Central Venous Catheters

IX. Central Venous Catheters
A. Description

1. Central venous catheters (Fig. 14-6) are used to deliver hyperosmolar solutions, measure central venous pressure,
infuse parenteral nutrition, or infuse multiple IV solutions or medications.

2. Catheter position is determined by radiography after insertion.

3. The catheter may have a single, double, or triple lumen.
4. The catheter may be inserted peripherally and threaded through the basilic or cephalic vein into the superior vena cava, inserted centrally through the internal jugular or subclavian veins, or surgically tunneled through subcutaneous tissue.
5. With multilumen catheters, more than one medication can be administered at the same time without incompatibility problems, and only one insertion site is present.

 

For central line insertion, tubing change, and line removal,
place the client in the Trendelenburg’s position if not contraindicated or in
the supine position, and instruct the client to perform the Valsalva maneuver
to increase pressure in the central veins when the IV system is open.
B. Tunneled central venous catheters
1. A more permanent type of catheter, such as the Hickman, Broviac, or Groshong catheter, is used for long-term IV therapy.
2. The catheter may be single lumen or multilumen.
3. The catheter is inserted in the operating room, and the catheter is threaded into the lower part of the
vena cava at the entrance of the right atrium.
4. The catheter is fitted with an intermittent infusion device to allow access as needed and to keep the system
closed and intact.
5. Patency is maintained by flushing with a diluted heparin solution or normal saline solution, depending on the
type of catheter, per agency policy.
C. Vascular access ports (implantable port)
1. Surgically implanted under the skin, ports such as a Port-a-Cath, Mediport, or Infusaport are used for
long-term administration of repeated IV therapy.
2. For access, the port requires palpation and injection through the skin into the self-sealing port with a
noncoring needle, such as a Huber-point needle.
3. Patency is maintained by periodic flushing with a diluted heparin solution as prescribed and as per
agency policy.
D. PICC line
1. The catheter is used for long-term IV therapy, frequently in the home.
2. The basilic vein usually is used, but the median cubital and cephalic veins in the antecubital area also can be used.
3. The catheter is threaded so that the catheter tip may terminate in the subclavian vein or superior vena cava.
4. A small amount of bleeding may occur at the time of insertion and may continue for 24 hours, but bleeding
thereafter is not expected.
5. Phlebitis is a common complication.
6. Insertion is below the heart level; therefore air embolism is not common.

X. Epidural Catheter

 

A. Catheter is placed in the epidural space for the administration of analgesics; this method of
administration reduces the amount of medication needed to control pain; therefore, the client experiences fewer side effects.
B. Assess client’s vital signs, level of consciousness, and motor and sensory function.
C. Monitor insertion site for signs of infection and be sure that the catheter is secured to the client’s skin and that all connections are taped to prevent disconnection.
D. Check HCP’s prescription regarding solution and medication administration.
E. For continuous infusion, monitor the electronic infusion device for proper rate of flow.
F. For bolus dose administration, follow the procedure for administering bolus doses through the catheter and follow agency procedure.
G. Aspiration is done before injecting medication; if more than 1 mL of clear fluid or blood returns,
the medication is not injected and the HCP or anesthesiologist is notified
immediately (catheter may have migrated into the subarachnoid space or a blood
vessel).
Contraindications to an epidural catheter and administration of
epidural analgesia include skeletal and spinal abnormalities, bleeding
disorders, use of anticoagulants, history of multiple abscesses, and sepsis.
  CRITICAL THINKING   What Should You Do?
Answer: When a client has any type of
central venous catheter, there is a risk for breaking of the catheter,
dislodgement of a thrombus, or entry of air into the circulation, all of which
can lead to an embolism. Signs and symptoms that this complication is occurring
include sudden chest pain, dyspnea, tachypnea, hypoxia, cyanosis, hypotension,
and tachycardia. If this occurs, the nurse should clamp the catheter, place the
client on the left side with the head lower than the feet (to trap the embolism
in the right atrium of the heart), administer oxygen, and notify the health
care provider.

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