Central Lines

[chloeysmom]

I am presenting an CEU course in my hospital on Central Lines. I know you guys have LOTS of neat little tricks/hints up your sleeves on how to assist/troubleshoot, etc....(I have gotten plenty of nice little tidbits on this forum thus far). I was wondering if you guys would care to shoot me anything you know about them. I am concentrating on Subclavian multilumens, RIJ, LIJ, Infusaports....

Thanks

Meli

[JentheRN05, RN]

Most important thing to get accross is flushing.

1st - flush line with 5cc NS

2nd - give med needed

3rd - flush line with 5cc NS again

4th - 2-3 cc of heparin to prevent clotting off of the site :)

This is ultimately the most important thing to know.

Of course remembering that this is a sterile field, because of the chance of inducing infection you must clense the area very well, and in most cases wear a mask if cleaning/changing dressing.

I hope this helps -

Funny thing about this post, I am 'supposed' to be having a meeting with the doctors wife (who is also a nurse) where I work to go over care of any 'lines/infusaports' lol

I realize she used to be a oncology nurse, but ya know, we were taught this in school, and I used it frequently when I worked in the hospital. So I really don't need to be 'retaught' but she doesn't know me (even though I've worked there for 6 months) and therefore doesn't know what I know. lol

[rninme]

Use of Heparin.... It depends on the type of cap you have on your central lines. If you are using CLC's (positive pressure), you don't use heparin after you flush.

Also, check you facility's P & P manual. Different types of central lines..ie triple lumen, groshong, etc ...have different requirements for flushing...size of syringe, amt of flush, HOW to flush...push,pause

[RoxanRN]

When in doubt about the validity of a reading, in addition to aspirating/flushing and making sure there is adequate pressure in the bag, I'll take the transducer and hold it (or lay it) at the level of the PSA. This will either confirm the reading is correct or help me determine which way I need to go with the holder (up or down) or if it just plain garfed up. Sometimes, changing the entire pressure system helps.

As always, check hospital policy.

[Vsummer1]

We have a new policy that states that after you draw blood from a lumen you need to replace the cap to prevent clogging.

Anyone else do that?

[Corvette Guy]

Use of Heparin.... It depends on the type of cap you have on your central lines. If you are using CLC's (positive pressure), you don't use heparin after you flush.

Also, check you facility's P & P manual. Different types of central lines..ie triple lumen, groshong, etc ...have different requirements for flushing...size of syringe, amt of flush, HOW to flush...push,pause

Heparin is used less & less these days as a flush D/T increased prevalance of heparin-induced thrombocytopenia [HIT] R/T heparin therapy, including heparin flushes.

[dorimar, BSN, RN]

We use the T piece caps that we change every 3 days and prn after blood draws. Saline flushes are used only, except on the new "power piccs" which don't have a reflux valve;then we use heparin (100 units per cc) to flush. Dressing changes are Q 3 days (where I work) and prn, or Q 7 days with biopatch ( I prefer biopatch). When inserting a sublcavian line, some docs will have the peep on the vent shut off to decrease chance of pneumothorax. CVP is best transduced to the distal port of a central line (usually the brown port). Not to say you can't transduce to another port though. Some anatomy allows line to migrate to RV (know your wave forms). The increased intra-thoracic pressure caused by positive ventilation and peep, can cause high readings on your CVP and PA pressures, that don't necessarily reflect true fluid status. (Laura Gesparis has a great lecture on the calculation of the true wedge of patient on high levels of peep). Transducer should always be at phlebostatic access when obtaining reading. Some docs need reminding about length of time line has been in place and need for change. Respiratory artifact can be present, and true reading is taken at end expiration. That's all the tidbits that pop into my head for now.

[Vsummer1]

Can anyone tell me if they have a study about 20 ml ns being favored to flush lines with certan populations?

The biopatch is a great thing in theory. Here is the bad thing... My CVP line (or anything else for that matter) through a TLC with a biopatch is only good for 7 days if the biopatch stays in place, and quite frankly my patients rarely can keep a good seal on an IJ for more than one or two days. Sterility is compromised so for heavens sakes, do NOT go by the "rules" but by common sense. I cannot tell you how many times I have encountered migrated biopatches just from tachypneic patients. And it "bugs" the heck out of me that I get the textbook nurses saying "oh, but it is a biopatch so we can reinforce the bandage and not change it for a whole week" or, "well, it is a biopatch so I left it alone and only changed the bandage as standard q 3days" never mind the crusty patch, or whilst I look a biopatch floating. I want to culture many a tip I see from the nurses who don't think but can quote me the policy. I had one today I wanted to call the ID doc in for! Lovely bandage dated yesterday, reinforced with several layers of disgusting clear tape wavering over an IJ and the biopatch hovering nicely over the lumen, no blue to be seen.

OOPs sorry, rant... forgive me, move on....

[ghmccart]

assess frequently to head off the nasty complications, and while you may work with them very frequently do not forget the seriousness of them, and the risks they carry, imagine it was in you.

[sadie_van]

Hi all

Im tring to do a litriture pull on biopatches and ports and the effects that the patches have on the huber needles after they swell with the patients sweat (pushing them out).

Does anyone or has anyone seen any articles regarding this issue?

Thanks for your help