Central Venous Catheter

1. Definition of "central venous catheter."

1. It is a tubing inserted directly into the heart.

2. It may be inserted for multiple reasons.

1. Prevention of multiple venipunctures.

2. Administration of chemotherapy.

3. Administration of total parental nutrition.

4. Administration of medications.

5. Administration of continuous I.V therapy.

6. Withdrawal of blood for laboratory testing.

2. Location and positioning of the catheter.

1. An incision is made just below the right clavicle.

2. The catheter is pulled through a tunnel made under the skin and inserted into the right side of the heart.

3. A dacron cuff is placed in the tunnel to stabilize the catheter and to act as a barrier against infection.

4. The end coming out through the skin is called the "exit site."

3. Clamping of the catheter.

1. The catheter must be clamped at all times when it is not in use, when catheter cap is changed, or when leak or break develops.

2. Tubing needs to be protected by covering with foam tape before applying clamp directly on tubing.

3. Clamp position should be changed frequently to avoid breaks in tubing.

4. A second clamp should always be kept nearby in case of emergency.

4. Proper procedure for dressing change.

1. Follow physician's orders or policy of agency for frequency of dressing change.

2. Assess skin for any signs of infection such as redness, drainage, swelling, or tenderness; report to nurse.

3. Follow physician's orders or policy of agency for specific dressing change procedure.

1. Always wash hands thoroughly before procedure.

2. Always cleanse exit site by beginning at the exit site and cleansing in a circular motion, going out away from the catheter.

3. Never return to the exit site with the same applicator.

4. Apply ointment and dressing per instructions.

5. Make loop in the tubing, and tape securely.

5. Procedure for catheter cap change.

1. Follow physician's orders or policy of agency for frequency of change.

2. Follow physician's orders or policy of agency, using meticulous aseptic technique to change catheter cap.

6. Possible complication and what to do.

1. Air embolism (indicated by coughing, shortness of breath, chest pain, cyanosis).

1. Clamp catheter.

2. Lie on left side.

3. Call an ambulance.

2. Infection (indicated by redness, swelling, or drainage at the insertion site, fever, sweating).

1. Notify your nurse or physician.

3. Catheter break (visible break).

1. Clamp catheter above the break close to the body.

2. Notify nurse or physician.

4. Hemorrhage (indicated by large amount of blood coming out through the catheter).

1. Clamp the catheter close to the body.

2. Call an ambulance.

5. Clotted catheter (indicated by resistance met when infusion solution or irrigating).

1. Never force the fluid because it may cause an embolism.

2. Call nurse.

6. Sepsis (indicated by fever, chills, hypotension, change in mental status).

1. Notify physician.