Central Venous Lines

1
Central Venous Lines

• Jayson T. Valerio RN, MSN
• Esmeralda Garza RN,MSN

2
Central Venous Lines

• Mr. WC, 77, has osteomyelitis and receives 1 gram
  of vancomycin q 24 hours via central venous line.
  Attempting to flush the catheter and get a blood
  return before infusing his next dose, you
  encounter a lot of resistance and cant aspirate
  blood. What could have happened to the line? What
  are your nursing responsibilities in taking care
  of a client with central lines.

3
What is it called ?

• Central Line?
• Central Venous Line?
• Central Venous catheter?
• CVL?
• CVC?
• Whatever you may want to call it A catheter is
• passed through a vein and into the thoracic
  cavity
• and into the vena cava or right atrium of the
  heart.
• A catheter line is considered to be a central
  line when
• the catheter tip is located at the Superior Vena
  Cava or
• Inferior Vena Cava

4
Types of Intravenous Access Methods

• Port A Cath - Mediport
• Hickman-Broviac
• Groshong
• PICC

5
Port A Cath, Mediport

• A small metal chamber (1x1x1/2 inch) with a
  rubber top that is surgically implanted
  underneath the skin to the right of the chest or
  arm.

6
(No Transcript)
7
Hickman-Broviac Catheters

• Thin, long tube made of polymeric silicone
  rubber extremely flexible and soft
• may have either a single, double or triple lumen
  at the tip

8
Insertion

• Generally inserted into the cephalic, subclavian,
  external or internal jugular vein with the distal
  tip advanced to just above the right atrium. The
  proximal end exits via a subcutaneous tunnel from
  the lower anterior chest wall. A felt cuff
  (Dacron) is used to anchor it in place
  subcutaneously.

9
(No Transcript)
10

• Hickman-Broviac double-lumen catheter
• smaller Broviac line often used for
  administration of IV therapy (parenteral
  nutrition or fat emulsions)
• should be irrigated between different infusions
  to prevent mixing of incompatible solutions,
  development of precipitation and resultant
  catheter occlusion
• larger Hickman line reserved for additional
  venous access and blood withdrawal
• should be irrigated with heparinized saline after
  blood withdrawal to prevent clot formation in the
  catheter lumen

11
Groshong Catheter

• Silastic catheter with up to 3 lumens
• Similar to Broviac and Hickman
• Catheter tip is rounded and closed
• Smaller more flexible catheter with less trauma
  to entrance site and tunnel
• Valve opens inward for blood aspiration and
  outward for infusion but remains closed when not
  in use
• The fluid in the catheter does not come in
  contact with the patients blood

12
(No Transcript)
13

• Clamping and frequent heparin flushing are not
  necessary since the valve is in closed position.
• Weekly flushing with saline is all that is
  required to keep the catheter patent.
• Advantage easier maintenance
• 3 to 7 times more likely than Hickman catheters
  to suffer valve-related catheter malfunction

14
PICC Lines

• Peripherally Inserted Central Catheter
• Long plastic catheter that is inserted into the
  arm and threaded through the brachial vein into
  the tip of the right atrium (superior vena cava)

15

• Used when long-term IV therapy is needed and the
  patient has poor venous access or
• needs several weeks of IV antibiotic therapy
• can be left in for up to 12 months if there are
  no complications

16
Care of PICC

• Dressings changed first 24 hrs, then once every 7
  days or prn (done by trained nurse)
• If PICC line is not being used, it will need to
  be flushed once a week
• Disadvantages Limits arm mobility
• bathing swimming
  prohibited

17
Flushing

• Syringe size recommended for use with catheters
• All PICC, Groshong, Broviac, Hickman, and
  implanted ports limit of 25 psi
• Higher pressure may damage blood vessels and
  viscous
• 10cc syringe or larger is recommended to infuse
  or flush catheters. This includes pediatric and
  neonatal catheters.
• Use of 3cc syringe generates pressure in excess
  of 25 psi 10cc syringe generates less than 8psi
  of pressure .

18
Flushing
19
Possible complications

• Infection
• Phlebitis
• Thrombosis or clotting
• Break or cut in the PICC (split line)
• Failure to bleed back
• Catheter dislodgement
• Catheter migration
• Pinch-off syndrome