REGIONAL NURSING

POLICY

SUBJ ECT/TITLE: POLICY NUMBER: PAGE:
CENTRAL VENOUS CATHETER and MIDLINE
CATHETER: GENERAL CARE LEVEL ONE SKILLS
C-7 1 of 15
AUTHORIZATION: DATE ESTABLISHED: DATE REVISED:
Nursing Council


1999.06 2008.11


REGIONAL NURSING POLICY
CALGARY HEALTH REGION
REASON FOR POLICY
To provide standards for the care and use of Central Venous Catheters (CVCs) and Midline Catheters related to
all aspects of level one care. This does not include percutaneous sheath introducers as these are only used
within critical care settings.

DEFINITIONS

Catheter/Skin Junction
or Exit Site

The point where the catheter leaves the body and where site care is performed.
Central Venous
Catheter (CVC)

A venous access device whose tip dwells in the superior or inferior vena cava.

Midline Catheter

A peripheral venous access device (7.5 20 cm in length) whose tip dwells in the
basilic, brachial or cephalic vein in the upper arm at or below the level of the axilla.
Midline Catheters are NOT considered CVCs.

Flush

The turbulent injection of normal saline to prevent the mixing of incompatible
medications or solutions and/or to clean the catheter lumen of blood or fibrin
buildup.

Lock

A technique used to maintain positive pressure inside the lumen in order to prevent
blood reflux from the vein into the lumen of a CVC and Midline Catheter, thus
preventing fibrin buildup, clots and thrombotic device occlusions.

Locking Solutions

Used to maintain patency or for treatment of complications such as catheter related
infection or occlusion. Examples may include solutions such as normal saline, low
dose heparin solution (10 100 u/mL), high dose heparin (1000 10,000 u/mL),
sodium citrate, vancomycin, 70% ethyl alcohol, tPA, sodium bicarbonate.

Advanced Venous
Access Service (AVAS)

A team of Health Care Professionals with specialized advanced clinical competence
to provide safe and effective service and support for adult patients of the Calgary
Health Region (The Region) who require insertion of a PICC or advanced care
with indwelling CVCs and Midline Catheters, beyond the competence of the
regulated health professional with level one and two CVC and Midline Catheter
skills.
EXCEPTION: Hemodialysis and apheresis CVC.



REGIONAL NURSING
POLICY
SUBJ ECT/TITLE:

CENTRAL VENOUS CATHETER and MIDLINE
CATHETER: GENERAL CARE LEVEL ONE
SKILLS
DATE
ESTABLISHED:
1999.06
DATE REVISED:
2008.11
POLICY
NUMBER:
C-7
PAGE:
2 of 15


REGIONAL NURSING POLICY
CALGARY HEALTH REGION
POLICY STATEMENT
Central Venous and Midline Catheters are an important part of clinical practice for the administration of
parenteral fluids, nutrients, medications and blood products and for blood collection. Regulated Health
Professionals involved in the general care of CVC and Midline Catheters must have the knowledge,
qualification and competence to provide this care as determined by applicable governing bodies and/or The
Region. The desired clinical goals are positive patient outcomes as evidenced by completion of therapy,
absence of complications and patient satisfaction.

POLICY

1. Specialized Clinical Competency
Procedures involving care and use of all CVCs (direct percutaneous, tunneled, implanted, and PICC) and
Midline Catheters are Specialized Clinical Competencies and may be performed only by a health
professional qualified in these procedures: Regional Nursing Policies S-3a and S-3b.

2. Regional Levels of CVC and Midline Catheter Clinical Competency
There are two regional levels of CVC and Midline Catheter clinical competence:
2.1 Level one: General care of CVC and Midline Catheter including
Infection prevention and control practices
Assisting with insertion and ensuring confirmation of tip placement
Assessment of the CVC or Midline Catheter and catheter/skin junction
Injection cap replacement
Dressing of the catheter/skin junction
Administration of medications and solutions
Flushing and Locking
Administration set changes
Accessing/disengaging the port of an implanted CVC
Obtaining blood specimens
Catheter specific care considerations
o PICC/Midline Catheter
o Direct percutaneous femoral site
o Hemodialysis CVC
o Apheresis CVC
Use of CVC or Midline Catheter for diagnostic imaging procedures
Patient and family teaching
Preventing and managing potential CVC or Midline Catheter complications
Immediate management of CVC or Midline Catheter occlusion and/or damaged catheter
2.2 Level Two: Removal of CVC and Midline Catheter including
Direct percutaneous CVC
PICC
Midline Catheters


REGIONAL NURSING
POLICY

SUBJ ECT/TITLE: POLICY NUMBER: PAGE:
CENTRAL VENOUS CATHETER and MIDLINE
CATHETER: GENERAL CARE LEVEL ONE SKILLS
C-7 3 of 15
AUTHORIZATION: DATE ESTABLISHED: DATE REVISED:
Nursing Council


1999.06 2008.11


REGIONAL NURSING POLICY
CALGARY HEALTH REGION
3. Infection Prevention and Control
Calgary Health Region Infection Prevention and Control Standard Practice includes; hand hygiene with an
antiseptic agent, the appropriate use of personal protective equipment, and aseptic technique to be used for
all procedures associated with CVCs and Midline Catheters.
3.1 Insertion of a CVC and Midline Catheter requires the use of maximum barrier precautions which
include the use of a sterile gown, sterile gloves, and large sterile drapes, a hair covering and procedure
mask by all those performing the procedure.
3.2 Exposure of the catheter/skin junction requires staff to mask and don sterile gloves.
3.3 The patient must mask if they are coughing, and/or unable to turn their head.
3.4 Minimize the number of times the system is accessed.
3.5 The injection cap is disinfected prior to access.
3.6 Skin antisepsis must be done using a chlorhexidine based preparation.
Chlorhexidine allergy: tincture of iodine, an iodophor or 70% alcohol may be substituted.
Antiseptic allergy and patients whose skin is not intact: sterile normal saline may be substituted.

4. Appropriate Care Settings for Types of CVCs and Midline Catheters
4.1 Percutaneous Sheath Introducers (PSIs) are limited to clinical settings where invasive monitoring
is used. PSIs are to be replaced by an alternate venous access device PRIOR to transfer to a patient
care unit.
EXCEPTION: Patients cared for on a designated cardiac science patient care unit that have a PSI must
have continuous cardiac monitoring.
4.2 Direct percutaneous CVCs are limited to inpatient care units.
EXCEPTION: Hemodialysis, apheresis and Child Health
4.3 Tunneled CVCs, implanted ports, PICCs or Midline Catheters may be used in all care settings including
the community.

5. Insertion and Confirmation of Tip Placement
5.1 Direct percutaneous CVCs may be inserted by a physician on an inpatient unit with the assistance of
nursing staff qualified in level 1 CVC care.
EXCEPTION: Hemodialysis CVCs (refer to: Southern Alberta Renal Program.
http://iweb.calgaryhealthregion.ca/sarp/ ) and Apheresis CVCs.
5.2 Tunneled CVCs and implanted ports are inserted by the physician in diagnostic imaging or the operating
room.
5.3 PICCs or Midline Catheters may be inserted by a regulated health professional qualified in this
procedure, or by a physician, on an inpatient unit, in the operating room, in diagnostic imaging or in a
designated clinic area.
5.4 If aseptic technique was not maintained during an emergency catheter insertion, the most responsible
health care professional must be notified so that the catheter is replaced as soon as possible (within 48
hours).
5.5 Radiographic verification of catheter tip location and order for use is required prior to using a newly
inserted CVC.


REGIONAL NURSING
POLICY
SUBJ ECT/TITLE:

CENTRAL VENOUS CATHETER and MIDLINE
CATHETER: GENERAL CARE LEVEL ONE
SKILLS
DATE
ESTABLISHED:
1999.06
DATE REVISED:
2008.11
POLICY
NUMBER:
C-7
PAGE:
4 of 15


REGIONAL NURSING POLICY
CALGARY HEALTH REGION
EXCEPTION: In emergency situations, the CVC may be used prior to radiographic verification of
CVC tip location. Verify tip placement as soon as possible for catheter inserted in emergency
circumstances.
5.6 Midline Catheters do not require radiographic confirmation of tip placement prior to use.
5.7 Documentation of insertion must be completed using the appropriate regional form (if utilized) and this
document must accompany the patient when transferred or discharged to other facilities or programs,
including home care.
5.8 Monitor catheter/skin junction every 4 hours and as needed for the first 24 hours in acute care, reporting
adverse signs and symptoms.
5.9 If bleeding occurs post PICC or Midline Catheter insertion, apply a pressure dressing and check within
30 minutes of application, then assess and document every 4 hours and as needed for the first 24 hours.

6. Assessment
6.1 The condition of the catheter/skin junction, venous access pathway, CVC or Midline Catheter, injection
cap, connections, tubing and other potential catheter related complications must be assessed and
documented once per shift and as needed or at each home visit.
6.2 The external length of the PICC and Midline Catheter from catheter/skin junction to the beginning of
the hub is measured and documented once per shift and as needed or at each home visit.
NOTE: Notify AVAS service if catheter length differs by more than 2 cm compared to catheter length
noted on insertion record.
6.3 Any catheter related complications must be reported to the responsible health care professional.
6.4 If migration is suspected, do not infuse into CVC until tip placement is verified by diagnostic imaging.
6.5 Repeat radiographic verification of CVC tip location when there is:
No documentation confirming tip location.
Reason to doubt CVC tip location is in the vena cava.
6.6 If catheter/skin junction infection is suspected, an order and swab for culture and sensitivity must be
obtained.
6.7 For non-valved catheters ensure a non-toothed, plastic clamp is available at all times.

7. Injection Cap Replacement
7.1 Luer lock injection cap(s) are to be placed on all CVC and Midline Catheter lumens.
EXCEPTION: If lumen is being used for Central Venous Pressure Monitoring
7.2 Non-valved CVCs and Midline Catheters must be clamped prior to replacing the injection cap.
EXCEPTION: Neonatal CVC
7.3 Injection caps are to be changed on all CVC and Midline Catheter lumens in the following
circumstances:
Every 7 days and as needed in hospital
Every 7 days and as needed in community when catheter in use
Every 30 days and as needed in community if catheter not in use
If it is leaking or broken
If blood trapped in injection cap
Injection cap has been removed from the catheter for any reason
A removable positive pressure device is present
EXCEPTION: Neonatal CVC


REGIONAL NURSING
POLICY
SUBJ ECT/TITLE:

CENTRAL VENOUS CATHETER and MIDLINE
CATHETER: GENERAL CARE LEVEL ONE
SKILLS
DATE
ESTABLISHED:
1999.06
DATE REVISED:
2008.11
POLICY
NUMBER:
C-7
PAGE:
5 of 15


REGIONAL NURSING POLICY
CALGARY HEALTH REGION
7.4 Document injection cap change in the patient health record.

8. Dressing
8.1 The catheter/skin junction for all CVC and Midline Catheters is to be covered with a sterile transparent
semi-permeable membrane or gauze dressing.
EXCEPTION: Implanted port when not accessed and neonatal CVC
8.2 Dressings should be changed as follows:
24 hours post insertion
Transparent semi-permeable membrane dressings every 7 days and as needed
Transparent over gauze every 48 hours and as needed
Gauze dressing every 48 hours and as needed
8.3 Direct percutaneous CVCs must always be sutured to the skin at the hub of the catheter.
8.4 PICC and Midline Catheters must be stabilized using a sterile securement device, skin closure strips or
sutures at the hub of the catheter.
8.5 Securement devices and skin closure strips, if in use, must be changed every 7 days and as needed.
8.6 Sutures of tunneled and implanted ports are removed as ordered.
8.7 Document dressing change in the patient health record.
8.8 Record the date of dressing change on the dressing.

9. Access
9.1 Use 10 mL syringes or larger for accessing a CVC and Midline Catheter unless otherwise noted in
specific programs.
9.2 Use separate syringes for each lumen.
9.3 Needleless system must be used when accessing injection cap(s).
9.4 If catheter is locked with any solution other than normal saline or low dose heparin WITHDRAW 3 ML
AND DISCARD THE SOLUTION.
9.5 Confirm that the CVC or Midline Catheter tip is in a blood vessel by aspirating a small amount of blood
prior to use.
NOTE: When aspiration is not permitted or possible, discuss with physician an alternative method of
confirming placement of CVC or Midline Catheter tip.
For management of suspected occlusion see policy point 17.
9.6 If there is doubt as to location of the CVC tip, request radiographic confirmation prior to use.

10. Flushing and Locking of CVC or Midline Catheter
10.1 An order is required for Flushing or Locking Solution.
Prior to instilling any Lock solutions (other than saline or heparin) ensure that the solution is
compatible with the composition of the catheter.
10.2 CVC and Midline Catheter lumens must be labeled with type and amount of solution insitu if Locked
with solution other than normal saline or low dose heparin.
10.3 CVC and Midline Catheter lumens are to be Flushed with normal saline as follows:
Prior to and immediately following:
o Infusion of solutions
o Administration of medications
o Administration of blood/blood products


REGIONAL NURSING
POLICY
SUBJ ECT/TITLE:

CENTRAL VENOUS CATHETER and MIDLINE
CATHETER: GENERAL CARE LEVEL ONE
SKILLS
DATE
ESTABLISHED:
1999.06
DATE REVISED:
2008.11
POLICY
NUMBER:
C-7
PAGE:
6 of 15


REGIONAL NURSING POLICY
CALGARY HEALTH REGION
Immediately following:
o Collection of blood specimens
10.4 The turbulent method must be performed when Flushing CVCs and Midline Catheters.
10.5 Positive pressure technique must be used when locking CVCs and Midline Catheters.
10.6 When NOT IN USE the catheter must be Flushed and Locked at established intervals to maintain
patency.
10.7 Non-valved CVCs and Midline Catheters must be clamped when the catheter is not in use.
10.8 Document all CVC or Midline Catheter Flushes and/or Locks in the patient health record.

11. Administration Sets/Extension Sets
11.1 New infusion tubing and solution must be used when a CVC or Midline Catheter is inserted.
11.2 Infusion pumps must be used for all CVC infusions.
EXCEPTION: Direct IV push, emergency situations
11.3 Luer lock connections are required for all CVC and Midline Catheter tubing or devices.
11.4 Infusion tubing systems are to be changed every 72 hours.
EXCEPTION:
Tubing that is disconnected intermittently is changed every 24 hours
Propofol tubing is changed every 24 hours
Parenteral nutrition/lipid emulsions tubing is changed every 24 hours
Blood administration sets/filters (see Regional Nursing Policy B-3)
Community setting every 96 hours
11.5 If extension tubing is attached to a single lumen PICC, Midline Catheter, or neonatal CVC at time of
insertion, it is part of the catheter and only changed if required.
If the original PICC or Midline Catheter extension tubing is changed, then the extension tubing is
changed every 7 days.
11.6 Document tubing changes in patient health record.

12. Implanted Ports: Accessing/Disengaging
12.1 Implanted ports must be accessed using only a non-coring needle.
12.2 Non-coring needles must be changed every 7 days and as needed.
12.3 Non-coring needle must be secured when insitu.
12.4 Document access/disengagement of the implanted port in the patient health record.

13. Obtaining Blood Specimens from CVC and Midline Catheter
13.1 Midline Catheters should not be used routinely for obtaining blood specimens.
13.2 Limit number of times a day CVC and Midline Catheters are accessed to obtain blood specimens.
13.3 Blood specimens should be drawn through the largest available lumen.
13.4 The vacutainer method should be used for obtaining blood specimens.
EXCEPTION: Use the syringe method
If the vacutainer method is unsuccessful
If a small volume specimen is required
If blood cultures required
13.5 Routine blood collection
Aspirate and discard 3 mL


REGIONAL NURSING
POLICY
SUBJ ECT/TITLE:

CENTRAL VENOUS CATHETER and MIDLINE
CATHETER: GENERAL CARE LEVEL ONE
SKILLS
DATE
ESTABLISHED:
1999.06
DATE REVISED:
2008.11
POLICY
NUMBER:
C-7
PAGE:
7 of 15


REGIONAL NURSING POLICY
CALGARY HEALTH REGION
Confirm the sequence of the blood specimens to be drawn
13.6 Coagulation studies
Venipuncture is preferred to collect samples for coagulation studies
CVC specimens must NOT be drawn from a lumen with an infusion of heparin, or a lumen distal
to an anticoagulant of a multi lumen catheter
o Aspirate and discard 12 mL prior to coagulation studies
EXCEPTION: Child Health verify amount
13.7 Blood Cultures
Do NOT aspirate blood for discard when obtaining sample(s) for culture and sensitivity
Blood cultures should be drawn using the syringe method
A peripheral set of blood cultures should be drawn simultaneously to the CVC blood draw, if this
is not possible, a second set of blood cultures may be drawn from the CVC 10-20 minutes after the
first blood culture
13.8 Blood transfer device must be used when transferring blood from syringe to blood culture bottles and
vacutainers.
13.9 For adults the CVC lumen or Midline Catheter used is to be flushed with 20 mL of normal saline after
blood withdrawal.
EXCEPTION: Child Health - verify amount.
13.10 All blood specimens are to be labeled and placed in biohazard bag with laboratory requisition prior to
leaving the patient.
Leave bar code on the blood culture bottle visible
13.11 Document blood collection in patient health record.

14. Additional Catheter Specific Care Considerations
14.1 PICC and Midline Catheters
Blood pressure cuffs are not to be placed on the arm where the PICC or Midline Catheter is insitu
Unless specifically ordered, venipunctures are not to be performed on the arm with the PICC or
Midline Catheter insitu
Midline Catheter infusions are limited to those solutions with a pH between 5 and 9 and osmolarity
of less then 600
Physician review and order is required when:
o PICC insitu longer than one year
o Midline Catheter insitu longer than four weeks
14.2 Femoral CVCs:
Patients with femoral CVCs require an order for ambulation or movement of affected leg
Pneumatic compression stockings (PCS) may be used on patients with femoral CVC
14.3 Direct Percutaneous CVCs
Physician review and order is required when CVC insitu longer than four weeks
14.4 Hemodialysis Catheters:
Used only for hemodialysis treatment
All hemodialysis CVCs must be labeled with the SARP label which indicates Locking Solution
insitu
General care for hemodialysis CVC will be provided during hemodialysis treatment


REGIONAL NURSING
POLICY
SUBJ ECT/TITLE:

CENTRAL VENOUS CATHETER and MIDLINE
CATHETER: GENERAL CARE LEVEL ONE
SKILLS
DATE
ESTABLISHED:
1999.06
DATE REVISED:
2008.11
POLICY
NUMBER:
C-7
PAGE:
8 of 15


REGIONAL NURSING POLICY
CALGARY HEALTH REGION
Contact hemodialysis for direction in the care and maintenance of these catheters when patient is
not receiving hemodialysis treatment
EXCEPTION:
In an emergency situation and no alternative for intravenous access is possible WITHDRAW AND
DISCARD 3ml of THE LOCKING SOLUTION LEFT IN-SITU in the hemodialysis CVC. As the
concentration of heparin used to Lock these catheters is extremely high (1,000 10,000 units/mL)
o Notify the Nephrologist of access to hemodialysis catheter as soon as possible.
When no other venous access is possible, an order is required from the Nephrologists to access the
hemodialysis catheter
o WITHDRAW AND DISCARD 3mL of THE LOCKING SOLUTION LEFT IN-SITU in the
hemodialysis or CVC as the concentration of heparin used to Lock these catheters is extremely
high (1,000 10,000 units/mL)
o Order for Lock solution must be obtained from Nephrologists
14.5 Apheresis Catheters:
Multiple catheters can be used for apheresis including direct percutaneous tunneled and implanted ports.
When a catheter is labeled for Apheresis the following points must be followed.
Use catheter only for apheresis treatment
All apheresis CVCs must be labeled with apheresis label which indicates Locking Solution insitu
General care for apheresis CVC will be provided during apheresis treatment
Contact the apheresis program for direction in the care and maintenance of these catheters when
patient is not receiving apheresis treatment
EXCEPTION:
In an emergency situation and no alternative for intravenous access is possible WITHDRAW AND
DISCARD 3mL of THE LOCKING SOLUTION LEFT IN-SITU in the apheresis CVC as the
concentration of heparin used to Lock these catheters is extremely high (1,000 10,000 units/mL).
o Notify the Medical Director of Apheresis (weekdays) or Nephrologists (evenings, nights and
weekends) of access to the apheresis CVC as soon as possible.
When no other venous access is possible, an order is required from the Medical Director of
Apheresis (weekdays) or Nephrologists (evenings, nights and weekends) to access the apheresis
catheter.
o WITHDRAW AND DISCARD 3mL of THE LOCKING SOLUTION LEFT IN-SITU in the
apheresis CVC as the concentration of heparin used to Lock these catheters is extremely high
(1,000 10,000 units/mL).
o Order for Lock solution must be obtained from Medical Director of Apheresis (weekdays) or
Nephrologists (evenings, nights and weekends).

15. Use of CVC and Midline Catheter for Diagnostic Imaging Procedures
15.1 Peripheral IVs are the preferred route for diagnostic imaging procedures.
Automatic power injectors, used for some diagnostic imaging procedures, may be used on direct
percutaneous CVCs if ordered by the attending physician
Automatic power injectors are not to be used with tunneled, implanted, PICC or Midline Catheters
unless specifically designed for that purpose (e.g. Power PICC)
CVC inserted for hemodialysis and apheresis are NOT to be used for diagnostic imaging purposes.


REGIONAL NURSING
POLICY
SUBJ ECT/TITLE:

CENTRAL VENOUS CATHETER and MIDLINE
CATHETER: GENERAL CARE LEVEL ONE
SKILLS
DATE
ESTABLISHED:
1999.06
DATE REVISED:
2008.11
POLICY
NUMBER:
C-7
PAGE:
9 of 15


REGIONAL NURSING POLICY
CALGARY HEALTH REGION
Regulated health professional qualified and competent in CVC and Midline Catheter care and
medication administration by direct IV may use an injector to instill contrast through an appropriate
CVC or Midline Catheter if no other route exists.
Regulated health professional qualified and competent in CVC and Midline Catheter care are
responsible for attaching and disconnecting the catheter to the injector.
Lumen of the most distal port or largest lumen of catheter is preferred for diagnostic imaging
contrast.
Ensure implanted port is MRI compatible as appropriate.

16. Patient and Family Teaching
16.1 Education related to CVC or Midline Catheter care and monitoring is to be provided to the patient,
caregiver, or legally authorized representative.
16.2 Document all teaching in the patient health record.

17. CVC and Midline Catheter Occlusion Management
17.1 Confirm that occlusion exists (see algorithm-Appendix A).
17.2 If occlusion exists, label lumen as occluded.
17.3 Consult the AVAS team or health professional qualified in occlusion management.
EXCEPTION:
Direct percutaneous notify attending Physician
Hemodialysis or apheresis CVC notify hemodialysis or apheresis units
Child Health notify attending Physician
17.4 Follow instructions of AVAS team.
17.5 Notify physician of occlusion.
17.6 Document occlusion management in the patient health record.

18. Damaged CVC and Midline Catheter Management
18.1 Maintain patients safety by implementing the following:
Direct Percutaneous CVC
o Clamp (non-toothed) CVC lumen proximal to the site of damage
o Wrap the damaged area with sterile occlusive dressing and secure
o Label the lumen Damaged DO NOT USE
o Damaged direct percutaneous catheters are not repairable therefore are to be removed
according to policy
PICC or Midline Catheter
o A damaged PICC or Midline Catheter is to be folded over on itself proximal to the site of
damage
o Wrap the damaged area within sterile occlusive dressing and secure
o Label the lumen Damaged DO NOT USE
o Secure catheter to the skin to minimize the risk of migration
Tunneled CVCs
o Clamp (non-toothed) the tunneled CVC proximal to the site of damage
o Wrap the damaged area in sterile occlusive dressing and secure
o Label the lumen Damaged DO NOT USE


REGIONAL NURSING
POLICY
SUBJ ECT/TITLE:

CENTRAL VENOUS CATHETER and MIDLINE
CATHETER: GENERAL CARE LEVEL ONE
SKILLS
DATE
ESTABLISHED:
1999.06
DATE REVISED:
2008.11
POLICY
NUMBER:
C-7
PAGE:
10 of 15


REGIONAL NURSING POLICY
CALGARY HEALTH REGION
Implanted Port
o Label the port Damaged DO NOT USE
18.2 Notify physician of CVC or Midline Catheter damage.
18.3 Damaged CVC or Midline Catheter needs to be repaired, replaced or removed as soon as possible.
18.4 If only one lumen of the catheter is damaged the other lumen(s) may be used until the catheter is
repaired, replaced or removed.
EXCEPTION: Implanted port
18.5 Contact AVAS or qualified health professional for consultation on repair of the damaged PICC,
Midline Catheter or tunneled CVC.
18.6 Contact responsible area for repair of hemodialysis or apheresis CVC
18.7 Following the repair:
PICCs and Midline Catheters:
o Repaired PICCs and midline lumens may be used immediately after repair
Tunneled CVCs:
o Repaired lumen must not be used for 3-4 hours following repair
o Splint must remain insitu for 48 hours following repair
o Flush the repaired catheter lumen(s) using minimal pressure for at least 48 hours
18.8 Document damaged CVC or Midline Catheter management in the patient health record.

PERSONNEL PERMITTED TO PERFORM PROCEDURE

Nurse Practitioner (NP), Registered Nurse (RN), Registered Psychiatric Nurse (RPN), and Graduate Nurse who:
Have the prerequisite knowledge and skill
Are qualified (completed the approved Regional learning module) in the regional specialized clinical
competency of CVC and Midline Catheter care

Licensed Practical Nurses (LPN) who:
Are authorized by their college
Have the prerequisite knowledge and skill
Are qualified (completed the approved Regional learning module) in the regional specialized clinical
competency of CVC and Midline Catheter care



REGIONAL NURSING
POLICY
SUBJ ECT/TITLE:

CENTRAL VENOUS CATHETER and MIDLINE
CATHETER: GENERAL CARE LEVEL ONE
SKILLS
DATE
ESTABLISHED:
1999.06
DATE REVISED:
2008.11
POLICY
NUMBER:
C-7
PAGE:
11 of 15


REGIONAL NURSING POLICY
CALGARY HEALTH REGION

Appendix A

Algorithm for CVC and Midline Catheter Occlusion Management






REGIONAL NURSING
POLICY
SUBJ ECT/TITLE:

CENTRAL VENOUS CATHETER and MIDLINE
CATHETER: GENERAL CARE LEVEL ONE
SKILLS
DATE
ESTABLISHED:
1999.06
DATE REVISED:
2008.11
POLICY
NUMBER:
C-7
PAGE:
12 of 15


REGIONAL NURSING POLICY
CALGARY HEALTH REGION

REFERENCES

Andris, D. A., & Krzywda, E. A. (1997). Central venous access: Clinical practice issues. Nursing Clinics of
North America, 32(40), 719-740.

Arkin, C. F., Adcock, D. M., Ernst, D. J ., Marlar, R. A., Parish, G. T., Szamosi, D. I., et al. (2003). Collection,
transport, and processing of blood specimens for testing plasma-based coagulation assays. Clinical and
Laboratory Standards Institute, 23(35), 1-17.

Brazier, M. (2000). Flushing protocols for central venous access devices: A literature synthesis. The CINA
Yearbook, 16, 56-60.

Calgary Laboratory Services (1999). Section 4.2 Blood collection tubes/order of draw. In Calgary Laboratory
Services Guide to Laboratory Services. Calgary, AB: Author

Calgary Health Region. (2002). Acute Care Infection Prevention and Control Manual. Calgary, AB: Author.

Calgary Health Region. (2002). Central Venous Catheter Learning Module for Registered Nurses. Calgary, AB:
Author.

Calgary Health Region, Acute Care Sector. (2000). Self-care instructions for central venous catheters. Calgary,
AB: Author.

Calgary Health Region, Child Health. (2002). Caring for your childs central venous catheter. Calgary, AB:
Author.

Calgary Health Region, Southern Alberta Nutrition Support Program. (2001). Parenteral nutrition: A self-
learning module for nurses. Calgary, AB: Author.

Canadian Intravenous Nurses Association (1999). Intravenous Therapy Guidelines 2
nd
Ed., Pappin
Communication. Communication. Pembroke. Canada.

Centers for Disease Control and Prevention (2002). Guidelines for the prevention of intravascular catheter-
related infections. Morbidity and Mortality Weekly Report, 51 (RR-10), 1-34.

Chaiyakunapruk, N., Veenstra, D., Lipsky, B., & Saint, S. (2002). Chlorhexidine compared with povidone
iodine solution for vascular catheter-site care: A meta-analysis. Annals of Internal Medicine, 136(11), 792-
801.

Cobbett, S., & LeBlanc, A. (1999). IV site infection: A prospective, randomized clinical trial comparing the
efficacy of three methods of skin antisepsis. The CINA Yearbook, 15, 48-49.



REGIONAL NURSING
POLICY
SUBJ ECT/TITLE:

CENTRAL VENOUS CATHETER and MIDLINE
CATHETER: GENERAL CARE LEVEL ONE
SKILLS
DATE
ESTABLISHED:
1999.06
DATE REVISED:
2008.11
POLICY
NUMBER:
C-7
PAGE:
13 of 15


REGIONAL NURSING POLICY
CALGARY HEALTH REGION
College and Association of Registered Nurses of Alberta (2003). CARNA Supervision of care provided by
nursing students and undergraduate nursing employees. (Draft) Edmonton, AB: Author

Gillies, D., O'Riordan, L., Wallen, M., Morrison, A., Rankin, K. & Nagy S. (2008) Optimal timing for
intravenous administration set replacement (review). The Cochrane Library 3.

Hadaway, L. C. (1995). Comparison of vascular access devices. Seminars in Oncology Nursing, 11(3), 156-
166.

Hadaway, L. C. (1997). An overview of vascular access devices inserted via the antecubital area. CINA, 13(1),
8-15.

Hankins, J ., Lonsway, R., Hedrick, C., & Perdue, M. (Eds.) (2001). The Infusion Nurses Society: Infusion
therapy in clinical practice (2
nd
Ed.). Philadelphia: W.B. Saunders Company.

INS (2006). Infusion nurses society: Infusion nursing standards of practice. Journal of Infusion Nursing,
29(1S), S12-S78.

J ones, G. R. (1998). A practical guide to evaluation and treatment of infections in-patients with central venous
catheters. Journal of Intravenous Nursing, 21(5), 134-142.

Krzwda, E. A. (1998). Central venous access: Catheters, technology and physiology. MedSurg Nursing,
7(3),132-140.

Larson, E., Aiello, E., Bastyr, J ., Lyle, C., Stahl, J., Cronquist, A., Lai, L., Della-Latta, P. (2001). Assessment
two hand hygiene regimens for intensive care unit personnel. Critical Care Medicine, 29(5), 944-951.

LeBlanc, A., & Cobbett, S. (2000). Traditional practice versus evidence-based practice for IV skin preparation.
The Canadian Journal of Infection Control, X, 9-14.

Lippincott, Williams & Wilkins (2004). Nursing Procedures. Lippincott, Williams & Wilkins. Philadelphia.

Masoorli, S., & Angeles, T. (2002). Getting a line on central vascular access devices. Nursing 2002, 32(4), 36-
43.

Moureau, N. (2001). Preventing complications with vascular access devices. Nursing, 31(7), 52-55.
Oncology Nursing Society (2004). Access Device Guidelines 2
nd
Ed. Recommendation for Nursing
Practice and Education. Oncology Nursing Society. Pittsburg.

Parker, J . (ed.) (1998). Contemporary Nephrology Nursing. New J ersey, N.Y. 901.

Randolph, A. G., Cook, D. J ., Gonzales, C. A., & Andrew, M. (1998). Benefit of heparin in central venous and
pulmonary artery catheters: A meta-analysis of randomized controlled trials. Clinical Investigations in
Critical Care, 113(1), 165-171.



REGIONAL NURSING
POLICY
SUBJ ECT/TITLE:

CENTRAL VENOUS CATHETER and MIDLINE
CATHETER: GENERAL CARE LEVEL ONE
SKILLS
DATE
ESTABLISHED:
1999.06
DATE REVISED:
2008.11
POLICY
NUMBER:
C-7
PAGE:
14 of 15


REGIONAL NURSING POLICY
CALGARY HEALTH REGION
Registered Nurses Association of Ontario (2004). Best Practice Guideline. Assessment and Device Selection for
Vascular Access. Toronto, Canada: Registered Nurses Association of Ontario.

Registered Nurses Association of Ontario (2005). Best Practice Guideline. Care and Maintenance to Reduce
Vascular Access Complications. Toronto, Canada: Registered Nurses Association of Ontario.

Ryder, M. A. (1995). Peripheral access options. Surgical Oncology Clinics of North America, 4(3), 395-427.

Safer Health Care Now (2006). Prevent Central Line Infections. How to Guide. Institute for Healthcare
Improvement.

Sansivero, G. E. (1998). Venous anatomy and physiology: Considerations for vascular access device placement
and function. Journal of Intravenous Nursing, 21 (5S), S107-S114.

Schmid, M. W. (2000). Risks and complications for peripherally and centrally inserted intravenous catheters.
Critical Care Nursing Clinics of North America, 12(2), 165-174.

Schulmeister, L., & Camp-Sorrell, D. (2000). Chemotherapy extravasation from implanted ports. CINA
Yearbook, 74-80.

Vesely, T. M., Stranz, M., Masoorli, S., & Hadaway, L. C. (2002). The diverse and conflicting standards and
practices in infusion therapy. J ournal of Vascular Access Devices, 7(3), 9-25.

Weinstein, S (2007). Plumers Principles & Practice of Intravenous Therapy. 8
th
Edition, Lippincott, Williams
& Wilkins. Philadelphia, PA.



REGIONAL NURSING
POLICY
SUBJ ECT/TITLE:

CENTRAL VENOUS CATHETER and MIDLINE
CATHETER: GENERAL CARE LEVEL ONE
SKILLS
DATE
ESTABLISHED:
1999.06
DATE REVISED:
2008.11
POLICY
NUMBER:
C-7
PAGE:
15 of 15


REGIONAL NURSING POLICY
CALGARY HEALTH REGION

CROSS REFERENCES
MANUAL: NUMBER: SUBJECT/TITLE:
Calgary Health Region Acute Care
Infection Prevention and Control Manual
3.0 Standard Practice
Calgary Lab Services Phlebotomy
Child Health Policies and Procedures 2-C-7 Central Vascular Access in the Neonate: Arterial
and Venous
Child Health Policies and Procedures C 3.0 CVC Introduction and General Principles
Child Health Policies and Procedures C 3.1 CVC Assisting Physician Insert Direct Percutaneous
Catheter
Child Health Policies and Procedures C 3.2 CVC PICC for Pediatrics: Insertion, Maintenance,
& Removal.
Child Health Policies and Procedures C 3.3 CVC Tubing Change
Child Health Policies and Procedures C 3.4 CVC Dressing
Child Health Policies and Procedures C 3.5 CVC Flush
Child Health Policies and Procedures C 3.6 CVC Changing Inject Caps
Child Health Policies and Procedures C 3.7 CVC Removal of Direct Percutaneous Catheters
Child Health Policies and Procedures C 3.8 CVC Drawing Blood Specimens
Child Health Policies and Procedures C 3.9 CVC Catheter Repair
Child Health Policies and Procedures C3.10 CVC Access Implanted Port
Child Health Policies and Procedures C 3.11 CVC Management of Occlusion
Child Health Policies and Procedures C 3.12 CVC Physician Management of Occlusion
Critical Care, Cardiac Sciences,
Anaesthesia Unit Policy
H202 Hemodynamic Monitoring: CVP Line - Connection,
Maintenance and Removal
Critical Care Unit Policy M700 Multi-Lumen Infusion Catheter - Insertion,
Maintenance and Removal
Regional Nursing Policy and Procedure S-3a & S-3b Specialized Nursing Competency
Regional Nursing Policy and Procedure P-4 Parenteral Nutrition Administration System
Change
Regional Nursing Policy and Procedure I-3 Intravenous (I.V.) Therapy Peripheral Access:
Initiation/Monitoring/Discontinuation
Regional Nursing Policy and Procedure B-3 Blood Component/Product Administration