Central Line Preventative Maintenance?

[JustEnuff2BDangerous, BSN, RN]

Recently I had a patient who had been in the hospital a few days for lung-related issues, and was preparing to go home; and when I say preparing, I mean was dressed, packed, and sitting in the wheelchair ready to be wheeled out. The very last thing her nurse that day did was D/C her central line.

Immediately after she D/Ced the CL, the patient's left side went flaccid and she was slumped over in the wheelchair. The patient had thrown a clot and had a massive ischemic stroke. The patient is now in the ICU and has been converted to DNR status; prognosis is poor at this time.

I assume its entirely possible that there could have been a clot attached to the central line and that when the nurse removed the CL, the clot was turned loose. I also assume it could have been coincidence, but that doesn't seem likely in this case, given the timing.

How do you prevent something like this from happening? Is it appropriate to routinely flush the central line if it is not having fluids infused through it to keep clots from forming?

[TigerGalLE, BSN, RN]

Aw that is horrible. I've seen something like this happen before. The difference was the patient had an air embolism. He was dressed and ready to go. Nurse pulled line. A few minutes later the patient stood to get in the wheel chair and collapsed. We got him back and he was transferred to ICU. He was later transferred to the hospice house where he passed.

We do flush our central lines every 8 hours and prn when not in use. It is also important for the patient to lay flat and perform a valsalva maneuver when you pull the line.

[*ac*]

I have seen this, too. The patient was not lying down - it was an air embolus. He died right then.

[PICNICRN, BSN, RN]

How sad!! I've never pulled a line with a sitting up/moving around pt. I was always taught lying down and pull on the exhale.

[NightNurse0711]

Most hospitals have specific policies on central line removal. There are specific steps that need to be followed in order to safely remove a central line, such as the patient lying flat, the valsalva manevuer (sp?), and applying a vaseline guaze to the site. Also a central line is not like an INT and should not be removed as the patient is headed out the door. The line needs to be removed no less than an hour before D/C so the nurse can monitor for any adverse complications. When I started working on a medical floor, I familiarized (memorized after doing it so much) myself with that policy. Also, lines should be flushed at least every 8-12 hours when not in use. Our hospital flushes with 20 mL NS or Heparin only if ordered by the MD.

[meandragonbrett]

and applying a vaseline guaze to the site.

Xeroform isn't typical for most facilities. Just slap a tegaderm on it. Learn a new idea every day!

[iluvivt, BSN, RN]

As of 2006 the INS guidelines recommend to apply some sterile ointment after you discontinue ANY central line...air can sneak in through the skin track...the chance is increased with larger catheters and on those patients that have poor skin integrity......I usually get some sterile vaseline off the gauze or betadine ung....and yes it sounds like your patient had some type of embolus, either an air or a embolus from a venous thrombosis caused by the Central line...there are some characteristic s and s/x that the nurse may have seen and possibly could have anticiapted but many are silent

[blondy2061h, MSN, RN]

Our policy is to flush any unused ports q8h.