CARE OF CENTRAL VENOUS CATHETER

Placement of central venous catheter 
central catheter internal tip will be in one of the positions below:

  • superior vena cava SVC)
  • Right atrium/superior vena cava junction
  • Right atrium (RA)
  • Inferior vena cava (IVC) above the diaphragm (in case of femoral catheters).
Indications:
  • To maintain central venous pressure (CVP).
  • To administer large amount of intravenous fluids in case of emergency, e.g. colloids, blood products, etc.
  • To administer irritants, vesicant and hyperosmolar drugs/fluids, e.g. adrenaline, sodium bicarbonate, Total Parental Nutrition (TPN), etc.
  • To have a long-term access for frequent or prolong usage, e.g. hemodialysis, chemotherapeutic agents, broad spectrum antibiotics, blood sampling, etc.
Complications:
  • Pneumothorax 
  • Infection
  • Thrombosis
  • Mechanical phlebitis 
  • Air embolism
  • Cardiac tamponade 
  • Patency impairment 
  • Blood clots in catheter 
  • Mechanical obstruction 
  • Catheter fracture 
  • Extravasation of fluids
  • Separation of port and catheter 
  • Surgical emphysema.
Important Points to Remember:
  • Chlorhexidine impregnated dressing help to reduce catheter associated bacteremia compared to other dressings.
  • Prefer a transparent dressing for clear assessment of site.
  • If there is bleeding or oozing, use dry dressing until it resolve.
  • Dressing has to be changed on weekly-basis to decrease skin irritation.
  • Dressing has to be changed soon after its get soiled or loosen.
  • Follow aseptic technique during dressing (wash hands using alcohol hand rubs).
  • Flush using normal saline after a injection or infusion will helps to keep catheter clean and prevent blood clots in catheter.
Guidelines of Healthcare Infection Control Practice Advisory Committee (HICPAC) to Prevent Intravascular Catheter-Related Infections:
Education, Training and Staffing
  • Educate health team members in regard with indications for intravascular catheter usage.
  • Periodically assessment of IV catheters.
  • Assign only trained person who is competent for insertion and maintenance of central intravascular catheters.
Hand Hygiene and Aseptic Technique
  • Perform hand hygiene
  • Maintain aseptic technique.
Skin Preparation 
  • Prepare skin with 0.5% chlorhexidine, tincture of iodine, an iodophor (or) 70% alcohol.
Catheter Site Dressing Regimens
  • If catheter site is bleeding or oozing, use gauze dressing until it gets solved.
  • Change catheter-site dressing when it is damp, loosen or soiled.
  • Do not use topical antibiotic creams on insertion sites except the dialysis catheters because of high-risk fungal infections and antimicrobial resistance.
  • Do not wet catheter site in water during bath likelihood to get infection.
  • Replace transparent dressing used in tunneled (or) implanted Central Venous Catheter sites not more than once in a week, until dressing is visibly soiled or loosen.
  • Monitor the catheter sites while changing dressing whether patient has tenderness at insertion site, fever without obvious reason, or other symptoms suggestive to local or bloodstream infection, then dressing has to be removed ans allow complete examination of catheter site.

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