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withdrawn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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