Central line catheters in School?

Jolie, BSN · Apr 5, 2005

I am a school nurse in charge of a Severe profound handicap program for the district. Does anyone have any info/thoughts/experience to share on having a student in the classroom with a centrally inserted catheter? Any information would be greatly appreciated.
Thanks!

Given the increase in the number of medically fragile children in the public schools, I think this will become more and more of an issue.

I'm not a school nurse, but have worked with one child in the home setting who had a PICC line, and was attending school. (A Catholic school without a nurse.) His parents were well educated on the care and safety issues regarding his line, and they took the initiative to educate the school staff. I was available as a back-up, but my services were not requestd. I would personally feel more comfortable with a PICC line than a Broviac or Hickman type catheter, but the decision on which type of line to insert will be made long before the school nurse enters the picture.

Will you be administering meds or TPN? Will you be responsible for any maintenance or routine care of the line, or will you be responsible for safety issues only? If this child's care is extremely involved, will your district provide a personal nurse for the child?

suzanne4, RN · Apr 5, 2005

I agree with the above poster. There are people that actually go to work with central lines on a daily basis, without any problems. Children should not be restricted from school because of this. The school nurse should have nothing to do with the catheter other than know that it is there. It is the responsibility of the parents over medications, etc.

Same as when a student has a gastrostomy tube. The school nurse has nothing to do with the tube other than make a phone call if it comes out.

bergren · Apr 5, 2005

You need a care plan and an emergency plan to cover both a central line or a gastrostomy (or a baclofen pump and other such devices) . To write a care plan, you need to interview the parents and obtain a HIPAA compliant release to talk to the prescribing health care provider. Depending on the accomodations you may also need a Section 504 Plan.

If you are using the Gastrostomy tube for a feeding, you certainly need a procedure and a flushing schedule. They frequently leak and get infected and have foul odors. So - true you need a plan if it comes out, but there are other things to consider.

Central line, yes you need to know what to do it it comes out, if it slips and infiltrates into the sub Q (how will a aide or teacher recognize that), what to do if it starts leaking, if they exhibit shortness of breath, recognizing infection and sepsis and how it is to be redressed if the dressing falls off. Does the catheter placement indicate restrictions on activity? The University of Cincinnati Childrens Hospital Medical Center states: "A child with a C-line is not allowed to participate in contact sports such as baseball, football, soccer, volleyball, wrestling or basketball. A direct blow to the chest can damage the C-line. Because of the risk of infection, swimming is not allowed". I am aware of students who were allowed to participate in sports with central lines, but this should be clarified with the health care provider . If the line is to be clamped in the event of a leak, where are the clamps, how are they to be applied?

I agree with the above poster. There are people that actually go to work with central lines on a daily basis, without any problems. Children should not be restricted from school because of this. The school nurse should have nothing to do with the catheter other than know that it is there. It is the responsibility of the parents over medications, etc.
Same as when a student has a gastrostomy tube. The school nurse has nothing to do with the tube other than make a phone call if it comes out.