CVPs and Central Lines

[BoyNurse07]

I need everyone's opinion please.

Does anyone measure central venous pressure via a water manometer? I work in a small hospital and we measure CVP via this method. I have a question regarding that. Do you leave the line attached to the distal port at all times? One nurse says to leave it attached to the distal port- if able- at all times. "It should never be unhooked". She says to add Heparin to the saline bag. Then another nurse says you can unhook it. Just hook it up when you want to measure it. Which is correct? I cannot find much information on the internet regarding this.

My next questions have to deal with Central Lines and Infus-a-ports.

I have seen a lot of different people comment on the non-use of Heparin Flushes. Any comments. We flush central lines and infus-a-ports, when not in use, every 8 hours with 10ml of saline and 3-5ml of Heparin Flush. Is this how everyone else does it? Also, when you are blood sampling; do you always flush before you get your sample: 1. Flush with 10ml, then waste 10ml, then draw your sample, then flush with saline, then heparin? Of course with TPN, you would flush before. I was taught in clinical, in nursing school, to 1. Draw back and discard 5ml, then your sample. I was never taught to flush prior to blood sampling; unless with TPN. Any thoughts? Thanks for you assistance.

[NRSKarenRN, BSN, RN]

have'nt done cvp manometer readings in about 15 years but remember keeping system setup as closed loop to prevent infection.

infuse a port do not need every 8 hour flush when not in use; cvp can be done every 8-12 hrs--make sure all lines flushed not in use.

purpose of nss flush before blood draw is to make sure line patent, any drugs/meds given through line last time would not interfere with blood sample to skew results, then after 5-10cc discard (facility preference) you draw sample. since i've worked with many oncology patients, facilities and homecare in philly area have moved to 3-5 cc flush/discard. with newer types of iv devices, some facilites have gone to all nss flush to decrease incidence of dic + hemmorrhage

articles:

central venous lines

c30-1 central venous catheters (cvcs) (subclavian, internal ...

cardiovascular monitoring ii

http://www.fmshk.com.hk/sahk/lecture_cvs.ppt

care, usage, maintenance and complication management of central venous catheters (cvc)

http://www.mededcon.com/cvc01.htm

best practice: heparin/saline lock of pivs

[auzzieneuronurse]

Hey boy nurse,

1) In my unit we never disconnect the CVP line (infection control) until we no longer need it and don't add heparin to the bag but I'm dealing with SAH pts. The presssure bag should keep the line open.

2) We don't hep lock CVC's, if the port isn't in use we flush it with 10mls normal saline every 6-8 hrs.

3) For blood taking from central lines we tend to withdraw 10mls and discard then take the sample and flush with saline post this.

4) I wouldn't be disconnecting a TPN line to take blood!! TPN should be a dedicated line and kept VERY sterile - the high glucose content is a great enviro for bacteria!

Thats what happens in my neck of the woods.

Cheers!