A Central Of Venous Catheter

PICC lines, or peripherally inserted central catheters, are a convenient healthcare treatment. A PICC line is a thin catheter that is inserted in the large veins near your forearm at the flex point. It can be inserted by a physician or by a specially trained nurse and is minimally invasive. People who can get PICC lines include "patients who have to receive IV therapy longer than five days, when there is difficulty maintaining peripheral access, for any infusions known to damage the inside of the vein, for infusion of total parenteral nutrition, patients with respiratory ailments that increase risk for using other central venous access devices, for patients receiving chemotherapy, and for any patients needing prolonged outpatient treatment that requires use of an IV." http://www.cpmc.org/learning/documents/nur-piccline-ws.pdf. I am going to further discuss how a PICC line is inserted, the benefits and the risks, safety of PICC lines, and caring for a PICC line.

Every day a registered nurse with specialized training in peripherally inserted central catheter insert this device into a patient’s vein every day. There are various reasons why a patient might need this catheter. It aids in transferring nutrients, medications such as antibiotics into the body. Patients who have continuous blood draws benefit from this catheter. It is an easier access and minimal needle sticks to the patient. Patients who entail for this catheter are cancer, critical care or nutritional impaired patients. Peripherally inserted central catheters are commonly referred to as PICC lines. It is a slim and hollow tubing that is placed in an area anterior above the elbow. Once inserted the goal is to thread the line through

It can also occur during blood transfusion or during dressing change. The insertion of central catheters can occur in the Interventional Radiology or sometimes at the bedside. Regardless of the where the insertion process occur, a sterile field must always be maintained and sterile techniques must always be employed to prevent any organisms from being introduced to the central line into the patient. According to The Joint Commission (2013), many organizations such as Michigan Keystone Intensive Care Unit Project and Institute for Healthcare Improvement are actually adhering to insertion bundles to reduce the CLABSI rates. The bundles include hand hygiene, maximal barrier precautions, chlorhexidine skin preparation, avoidance of femoral vein, and prompt removal of central catheter. Furuya et al. (2011) studied the effectiveness of the insertion bundle and how it impacts the bloodstream infections for patients in the Intensive Care Unit. As a result, lesser infection have occurred when the compliance is high. As mentioned, the site of the catheter also needs to be considered in the insertion process. Avoiding areas such as the groin to access the femoral artery is recommended because this area can be easily contaminated with urine or feces. In addition, after the insertion of a new central line, all the used IV tubing

Lewis et al. explain in Medical-Surgical Nursing, a central line is a catheter placed into a large blood vessel for a patient who requires frequent or long-term access to the vascular system. The authors explain that catheters are used for the administration of high volume fluids, medications that are irritating (such as chemotherapy), long term pain medication, blood products, parenteral nutrition, and hemodialysis. Kaiser policy states four different types of central line used for patients: Centrally inserted catheters, peripherally inserted catheters, injection implanted ports and hemodialysis catheters. Centrally inserted catheters

Article by Clancy (2009) explained central lines were a result of an estimated 250,000 blood stream infections and accounted for 30,000 to 62,000 patient deaths, then adding that each infection cost upwards of $36,000 and cumulatively add up to at least $9 billion in preventable costs annually. The article also explains how the mindset has changed from the cost of having a central line in place and expecting complications to lowering infection rates by an intentional interventional process/s. The article speaks of 5 basic steps to reduce CLABSI, hand washing, insertion techniques, skin cleansing, avoidance of certain sites and earlier removal of the CVC. Studies showed that these guidelines were only followed 62% of the time. The system was changed to ascertain that all the clinicians were in compliance. This prompted 5 interventions, education, a CVC insertion cart with all necessary equipment, physicians having to validate central line necessity, a concise checklist for bedside clinicians and the empower of nurses to stop procedures if guidelines were not followed. These low cost interventions from 11.3/1000 in catheter days in 1998 to zero in the fourth quarter of 2002.

Mrs. Toren Dukes currently serves at MD Anderson Cancer Center as a supervisor of the Registered Nurse (RN) Infusion Therapy department. She places Intravenous Lines (IV’s), Central Lines, Peripherally Inserted Central Catheter (PICC) lines and Ports for the entire hospital, both inpatient and outpatient services.

Central line bundle is a group of evidence-based practice strategy for patient with central catheters, when implemented together, produce better outcomes than implemented individually (Institute of health care improvement, 2010.). The main elements of central line bundle are hand hygiene, maximal barrier precaution upon insertion, Chlorhexidine skin antisepsis, optimal catheter selection, and daily review of line necessity with prompt removal of unnecessary lines Aseptic technique when using and caring for a central line catheter can decrease the chance of contamination in this critically ill infants. Staff education on adherence to aseptic technique and strict central line care guidelines are essential to decreasing bloodstream infections.

The steps to do a central line are as follows: Set up materials needed for the procedure, check the patients charts, lay them down with a roll under their back to expose the chest. Swab the chest with antiseptic, inject the anesthetic lidocaine, then use a syringe and puncture a hole near the clavicle. Next use the guidewire to find your way through the veins to the heart, and using that follow it in with the central line. The last step is suture it in place and clean up. (12)

PICCs lines have become well recognized as reliable central venous access devices (VADs), with lower potential for complications than short-term central venous catheters. PICCs first gained popularity in the 1980s, and their use has grown steadily since then. They were initially popular in many parts of the United States due to the need for venous access in home care patients. They have grown in popularity because of their reduction in potential complications and costs compared with short-term central venous catheters, and because PICCs can be inserted by registered nurses who have been trained in the procedure.

Central lines are a common device used world wide in acute care settings for eligible patient populations such as those receiving chemotherapy, patients with poor venous access, or for those that require prolonged treatment of intravenous medications. Although central lines provide many advantages, they place patients at high risk for acquiring central line associated blood stream infections (CLABSI). CLABSI's are a serious complication associated with central lines and in some cases can be life threatening. There are many evidence based approaches that are used in acute care settings to reduce the incidence of CLABSI's such as meticulous skin care, daily bathing with chlorehexadine surgical scrub, and strict sterile technique when changing central line dressings. These prevention measures are a standard of care nationwide for patients with central lines since they are cost effective and evidence based. Unfortunately, even with proper implementation and compliance with these interventions, CLABSI's are still prevalent amongst vulnerable patient populations.

A percutaneous central line is entered into the patient’s subclavian vein. Because TPN solution is concentrated it is better to have CVC access in the subclavian vein so the solution has less distance to travel to its destination. This reduces the risk of the line clotting or damaging the vein.

In case of persistent hypotension after administering IV fluids, the nurse should advocate placing a central line to closely monitor central venous pressure (CVP). The Surviving Sepsis Campaign added a new guideline in 2012 to monitor CVP every 30 minutes for 6 hours straight. This allows the nurse at the bedside to be able to quickly resuscitate the patient with adequate fluids until the CVP normal level of 8-12 is achieved. (Surviving Sepsis Campaign,

To perform a cardiac catheterization the cardiologist will insert a sheath, or a short tube usually into the femoral artery. A long very thin catheter will then be fed through the sheath and guided through the arteries until it is in the heart and coronary arteries. The physician uses fluoroscopy equipment to guide the catheter into the coronary arteries. To allow for clear viewing of the coronary arteries, contrast material is injected into the catheter. As the contrast material flows through the heart chambers and coronary arteries x-rays are taken. The

The use of intravenous therapy in the hospitals is now considered a routine therapy. In 2016, DeVries and Valentine stated that 70% to 80% of hospital patients have peripheral intravenous lines at some time during their stay. A peripheral intravenous (PIV) line is a small hollow tube (catheter) that is inserted into a vein and can be connected to special tubing. PIV line is commonly used to administer medications or fluids directly into the vein. The article “Intravenous Therapy: A Review of Complications and Economic Considerations of Peripheral Access,” states that the history of intravenous (IV) therapy dates back to the Middle Ages. Dr. Thomas Latta pioneered the use of IV saline infusion during the cholera epidemic and in the 20th century, two world wars established a role for IV therapy as routine medical practice (Dychter, Gold, Carson, & Haller, 2012).

When blood is removed from a vein, it is called venipuncture or phlebotomy. Venipuncture should be performed with care. The veins of a patient are the main source of specimens for testing, the entry point of medications, and the site for IVs and blood transfusions. Because there are only a limited number of easily accessible veins in a patient, it is important that everything be done to preserve their good condition and availability. Universal precautions should be observed at all times. Gloves should always be worn when obtaining blood specimens. BEFORE BEGINNING ANY PROCEDURE—ACCURATELY IDENTIFY THE PATIENT ! Follow the proper protocol to identify the patient make positive identification of the patient by checking hospital armband for