Nursing in Critical Care
Central Venous Lines

  1. Indications
    • CVP monitoring.
    • Medication administration.
    • Parenteral nutrition.
    • Poor peripheral access.
    • Conduit for Swan-Ganz catheters, temporary cardiac pacemakers, hemodialysis catheters.

     

  2. Contraindications
    • Bleeding diathesis.
    • Overlying skin infection.

     

  3. Materials
    • Sterile gloves and drapes.
    • Povidone-iodine and alcohol swabs.
    • 16-gauge central venous catheter kit.
    • 1% lidocaine without epinephrine.
    • Pressure monitor - optional.
    • Heparinized saline.
    • Sterile gauze.

     

  4. Seldinger Technique (using infraclavicular approach to the subclavian vein)

    For other approaches or access sites see ACLS manual.

    1. Position patient supine in slight Trendelenburg position. Identify insertion site. Prep, drape, and anesthetize the desired access site.
    2. The introducer needle is inserted at the junction of the medial and central thirds of the clavicle and "walked" around and under the clavicle toward the sternal notch while aspirating back with the syringe held parallel to the chest wall. Free blood flow indicates vessel entry. If bright red, pulsating blood return is encountered, withdraw and redirect the needle.
    3. Advance the needle another 2 to 3 mm and then remove the syringe. Quickly place finger over hub to avoid air embolism. A free flow of blood confirms placement.
    4. The flexible guide wire is inserted through the needle and into the vein. Do not advance the wire into the right atrium. Remove the needle over the guide wire, making sure the guide wire is securely held throughout removal of the needle. Make a skin incision next to the wire to allow passage of the catheter.
    5. Slide the vein dilator onto the wire and advance it through the skin and into the vein. Be sure not to advance the guide wire. Remove vein dilator and slide the venous catheter over the wire and into the vein. Be sure to maintain guide wire in position.
    6. Remove guide wire and attach IV tubing to catheter. Suture catheter into position and dress site with sterile gauze and antibiotic ointment.
    7. Obtain chest radiograph to check line placement and to rule out pneumothorax.

     

  5. Complications
    • Infection.
    • Catheter tip embolus or thrombotic embolus.
    • Bleeding.
    • Hematoma formation.
    • Arterial cannulation.
    • Pneumothorax.
    • Hemothorax.
    • Chylothorax.
    • Air embolism.
    • Arrhythmias.

CVL Line
1. Site care must be done every 72 hours.
2. Proximal port
Blood administration.
Blood sampling
IV fluids

This page last updated 07/25/10
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