Policy development: Central lines

burn out · Apr 2, 2011

I guess it may depend on the reason for the line, I kept a c-line 6 months in a patient in home care to receive chemo. It was removed because the chemo was over. No infections no problems.

MunoRN, RN · Apr 2, 2011

Sitting on a policy and procedure committee. Do you have a limit on the number of days a central line can remain in place? Care to share some evidence used to support this decision? Thanks for your input!

The CDC recommendation is that central lines should not be routinely replaced, only if it is a known or suspected source of infection.

http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf

mpccrn, BSN, RN · Apr 13, 2011

So how do you give 2 mg of Haldol, 10 mg Hydralazine, etc.? The doses are less than an mL. Draw it up in a heparin syringe and shoot it into a 10 mL syringe?

That's exactly right. Our hospital policy states that only 10cc srynges can be used on PICC and Midlines. Anything smaller will generate too much PSI and can result in catheter rupture

esie · Apr 14, 2011

Our policy is to perform a full line and dressing change on CVL, IAL, PICC, and Vascath lines every seven days or PRN, but no fixed time on replacement of the catheter. Having said that, they generally are removed and reinserted every couple of weeks. However, if the catheter is suspected of being a source of infection (in the case of ongoing febrile states, positive blood cultures etc) it will be resited.

**LaurelRN, MSN · Apr 16, 2011

Our policy is 7 days for an IJ or subclavian line. Femoral lines are 24 hours unless we absolutely can't get another line. The only exception is fever of unknown origin- then the line has to be changed no matter what.

As for the syringe size. I've been inserting PICC lines for about 6 months now. We use BARD PICC lines. They have a written recommendation that no syringe smaller than 10 ML should be used- the PSI is too high. Granted it is unlikely that you would damage the line- but why take the chance? Just dilute whatever med you're giving into a 10 ML syringe

iluvivt, BSN, RN · Apr 25, 2011

The new recommendation from the CDC on Central lines (excludes PICCs) is that if you anticipate the line will needed for more than 5 days you should place an antiseptic or antimicrobial CVC. Maximal barrier precautions should be used for all central lines placements and all lines placed urgently under suboptimal conditions need to be replaced (not exchanged) as soon as feasible. Joint Commission had adopted the SHEA/IDSA guidelines for prevention of CRBSI...you need to read these... This order does not include PICCS...use SC as first choice..then IJ last is femoral. Consider risk vs benefit when choosing between the IJ and SC as a choice.....SC has lower infection risk but higher insertion related complications. A PICC though it can be used as an acute care line is truly an intermediate to long term line. We currently remove all IJs and SC by day 4 and when we switch to the antiseptic/antimicrobial CVCs ..we will push that to 7-8 days max dwell time. Generally speaking if an infection occurs from a CVC within the 1 week it is insertion related...after that it is,the catheter skin junction and the caps and IV systems...or in other words NURSING CARE. The trend and mandate we are headed for is a zero tolerance for any catheter related bloodstream infection.

funkywoman · Jun 30, 2011

It's medicine, it doesn't care what size syringe it's in, it's still gonna do the same job.

smaller syringe is more pressure on the picc therefore dont wanna rupture the picc, seen it too many times when I worked at one place in FL