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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.

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:

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