purpose of central lines
his osmolarity IV therapy, prolonged therapy, frequent blood work and transfusions, pressure monitoring, incompatible meds
high osmolarity therapy percentage requiring central line
more than 10% dextrose, 5% protein electrolytes, TPN, hypertonic solutions
hypertonic solutions
D5 NS
D5 LR
D10 W
D5 1/2 NS
3% NaCl
25% albumin
PICC
peripheral inserted central catheter
- good for up to a year
- can be inserted at bedside or surgically
- X-ray required prior to use
best location site for PICC
basilic
- on upper arm; ulnar side
open picc line
“power picc” “arrow”
- has clamps
closed picc line
“groshong” “power picc solo”
- has valve
- no clamps
locations for central lines
basilic, brachial, cephalic, peripheral, internal jugular, subclavian
- all rest in superior vena cava
non-tunneled central line
short term
- multiple lumens
- highest risk of infection
non-tunneled central line use
urgent and short term
non-tunneled central line insertion
inserted at bedside but require x-ray prior to use
tunneled central line
secured via dacron cuff and fibrous tissues grows into it
- lowest risk of infection
- named as “broviac” or “hickman”
tunneled central line use
long term (1-3 years)
tunneled central line placement
requires surgical placement and removal
IVAD
inserted in the OR and is placed under the skin
- long term (1-3) years
accessing IVAD
only access using huber point needle
needle change for IVAD if accessed
needle must be changed every 7 days
needle change for IVAD if not accessed
needle must be changed every 30 days
dressing change
measure to make sure line dosent move
- change every 7 days using tegaderm and 24 hours post insertion
- sterile technique
site assessment frequency for central line
assess every 4 hours when inserted and after that every shift
indications for flushing
before infusions, prior to meds, blood sampling, after disconnection, prior to locking
- flush with 20ml
locking frequency for non tunneled
every 24 hours
locking frequency for tunneled
every 7 days
locking frequency for picc
every 24 hours
