Central Venous Line

Central Venous Line Insertion:

Definition:
Central venous Catheterization means insertion of
(CVC) into a Central vein. While this may mean the
superior or inferior vena cava, via any peripheral route,
it usually refers to insertion into the superior vena cava
via right or left subclavian, external or internal jugular
vein, or medial cephalic puncture.

 Indications:
Central venous pressure monitoring, as a guide to
blood volume replacement.
Parental feeding with hypertonic solutions, which
would damage peripheral veins.
Intravenous administration of fluids or drugs when
other veins are unavailable.
Emergency blood transfusion provided a blood
warmer is used.

 Central Venous Pressure (CVP) is a measure of the

mean pressure in the superior vena cava (SVC),
reflecting right ventricular end-diastolic pressure or
preload.
Normal value of CVP:8-15 mmHg.

 Equipment:
CVC insertion tray.
Sterile gloves, mask.
Sterile gown.
CVC catheter
Single lumen 16 G -30 cm for left subclavian,
20 cm for other routs.
Multilumen - 2, 3 & 4 lumen lines available.

Iodine solution.
Lidocaine 1%, 5 ml.

 5 & 10 ml Syringes & 21 & 23 G needles.

IV drip set & intravenous fluid.
Primed pressure monitoring kit & cable
1 x 500cc normal saline with l00 u heparin.
1 x pressure cable
1 x pressure tubing set with transducer

 Opsite dressing
2/0 black silk suture
Incontinence sheet
3-ways stop-cock tap with 6 extension tubing- if
single lumen CVC used
10 ml syringe, Heparin and saline for priming
Multilumen Catheter.
CVP manometer set.

 Procedure:
Reinforce the doctors explanation of the procedure, and
answer the patient questions.
Place the patient in Trendelenburgs position (to dilate the
veins and reduce the risk of air embolism).
For subclavian insertion, place a rolled blanket under the
opposite shoulder (to extend the neck, snaking anatomic
landmarks inure visible).
Turn the patients head away from the site (to prevent
possible contamination from airborne pathogens and to make
the site more accessible).

 Prepare the insertion site. Make sure the skin is free

of hair (because hair can harbor microorganisms,).
You may also need to wash the skin with soap and
water before the actual skin preparation (to remove
surface dirt and body oils,).
Establish a sterile field on a table, using a sterile
towel or the wrapping from the instrument tray.

 Put on a mask and sterile gloves and gown, and clean

the area around the insertion site with sponges soaked
in povidone-iodine solution, working in a circular
motion outward from the site to avoid reintroducing
contamination.
After the doctor puts on a sterile mask, gown, and
gloves and drapes the area to create a sterile field,
open the packaging of the 3-ml syringe and 25G
needle and present it to the doctor, using sterile
technique.

 Wipe the top of the lidocaine vial with an alcohol

sponge and invert it. The doctor then fills the 3-ml
syringe and injects the anesthetic into the site.
Open the packaging of the catheter and give it to the
doctor using sterile technique. The doctor then inserts
the catheter.
During this time, prepare the I.V administration Set
for immediate attachment to the catheter hub; also
prepare the manual manometer.

 After the doctor attaches the I.V. line to the catheter

hub, set the flow rate at a keep-vein-open rate to
maintain venous access. The doctor then sutures the
catheter in place.
Place the patient in a comfortable position and
reassess hemodynamic status.
After an X- ray confirms correct catheter placement,
set the flow rate as ordered.

CVP Monitoring:
Place the patient in a supine position and decide the
zero point on the manometer.
Tap to patient is switched off and fluid allowed
running from the bag up the manometer
The tap is then turned from the manometer to the
patient.

 The fluid level in the manometer tubing will fall quite

rapidly for a few centimeters.
As the level reaches the patients CVP reading, the
fluid fail slowly and merely swinging up and down
with the patient respiration.
The tap is then returned so fluid runs to the patient.

Complications:
Complications can occur at any time during the
infusion therapy.
Traumatic complications, such as pneurnothorax,
typically occur upon catheter insertion but may not be
noticed until after the procedure is completed.
Systemic complications, such as sepsis, typically occur
later during infusion therapy.
Other complications include phlebitis, arrhythmias.

 Care of Central Venous Line:

Sterile gloves (2).
Antiseptic solution (Alcohol and povadine
solution).
Sterile cotton swabs.
4x4 inch, gauze and sterile scissors.
Tincture of benzoin.
Tap.
Paper bag for soiled dressing.

Procedure:
Review the clients chart for the data of catheter insertion
and the last dressing change or time of insertion. (This
provides a base from which to make comparisons).
Help the client to assume supine or semi-fowlers
position; (to facilitate changing of the dressing).
Ask the client to turn his/her face from the insertion site;
(to reduce the transmission of microorganisms from the
client supper respiratory tract to the catheter insertion
site).

 Open sterile supplies on a clean dressing trolley.

Remove the dressing from the insertion site and
put it in the paper bag.
Assess the site for signs of infection; such as
redness. tenderness, or swelling.
Wash your hands.
Don sterile gloves.

 Clean the skin around the insertion site by:

Holding the tube in one hand up off the clients
skin.
Using sterile 4x4-inch gauze pads soaked in
povadine, clean the skin in circular motion from in
to out of the insertion site. (Using an out ward
motion prevents reintroduction of microorganisms
on to the site that was previously cleansed,).

 Using sterile 4x4-inch gauze soaked in alcohol and

cleans the site in the same way. (Alcohol clean and
defeats the skin, remove the tap, and destroys the
cell wall of bacteria).
Cleans the proximal tubing:
Use a 4x4-inch pad with povadine solution and
clean the catheter from the insertion site in a
circular motion to the outer distal port. (This
decreases the transmission of microorganisms from
the catheter to the client).

 Allow the povadine to dry.

Examine the tubing connections and ensure that all
connections are secured. (Connection can become
loose with turning and manipulation).
Remove your gloves, (as they considered
contaminated).
Don a new pare of sterile gloves.

 Apply a sterile occlusive dressing 4x4-inch pads

with transparent dressing by:
Asking the client to abduct his/her arm and turn
the head away from the insertion site. (This
movement will stretch the skin so that movement
is possible after the dressing is applied).

 Apply tincture of benzoin to the surrounding skin

and allow the area to air-dry. (To protect the skin
and promote adhesion of the tap on the skin).
Loop the tube and apply the dressing directly over
the tube. (Looping the tube assists in preventing a
direct pull on the tube at the insertion site).
Remove the gloves and discard them in a
receptacle.

 Label the dressing with your name, date, and time of

the dressing change. (Provides information necessary
to plan the next site care).
Record the procedure. Note the date and time, and the
description of the site. (Communicates to the other
members of the health care team and contributes the
leagal record by documenting the care given to the
client)

Central Venous Line Removal

Equipment:
Clean Gloves and sterile gloves.
Sterile suture removal set or blade.
Sterile drape.
Alcohol sponges.
Iodine.
Sterile gloves 4X4 inch.
Forceps.
Tap.
Sterile plastic adhesive- backed dressing or transparent
semipermeable dressing.

Procedure:
Explain the procedure to the patient.
Place the patient in a supine position, (to prevent
emboli,),
Wash your hands and put on clean gloves and a mask.
Turn off all infusions and clamp the catheter, prepare a
sterile field; using sterile drape.
Remove and discard the old dressing and change to
sterile gloves.

 Clean the site with alcohol sponges or with gauzes

soaked in povidine- iodine solution, inspect the site
for the signs of drainage or inflammation.
Remove the suture, and withdraw the catheter in a
slow motion, with gauze over the puncture site.
Apply pressure on the puncture site with dry gauze.
Apply povidone- iodine solution to the insertion site
and apply dressing.

 Inspect the catheter (to see if any portions have

broken off during removal). If so notify the doctor
immediately and monitor the patient.
Dispose of the I.V tubing and equipment properly.