The Central And Picc Line Insertion

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.

However, there are additional guidelines in terms of assessing the patient for prolonged catheter use. There should be frequent assessment and evaluation of the patient’s need for continued use. It is important to note that in addition to determining the patient’s need for catheterization, prior to insertion the nurse should also complete the following:

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

Only when it is absolutely necessary should a catheter be inserted into a patient. Every patient is assessed for the need for a Foley catheter. If the Foley is inserted, assessments are also then done daily to see if the need is still valid. If the reason is not justifiable the catheter must be removed from the patient (Joint Commission releases new NPSG for CAUTI, 2011). Nurses must follow guidelines while inserting indwelling catheters as well. Aseptic technique is critical to maintain during this process. The use of sterile equipment and a sterile procedure helps to reduce the risk of CAUTI. If in any way the catheter becomes contaminated during the process of insertion, the nurse should discard of the entire catheter and start with a new, sterile kit. Proper hand hygiene is very important before and after contact with indwelling catheters to decrease risk of infection. Maintenance of a close drainage is system is also important that way bacteria are not able to get in and cause infection (Revello & Gallo, 2013). Decreasing the number of times Foleys are inserted and how long they stay in for can help reduce the risk of CAUTI since the longer a Foley stays in, the higher the risk of infection becomes. Nurses must keep the catheter line patent, with no kinks to allow urine to flow freely through into the collection bag. When a urine sample must be obtained it must be done in a sterile

*Intravenous (IV) injection administration – The medicine is administered directly into the veins. Medicines are rapidly absorbed into the body via this route, which is advantageous when a situation is life threatening.

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.

The clinician demonstrated evidence based practice in his care. By informing the patient about the procedure and waiting for a clear approval. He demonstrated great communication skills as well as keeping the client’s values and circumstance at the core of his care throughout. In addition, the five moments of hand hygiene, aseptic technique and the rights of medication administration of current best practice were utilised. Furthermore, clinical expertise were demonstrated the clinician completed the task in a timely manner with good dexterity highlighting that he has been administering IV therapy for quite some time and is experienced in the way he handled the

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 central line is not very difficult, but it is stressful enough to make Gawande nervous for his first procedure. Gawande took a long time to prepare for his first central line. When S. his supervisor, come to watch him do the central line, she pointed out a few

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.

Here, we first look at how catheters are used and then discuss the problems that may appear when they are not used in the proper manner.

When hearing a patient needs a peripherally inserted central catheter (or PICC) chances are they (or their loved one) are already suffering from one of several critical illnesses. PICCs are commonly thought of when a patient has cancer, kidney disease, or in the case of premature infants. The PICC is used as long term option when a regular intravenous catheter would be in a state of constant replacement.

Brown, M.M., Goss, J., Mack, K. (2016). Nursing care of hospitalized patients with a non-tunneled central line: placement, maintenance and removal.

Prepare the tubing by filling it with normal saline and making sure there are no large air-bubbles. If using off the shelf iv tubing, be sure to clamp it so that the saline doesn’t drip out onto the floor. When using the Smart Set this is not a problem, because the valves have a normally closed position.