2019

CARE OF CVC
MS. ANJU ANTONY
INFECTION CONTROL NURSE
 CONTENT
1. Pre test
2. What is central line?
3. Types of cvc
4. Parts of CVC
5. Nursing care of CVC
6. Flushing CVC
7. Taking lab samples from CVC
8. Procedure for dressing change
9. Removal of CVC
10. Post test
 PRE TEST
1. Where central line is inserted to?
A) Aorta b) superior vena cava c)left atrium
2. Which is not a part of CVC ?
A) Lumen b) Clamp c)Piston
3. How to confirm position of CVC ?
a) Return of blood b) palpation c) x- ray
4)Which is not a common vein accessed for CVC?
a)Internal jugular b) Sub-clavian c) saphenous
5) Flushing of catheter is done
a)Every hour b) after administration of medications c) none of the above
6)Cleaning of CVC insertion site is done
a) Center to periphery b) periphery to center c) longitudinal strokes
7)Remove CVC when patient
a)inhales b)exhales
 What is central line?

A central venous line is a device inserted into the superior vena

cava or right atrium.
The main veins accessed are
• Internal jugular
• Subclavian
• Femoral
• External jugular
• Antecubital veins
(Basilic or Cephalic)
Types of Catheters
PARTS OF CVC
Triple Lumen Central Venous Catheter

Distal lumen for CVP monitoring, blood administration,

medications.

Medial lumen exclusively for total parenteral nutrition.

TRIPPLE LUMEN HD CATHETER

The third lumen in these catheters provides greater flexibility ensuring

proper blood sampling and guide-wire placement.
Equipment required for central venous canulation
• Patient on a tilting bed, trolley or operating table
• Hat, mask and sterile gown and gloves
• Large sterile drapes and gauze swabs
• Chlorhexidine in alcohol solution
• Local anaesthetic with needle and syringe
• Saline flush
• Appropriate central venous catheter set
• Three-way taps
• Scalpel blade
• Sutures
• Sterile dressing
• Ultrasound machine (if available)
 Maintain strict
aseptic
technique while
handling CVC
Scrub the hub
15 times
before
injections
NURSING CARE
1. Confirm CVC catheter tip placement by chest x-ray before initial use.
2. Use gauze dressing for 24 hours after the insertion of catheter
3. If the patient is diaphoretic or the site is bleeding or oozing, use gauze dressing
4. Also, confirm placement if a patient is admitted with an existing PICC or
undocumented CVC
5. If a catheter or connection is damaged or dislodged, immediately clamp the catheter
with a catheter clamp or kink and tape the line.
6. Use aseptic technique during the insertion and maintenance of the catheter.
7. Chlorohexidine is recommended, but Povidone iodine can be used.
8. Use gauze dressing for first 24 hours or if there is oozing from the site.
9. Replace dressing if it becomes damp, loose, or visibly soiled
10. Do not submerge the catheter or insertion site in water
11. Replace gauze dressings every 2 days for short-term catheters
12. Replace transparent dressings every 7 days for short-term catheters
13. Monitor the insertion site visually when changing the dressing or under a
transparent dressing
14. Closely observe the catheter after insertion for catheter damage or patient injury.
A damaged catheter may cause rupture or fragmentation that may lead to

embolism or surgical removal.

 PREVENTION OF CLABSI!!!!
The hub is scrubbed for 15 sec and left to dry 15 sec
FLUSHING THE CATHETER
Flush the catheter with normal saline 10 ml
after administration of medicines
Withdrawing Blood Samples
 Take samples from the lumen
which is specified for the same
in case of multi-lumen catheter
 Withdraw and discard 1.5 ml
from the lumen
 Take samples
 Flush the lumen with 10 ml
normal saline
Procedure for dressing change
1. Clean the work surface
2.Wash your hands
3.Put on clean gloves
4.Remove the old dressing, starting from the top and working
down.
5.Remove the gloves
6.Wash your hands again
7. Put on sterile gloves
8. Assess the insertion site for signs and symptoms of infection or dislodgement.
9. Assess the external length of the catheter to determine if migration of the catheter has
occurred
10.Clean the insertion site with chlorhexidine preparation with alcohol.
11. Start at the insertion site and circle outward with cleaning implements. Never go back to the
center of the insertion site with a used implement.
12.Repeat cleaning two more times
13.Antiseptics should be allowed to dry according to the manufacturer’s recommendations
14.Gently clean the outside of the catheter with the inside surface of an alcohol wipe starting from
the insertion site and move up the catheter.
15.Clean the caps following ‘scrub the hub’ technique for 15 times.
16.Replace the dressing.
Clamp the catheter whenever:
it is not being used

it is open to the air, such as catheter

cap changes or connecting tubing

Scrub the hub for 15 seconds
REMOVAL OF CVC
1. Hand hygiene
2. Remove dressings
3. Identify the anchoring suture(s)
4. Remove all sutures
5. In one motion, gently and firmly withdraw the catheter
while having the patient hum or exhale
6. Using an occlusive sterile dressing with antibiotic ointment,
firmly hold pressure to the site for at least two minutes, or
until bleeding/draining has subsided
7. Dress the site using the same sterile dressing, unless
saturated.
8. For patients unable to follow instruction or receiving mechanical ventilation:
Gauze will be held over site in preparation for catheter removal.
 The patient’s respiratory cycle will be monitored. Catheter will be removed in a
steady motion during the patient’s exhalation phase
 Simultaneously sterile occlusive dressing with antibiotic ointment will be applied
to seal the skin entry site as the catheter is removed.

9. After removal, pressure will be held for 2-3 minutes or until bleeding has
stopped. After removal, a sterile occlusive dressing will be applied over the site.

10. Occlusive dressing will remain intact for 24 hours.

Post-procedure
If air entrapment is suspected, patient will be placed in Trendelenberg position,
obtain STAT portable chest x- ray and oxygen applied at 100%. Patient may be
transferred to ICU.
Follow-up treatment
Instruct the patient on wound care, as needed, and on the signs and symptoms of
infection.
Documentation
1. Documentation of the pretreatment evaluation and any abnormal physical
findings.
2. Record the time out, indication for the procedure, procedure, type and size of
catheter removed, EBL(Estimated Blood Loss), the outcome, how the patient
tolerated the procedure, medications (drug, dose, route, & time) given,
complications, and the plan in the note, as well as any teaching and discharge
instructions.
Clean the hub 15 times
before administration
of medication/ infusion/
blood sample
collection
 POST TEST
1. Where central line is inserted to?
A) Aorta b) superior vena cava c)left atriyum
2. Which is not a part of cvc ?
A) Lumen b) Clamp c)Piston
3. How to confirm position of CVC ?
a) Return of blood b) palpation c) x- ray
4)Which is not a common vein accessed for CVC?
a)Internal jugular b) Sub-clavian c) saphenous
5) Flushing of catheter is done
a)Every hour b) after administration of medications c) none of the above
6)Cleaning of CVC insertion site is done
a) Center to periphery b) periphery to center c) longitudinal strokes
7)Remove CVC when patient
a)inhales b)exhales