Central line and blood SamplingFor Nurses

What is central line..?In medicine, a central venous catheter ("central line", "CVC", "central venous line" or "central venous access catheter") is a intravenous device that is inserted into a vein in the neck (internal jugular vein), chest (subclavian vein or axillary vein) or groin (femoral vein).

It is used to administer medication or fluids, obtain blood tests (specifically the "mixed venous oxygen saturation"), and directly obtain cardiovascular measurements such as the central venous pressure.

Types Short-term (Percutaneous, Non-Tunneled, Non-Cuffed) Short Term

PICC (Peripherally Inserted Central Catheters) Long Term

Tunneled Catheters Long Term

Implanted Venous Access Devices (IVAD)

Openended

The catheter is open at the distal tip

The catheter requires clamping before entry into the system

Clamps are usually built into the catheter

Requires periodic flushing

Any type of CVC can be open-ended Center Venous Catheters: Open-ended or Closed-endedClosed-ended

A valve is present at the tip of the catheter (eg. Groshong) or at the hub of the catheter (eg. PAS-V)

Clamping is not required as the valve is closed except during infusion or aspiration

May be present on Tunneled Catheters, Implanted Ports and PICCs

Administer intravenous fluids and blood products

Administer medications

Administer hypertonic solutions (Total Parental Nutrition [TPN]), vesicants (i.e.chemotherapy), irritants (i.e.cloxacillin), and solutions with extreme pH values (i.e.vancomycin).

Obtain venous blood samples

Provide long term intravenous therapy

Administer large volumes of intravenous fluid quickly

Administer vasopressor or vasodilator therapy (e.g. Dopamine)

Indications for Use

Monitor central venous pressure (CVP)

Provide access for transvenous pacemaker or pulmonary artery catheters

Access venous circulation when a patient has difficult or impossible peripheral access

Provide hemodialysis access

Type of therapy to be administered

Length of therapy (i.e. Short term or Long term)

Complex or unusual vascular anatomy

Previous devices and complications

Clinical diagnosis and assessment

Clinical situation

Care setting

Patient/family preference

What alternatives are there?

Always advocate for Best Practice!

The type of CVC inserted depends on the:

InsertionThe skin is cleaned, and local anesthetic applied if required.

The location of the vein is then identified by landmarks or with the use of a small ultrasound device.

A hollow needle is advanced through the skin until blood is aspirated; the color of the blood and the rate of its flow help distinguish it from arterial blood (suggesting that an artery has been accidentally punctured).

The Seldinger technique is a medical procedure to obtain safe access to blood vessels and other hollow organsSeldinger technique

Blood Sampling Explain procedure to patient before starting.Aseptic preparation before starting procedure.Maintain proper barrier protection to protect nurse against possible blood contamination. Prepare dressing pack at patients bed sidePlace patient in supine position. Have patient turn head away from CVC site during procedure.Turn off infusion at least one minute before sampling.

After removing 5 mls of blood from CVC pigtail attached syringe and remove required amount of blood for blood test. Draw off blood for electrolytes and full blood counts before coagulation studies. If coagulation studies are the only tests required it may be necessary to draw up to 10 mls of blood for discard before drawing sample bloods. Re-heparinize CVC port for 'Heparin Lock for Central Venous Catheter Lines'.Record date and time of procedure on flow chart.Note in patient's chart procedure carried out and any problems noted during procedure.

Complications Central line insertion may cause a number of complications. The benefit expected from their use therefore needs to outweigh the risk of those complications.The major complications arePneumothorax (for lung Catheter).

Central line associated blood stream infections.

Thrombosis.

Other complications (like intra thoracic pressure, air embolism, etc. )

For the operator maximal barrier precautions means strict compliance with handwashing, wearing a cap, mask, sterile gown and gloves. The cap should cover all hair and the mask should cover the nose and mouth tightly. These precautions are the same as for any other surgical procedure that carries a risk of infection. Precautions to prevent infections

For the patientmaximal barrier precautions means covering the patient from head to toe with a sterile drape with a small opening for the site of insertion. Maximal barrier precautions clearly decrease the odds of developing catheter-related bloodstream infections.

ReferencesCentral Venous Catheter Guidelines by NHS, Worcestershire.Mermel LA, McCormick RD, Springman SR, Maki DG. The pathogenesis and epidemiology of catheter-related infection with pulmonary artery Swan-Ganz catheters: A prospective study utilizing molecular subtyping. American Journal of Medicine. Sep 16 1991;91(3B):197S-205S.Raad, II, Hohn DC, Gilbreath BJ, et al. Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion. Infection Control and Hospital Epidemiology. Apr 1994;15(4 Pt 1):231-238.http://en.wikipedia.org/wiki/Central_venous_catheter retrieved on 03/04/13.