help with central venous lines

Can anyone help me with central venous lines? I am being tested on administration of fluids or sampling of blood from both central venous catheters as well as implanted infusion ports.

My textbook is a little too wordy and i am wondering if someone can link to me a site or provide more straightforward info on these procedures. Any links to videos of this skill and any other nursing procedures would be greatly appreciated.

Thanks!

3458 BN student Year II

One of the best resources on the web concerning central lines:

http://www.icufaqs.org/CentralLines.doc

Hope this helps :)

Excellent resources, Daytonite. Thank you so much.

This link also has some excellent information:

http://www.wlm-web.com/hcnet/TXFiles/tx016o.pdf

Daytonite is definitely the pro on central lines!!! :)

~J

hi, 3458fiona!

i have a few links that you might find helpful. i've been trying to find actual online hospital policies or procedures of blood sampling from central vascular catheters and have not been successful. i have drawn so much blood from central lines in my practice i can probably do it with my eyes closed (i don't recommend that anybody do that though!). the first link is a iv link that is not necessarily for central lines. it does have a lot of good information about iv fluids, what is in them and which ones you want to give for what.

i could only find two documents that had anything pertaining to the drawing of blood from a central line. one was in a critical care unit standards of care. the other was a patient teaching document that has 4 lines telling how to draw a blood sample. if you have access to a facility procedure manual you will probably have better luck finding a step-by-step procedure and policy there. otherwise, you basically need to stop all iv infusions into the central line, clamp off all ports, use the largest lumen port to draw the blood, clamp the line, remove the cap, attach a 10cc or larger luer-lock syringe, unclamp the line, aspirate and withdraw at least 5cc of blood, clamp the line, remove and discard the syringe with the 5cc of blood, attach a 20cc syringe (or larger is needed) with luer lock, unclamp the line, withdraw the amount of blood you need for the blood test, clamp the line, remove the syringe and set it aside, attach a 10cc syringe with 10cc of normal saline in it, unclamp the line, flush the catheter with the 10cc of saline, clamp the line, remove the empty syringe, apply a new cap or reattach the iv tubing, unclamp the line(s), resume the iv infusions. place a needle on the end of the syringe with the blood sample and fill the vacutainer tubes with blood for the lab. don't forget to label the tubes with the patient's name. you should also be swabbing the ends of the catheter with alcohol (i forgot to mention that!) as you are attaching all this syringes, caps and iv tubings.

http://www.muw.edu/nursing/iv.htm - iv fluids, the different types and why you would use them. also includes information on blood transfusion in the second half of the document

http://www.nursewise.com/courses/iv_hour.htm - this article by a nurse includes information on electrolytes and what is contained in the various iv solutions along with some information on calculating iv rates.

http://www.med.umich.edu/ccmu/festan.htm - critical care unit standards of care for iv's and iv access devices from the university of michigan medical center. there are a few lines on the procedure of blood sampling from a central iv line.

http://www.csmc.edu/pdf/cp0006pasvcatheter.pdf - this is a document of patient instructions on care of a p.i.c.c. line. there are 4 lines here that tell the patient how to draw a blood sample.

http://www.musc.edu/medcenter/cvl/powerpoint/ - "musc central venous catheter tutorial". a 44 slide presentation that reviews the basic types of central venous catheters (dialysis, picc, implanted ports, tunneled and nontunneled) and includes the procedures for flushing, accessing an implanted port, assessment of cvc sites, tubing and catheter changes, dressing changes, catheter removal and the de-clotting procedure. this is an employee inservice presentation but has good general information.

http://courses.washington.edu/theralab/2003/ivcath.pdf -- this is an excellent site that gives a brief overview of central lines.

http://www.ocalaregional.com/cpm/central%20venous%20catheters.htm - a self study module on central venous catheters from ocala regional medical center in ocala, florida. subjects include the purpose and various types of central venous catheters that are in use, complications of central venous access devices, dressing changes, tubing changes, herarinizing, blood sampling and cathter removal.

i'm not sure what you are specifically looking for with regard to nursing procedures but these are the links i have:

http://www.bumc.bu.edu/dept/content.aspx?departmentid=69&pageid=8063 - videos on starting iv's and using iv devices to collect blood specimens

http://www.cotc.edu/professional/streaming/archive/nursing.htm - videos from central ohio technical college of a number of nursing procedures. you need a real one player to see the videos. i have seen many of their iv instruction videos are they are pretty good.

http://www.healthsystem.virginia.edu/internet/anesthesiology-elective/cardiac/cvcath.cfm - placement of a central venous catheter. the text includes pictures. at the bottom of the web page is a link to a video of the procedure. requires quick time to see.

if there is something more specific that you are looking for, or i just missed the boat here, send another post. i have a lot of links that pertain to iv therapy. i was an iv therapist for 6 years and held a national certification in iv therapy in the u.s. while i was working in iv therapy. i have information on complications and the maintenance of central lines, but i didn't include them here since you didn't ask about that.

you are a saint! thank you so much for your help!! especially in getting back to me so quickly, you have helped immensely. i would love it if you could provide information on complications and maintenance of central lines. thank you for offering,

fiona

Daytonite helped me with this last term (for a group presentation). When I interviewed the Clinical Nurse Specialist for the post-surg...she told me (and research backed it up) that the number one prob with central access devices/lines is Heparin Induced Thrombocytopenia (HIT). A lot of facilities are using devices such as the CLC 2000, which is a positive pressure cap. When the line is flushed, it pushes positive pressure therefore reducing clots and reducing the need to use heparin flush (therefore decreasing the pt's exposure to heparain, and ultimately avoiding HIT). You can watch a video on the CLC 2000 on their website to see how the device works. http://www.icumed.com/clc2000.asp

We also had to compare policies and procedures between two different hospitals on flushing central lines. It was interesting to see the difference, especially when one hospital had incorpated use of this device and the other one hadn't.

Another problem is infection (but this is decreasing in facilities where the positive pressure device is used).

Good luck!

~J

Daytonite helped me with this last term (for a group presentation). When I interviewed the Clinical Nurse Specialist for the post-surg...she told me (and research backed it up) that the number one prob with central access devices/lines is Heparin Induced Thrombocytopenia (HIT). A lot of facilities are using devices such as the CLC 2000, which is a positive pressure cap. When the line is flushed, it pushes positive pressure therefore reducing clots and reducing the need to use heparin flush (therefore decreasing the pt's exposure to heparain, and ultimately avoiding HIT). You can watch a video on the CLC 2000 on their website to see how the device works. http://www.icumed.com/clc2000.asp

We also had to compare policies and procedures between two different hospitals on flushing central lines. It was interesting to see the difference, especially when one hospital had incorpated use of this device and the other one hadn't.

Another problem is infection (but this is decreasing in facilities where the positive pressure device is used).

Good luck!

Thanks for your help, the website has a lot of great info!

One of the best resources on the web concerning central lines:

http://www.icufaqs.org/CentralLines.doc

Hope this helps :)

Thank you for providing the link to this website---lots of very helpful information,

fiona

Fiona. . .I sent you 3 e-mails with file attachments that had lists of Internet links for information on IV's, central lines, physical assessment and procedures, some of which included links to sites with videos. If you did not get them, let me know because I used a different program to e-mail than I usually do.

I'm afraid they didn't show up, are you able to resend?

thank you,

fiona