How do you clean a central venous line?
Smith SF, Duell DJ, Martin BC, Aebersold ML, Gonzalez L. Central vascular access devices. In: Smith SF, Duell DJ, Martin BC, Gonzalez L, Aebersold ML, eds. Clinical Nursing Skills: Basic to Advanced Skills. 9th ed. New York, NY: Pearson; 2017:chap 29. Show Last reviewed on: 9/28/2020 Reviewed by: Debra G. Wechter, MD, FACS, general surgery practice specializing in breast cancer, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Patients receiving treatment for various illnesses may have a central venous catheter (CVC) inserted. A catheter is a soft hollow tube. The central venous catheter is placed into a large vein leading into the heart and comes out through a small opening in the chest area. This opening is called the exit site. A CVC can be used to give you fluids, blood products, and medicine. It can also be used to take blood samples. That way, you will not have to be “stuck” again and again. The type of CVC to be placed will depend upon the type of illness you have and the therapy you will most likely need. The catheter can remain in place for weeks to months. The CVC may be inserted in the operating room or at the bedside, depending upon the type of catheter. In both instances local numbing of the skin is used. Sutures may be placed at the exit site to help hold the catheter in place. Some catheters tunnel under the skin and have a small bulged area near the exit site, called a “cuff.” The cuff remains under the skin and helps to hold the catheter in place and prevent infection. To the right is a drawing of a person’s chest and blood vessels, showing one possible placement of the tunneled catheter. Types of Central Venous CathetersThe type of catheter you will receive is marked below.
These catheters may have the following features:
Catheter Care at HomeYour catheter has been inserted through a small cut (incision) near the catheter exit site. Steri strips (small adhesive strips) are placed over the incision. Do not remove these strips. Let them fall off. Check this site for bleeding, redness, warmth or drainage until it is completely healed. Call your doctor if you have any of these symptoms. Before you leave the hospital, your nurse will show you how to flush the catheter and how to change the cap and the dressing. He or she will allow time for you to become familiar with catheter care and will answer your questions. For most patients, a home care nurse will visit after discharge to help the patient and caregiver become independent in caring for the catheter. A member of your health care team will review your insurance and help arrange for catheter care at home or in your doctor’s office. Signs of Catheter ProblemsThe signs of catheter infection and problems are similar for all types of central venous catheters. If you have any sign of infection or catheter problem, call your doctor immediately. Signs of infection, clotting, or other problems include:
A problem-solving chart is at the end of this booklet. Use it as a guide for catheter-related problems. Guidelines for Central Venous Catheter CareYou must always wash your hands carefully for 15 seconds before and after working with the CVC. Anyone who helps you with CVC care must do the same. This is necessary to protect you from infection. Use liquid antibacterial soap and paper towels to dry your hands. To prevent infection, anything that touches the exit site of the CVC and anything that goes into the CVC must be sterile. Your nurse will show you how to care for the CVC properly. The following guidelines are helpful in preventing infection:
Changing the CVC DressingThe CVC dressing is changed every 7 days if you are using a transparent dressing. Change it every 48 hours if you are using gauze or Telfa island dressing and tape. If the dressing becomes wet or loose, change it even if it is not the normal time to change it. A nurse will give specific instructions to you and your caregiver about your type of dressing. Supplies
Other supplies as needed: Steps
Flushing of Catheter With a ClampSome CVCs have separate tubes. Each tube is called a lumen. Each lumen of the CVC needs to be flushed regularly to keep it clear of backed-up blood. If you have more than 1 lumen, it is helpful to have a routine for flushing lumens in the same order each time. For instance, you might always flush the red one first, then the white, then blue. You will flush each lumen of the CVC once a day using 3 cc of heparin solution (100 units heparin/cc), unless you have been instructed differently. Other flush: Supplies (Exact supplies may vary.)
Steps
Flushing of Groshong CatheterGroshong catheters are flushed once a week or when the catheter is used. The lumens are flushed using 10 cc of saline solution on the same day of each week. Heparin is not used because of the special construction of the Groshong catheter. Supplies (Exact supplies may vary.)
Steps
Central venous catheter cap changesThe injection cap on each lumen of your CVC is changed every 5 to 7 days. Change a cap any time it is leaking. Supplies
Steps
This requires doing a lot with only one hand, but it is important to hold onto the lumen of the CVC to keep it from hanging free and touching anything. The patient and caregiver may need to work together to have enough hands for this procedure. Problem-solving for central venous cathetersSee the table on the next page for some potential CVC problems and what to do about them. It is a good idea to carry a few CVC supplies with you at all times. |