TPN infusing medications PROXIMAL 18 gauge drawing blood samples infusing medication Triple Lumen's have 3 separate lines w/ in one catheter. The drugs will never mix until they hit the superior vena cava, where there is massive blood flow to dilute. NO INCOMPATIBILITY ISSUES!! *Any of the 3 lines can administer blood, but blood should be taken from the proximal 18 gauge. |
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Long-term tunneled catheter Names:
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Hickman, Broviac, Leonard
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Long-term tunneled catheter surgical insertion (not as common)
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Hickman, Broviac, Leonard
surgical insertion via subclavian vein, then tunneled under the skin and exits out the lower part of the chest Needs daily care to maintain patency and prevent infection Has a Dacron sheath (that holds it in place for years Not used much anymore (newer types are easier to use and much safer)(these can lead to infection) |
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What is an implanted vascular access Port?
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A venous catheter with one end located in the Central Venous Circulation and the other
attached to a port which is surgically implanted in a subcutaneous pocket A port is for very long term. ex. chemotherapy) |
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What are the names of implanted vascular access Ports?
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Names of Implanted Catheters:
Life Port Medi Port After a while the pt. will loose sensitivity around the port. |
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Post Op. Care following an implanted catheter:
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Incision site care
Initial Access Identification Card (alarms will sound at airport) |
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Routine Care of Implanted Ports
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De-access/Re-access Procedure
Huber needle: A specially designed hollow needle used with implanted ports. A Huber needle has a long, beveled tip that can go through your skin as well as the silicone septum of your implanted port's reservoir, causing very little damage or injury. Sterile Technique Site Assessment Non-coring needles (needles that do not damage the port) Monthly flushes for patency-must use Heparin to maintain monthly patency |
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Define PICC
Different from a central line based on insertion site being peripherally rather than in the trunk |
A venous Catheter that is inserted through a peripheral vein (veins not in chest or abdomen, rather arms, hands, legs and feet), usually through the cephalic or basilic veins, with the tip residing in the Central Cirulation
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Patient Education for PICC LINES:
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Rational For PICC
Need for Assessment Sterile Technique Possible Complications Reason for x-Ray Dressing Changes (NO dressing changes on PICC lines because they move.) Routine Care |
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PICC insertion:
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Sterile technique:
Positioning: Pressure Dressing: XRAY for placement: No fluids until placement confirmed |
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PICC site assessment:
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Measure Arm Circumference
Look for: Redness; Tenderness; Edema Note any drainage from site Measure external catheter length Make Sure Dressing is Dry and Intact |
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Routine Care for All Central Lines:
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Site Assessment
Catheter Flushes Cap/Injection Port Changes With all Central Lines/PICC lines we must have a reason for insertion. Just because you cannot get an I.V. started you do not go for a PICC. Get someone else to attempt the I.V. first. Central/PICC lines are billed differently. Dressing Changes |
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Initiating Therapy:
ALL CENTRAL LINES MUST BE ADMINISTERED WITH A 10CC syringe ONLY. Anything smaller can damage the integrity of the line due to volume of pressure. If you must administer a very small amount draw the med. up in a tuberculin syringe first, then mix with NS and add to 10CC syringe!! When flushing use a 10CC syringe also!!!!! |
Dressing: If gauze make occlusive
Ointment per protocol Flushes Normal Saline-Heparin dependent on equipment and hospital protocol Use Push Pause Method to give flushes Infusion: Isotonic KVO Electronic Controller/Pump ALL CENTRAL/PICC lines are VERY STERILE!! |
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Management of Infusions:
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Fluid Administration:
Initiating fluids Changing solution and tubing Medication Administration:(always administer with a pump for complete accuracy) Piggy Back Medications I.V. Push Meds. |
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What is important to remember when drawing blood through a central line?
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*Turn off running IV fluids
*Aspirate and discard first 5cc withdrawn *Withdraw enough for all lab tubes *Fill tubes for lab tests and label *Flush central catheter or re-start IV |
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What is Extravasation?
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The inadvertent administration of a vesicant solution and/or medication into the surrounding tissues.
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What are the signs/Symptoms of Extravasation?
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Tissue sloghing (from necrosis) can involve small or large area, including connective tissue, muscles, tendons, and bone
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Nursing Interventions for Extravasation:
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Discontinue infusate immediately
Follow institutional policies and procedures (varies) Possible Procedures: Leave cannula in place-aspirate residual medication Instill antidote per protocol Remove cannula/catheter Infiltrate affected area with antidote Apply dry sterile dressing Elevate extremity Apply warm or cold compress as indicated (dependent upon medication infiltrated) Notify physician and continue to observe area Restart an IV infusion site as soon as possible Use opposite arm **Preferably initiate a central line for infusing vesicants |
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Central Catheter Removal: (Confirm if hospital P & P allows nurse to perform this procedure!!!!!!!!!!
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Scrub hands
Assist pt. to Lie Flat or Trendelenberg Apply Sterile Gloves Remove Tape and Dressing Assess Insertion Site Clip and Remove Sutures (prn) Cleanse around site with alcohol Instruct pt. in Valsalva Maneuver (The maneuver is based on the fact that when a patient forcibly exhales against a closed nose and mouth while bearing down, as if having a bowel movement, specific changes occur in blood pressure and the rate and volume of blood returning to the heart.) Gently pull catheter to remove Apply Occlusive Dressing-antiseptic ointment Assess Catheter Integrtity-inspect tip, measure catheter Document |
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Valsalva maneuver
(Done while removing central catheters) |
The Valsalva maneuver is performed by attempting to forcibly exhale while keeping the mouth and nose closed. It is used as a diagnostic tool to evaluate the condition of the heart and is sometimes done as a treatment to correct abnormal heart rhythms or relieve chest pain.
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