CENTRAL VENOUS CATHETER CARE AND …
CENTRAL VENOUS CATHETER CARE AND MAINTENANCE GUIDELINE DRAFT
CATHETERS
CATHETER FLUSHING
DRESSING
REFLUX VALVE /CAP
BLOOD WITHDRAWAL
Catheters without
valve, with external
clamp (PICC & Tunneled) Example: ? Cook TM ? Broviac TM
? When used intermittently, flush with:
CHANGE as follows:
CHANGE as follows:
? Use only >10 ml syringes
S ? Saline
? Positive flow reflux
? Place fluids running into other
Adult: 5 ml
? Gauze - q24 hrs
valve q72h
ports on hold prior to
Pediatric/NICU: Amount needed to
withdrawing blood (Exception:
clear line (Peds: Usually 3-5 ml)
? Transparent only - q72 ? When positive flow
vasoactive drugs)
A - Antibiotic/I.V. solution
hrs or if dressing
reflux valve becomes
(all medications)
becomes non-
ineffective (e.g.,
? Adult:
S ? Saline
occlusive
leaking, soiled,
- Discard 4-6 ml blood
Adult: 3 ml
cracked)
- Withdraw required amount of
Pediatric/NICU: Amount needed to ? Transparent with
clear line (Peds: Usually 3-5 ml)
BiopatchTM - q5 days ? Change cap every time
blood - Flush with 10 ml NS
H - * Heparin (3 ml)
or if dressing becomes
it is disconnected from
* followed by 3 ml Heparin
- Adult: 100 units/ml
non-occlusive
catheter hub
100 units/ml diluted in
- Pediatric:
5-10 ml NS
< 12 kg - 10 units/ml
? Check Biopatch TM :
? Before sending patient
> 12 kg - 100 units/ml
- a minimum of q4h
home
? Pediatric/NICU:
- NICU: 10 units/ml (maximum 3 ml)
- before and after
- Withdraw blood (amount
or per physician's order
an infusion
? Coordinate cap/
needed to clear the line)
? When not in use, flush as follows:
- q dressing change
positive flow reflux valve change with
- Withdraw required amount of blood
- Adult flush q day
? Post-bathing or when
Heparin flush
- Reinsert initial blood
- Tunneled catheters: * 300 units
soiled/wet
withdrawn
of heparin diluted in 5-10 ml
- Flush with the amount of NS
Normal saline (NS). (Do not
? NICU - Broviac TM
use less than 5 ml)
only M-W-F
- PICC: 5 ml NS followed by * 3
needed to clear line - * Follow with flush of 3 ml
Heparin
ml Heparin 100 unit/ml - Pediatric:
- Tunneled catheters: q day - PICC: q 8 hr - * With 3 ml of heparin:
? NICU ? PICC dressing changes by Fellow/Nurse Practitioner
Pediatric: < 12 kg - 10 units/ml >12 kg - 100 units/ml NICU: 10 units/ml or per
< 12 kg - 10 units/ml
physician's order
>12 kg - 100 units/ml
- NICU
? ONLY withdraw blood using the
- Tunneled catheter: q 12 hr
following PICC sizes:
- PICC: q 6-12 hr
- Gauge 16 (Fr 5) - adult
- *With maximum 3 ml heparin
- Gauge 18 (Fr 4) - adult/ped
10 units/ml or per physician's
- Gauge 20 (Fr 3) - adult/ped
order
- Controversial, blood
may hemolyze
? After administration of viscous fluid
flush with NS
? DO NOT use the following PICC
- Adult: 20 ml
sizes to withdraw blood:
- Pediatric/NICU: Amount of NS
- Gauge 24 (Fr 2) or smaller
* Heparin use requires a physician's order
CENTRAL VENOUS CATHETER Page 4 of 7
CENTRAL VENOUS CATHETER CARE AND MAINTENANCE GUIDELINE DRAFT
CATHETERS
CATHETER FLUSHING
needed to clear line - NICU: PICC < 1ml
? ALWAYS use 10 ml syringe or greater (3 ml - NICU) even if the amount of solution is 10 ml syringes ? Place fluids running into other ports on hold prior to withdrawing blood (Exception: vasoactive drugs)
? Adult: - Discard 4-6 ml blood - Withdraw required amount of blood - Flush with 10 ml NS
? Pediatric/NICU: - Withdraw blood (amount needed to clear line) - Withdraw required amount of blood - Reinsert initial blood withdrawn - Flush with the amount of NS needed to clear line
? Withdrawal of drug levels - Flush with 3 ml NS prior to withdrawing blood
? Withdrawal of blood during or immediately after a TPN infusion - Adult: Flush with 20 ml NS before drawing blood specimen - Pediatric/NICU: Flush with the amount of NS needed to
* Heparin use requires a physician's order
CENTRAL VENOUS CATHETER Page 5 of 7
CENTRAL VENOUS CATHETER CARE AND MAINTENANCE GUIDELINE DRAFT
CATHETERS Implantable Ports
CATHETER FLUSHING
? ALWAYS use 10 ml syringe or greater
(3 ml - NICU) even if the amount of solution is 12 kg - 100 units/ml NICU: 10 units/ml
* Heparin use requires a physician's order
CENTRAL VENOUS CATHETER Page 6 of 7
CENTRAL VENOUS CATHETER CARE AND MAINTENANCE GUIDELINE DRAFT
CATHETERS Triple Lumen
Introducer Sheath Restricted to the ICU/CMA
CATHETER FLUSHING ? Follow SAS when used intermittently
DRESSING
REFLUX VALVE /CAP
BLOOD WITHDRAWAL
See catheters without valve See catheters without valve See tunneled catheter with valve
? When not in use, flush a minimum of q8 with NS Adult: 3 ml Pediatric/NICU: Amount needed to clear line (Peds: Usually 3-5 ml)
? Flush with NS: - After verifying correct placement with chest x-ray - After blood withdrawal or blood transfusion - Amount Adults: 10 ml Pediatric/NICU: Amount needed to clear line
? Only use >10 ml syringes for final
flush
? Start a continuous I.V. infusion at a minimum of 10 ml/hr immediate post insertion
See catheters without valve
NEVER CAP
? Stop infusion
Always ensure that an I.V. ? Discard 5 ml of blood
solution is continuously
? Withdraw required amount of
infusing at a minimum rate
blood
of 10 ml/hour to avoid
? Flush with 5 ml NS
clotting.
? Restart I.V. infusion
* Heparin use requires a physician's order
CENTRAL VENOUS CATHETER Page 7 of 7
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