CVC line insertion

1. ASSISTING IN CVC LINE
INSERTION

2. DEFINITION
A catheter (tube) that is passed
through a vein to end up in the
thoracic (chest) portion of the
vena cava (the large vein
returning blood to the heart) or in
the right atrium of the heart. ...
The central venous line may be
inserted for the short term or
long term.

3. INDICATIONS
Central venous pressure monitoring.
Emergency venous access (due to difficult peripheral
intravenous access)
Long-term parenteral nutrition, especially in
chronically ill person
Long-term pain medications
Chemotherapy
Drugs that are prone to cause phlebitis in peripheral
veins (caustic), such as: Calcium
chloride,Chemotherapy
Hypertonic salinePotassium chloride
(KCl),Amiodarone
Vasopressors (for example, epinephrine, dopamine

4. ROLE OS ASSISTING NURSE
•Assist in positioning the patient as directed depending on
the site of insertion. • Jugular/Subclavian - Place the
patient in slight trendelenburg or flat, remove head of
the bed (optional). May place rolled towel between
scapulae.
Note: This position distends the vein for easier
insertion and decreases the risk of venous air
embolism.
• Femoral - Place patients flat.
•Assist the physician as required with placement of drapes
and catheter insertion.
•Administer medications as ordered.
•Prepare CVP monitoring system for short term CVC

5. •Ensure CVC is not accessed until xray of placement is
confirmed, or in an emergency until placement is
confirmed by blood return.
•Document date, time, catheter type (single, multi-
lumen), site, physician inserting catheter and patient’s
tolerance in the progress notes
•Any medications used during the procedure on
appropriate record.
Report
Report to physician any signs or symptoms of
complications of insertion:
Dyspnea, cardiac arrhythmias, hematoma,
excessive bleeding

6. THE PHYSICIAN WILL:
•Obtain verbal consent and prescribe any medications
as needed during the procedure
•Optimal positioning of the patient depending on the site
of insertion
•Perform hand hygiene prior to doing PPE.
•Use a 2% chlorhexidine-based antiseptic for skin
preparation. Providone-iodine may be used if patient
allergic to chlorhexidine.
Note: The antiseptic solution must be allowed to dry
prior to making the skin puncture.
•Full sterile drapes are placed on the client.

7. •CVC inserted by physician.
•Suture/secure the CVC in place following insertion
•Cleanse insertion site with 2% chlorhexidine-based
solution following insertion, allow to dry, apply sterile
dressing using aseptic technique.
•Connect needleless adaptors to each unused lumen.
Flush and lock unused lumen(s).
• Perform hand hygiene after doffing PPE.
•Order X-ray to confirm placement
•Prescribe IV solution and rate to commence after x-ray
verification of the catheter tip location.
•Document procedure in EPR.

8. • DISTEL PORT(BROWN)-16 G LEUMEN
THE LUMEN THAT OPENS UP AT THE VERY TIP-END OF THE
CATHETER
IT’S THE LARGEST PORT
CVP MONITORING
HIGH VOLUME FLUIDS
BLOOD SAMPLING
• MEDIAL PORTS(BLUE)-18G LEUMEN
FOR TPN AND MEDICATIONS
• PROXIMAL PORT(WHITE)-18 G LEUMEN
MEDICATIONS AND BLOOD PRODUCTS ADMINISTRATION
USE OF EACH LEUMEN IN CVC

9. NURSING CARE
Closely monitor the site of insertion for any redness
or discharges.
Monitor and record vital signs.
Follow strict aseptic techniques to minimize the risk
of infection
Use transparent dressing to visualize the site.
Label the CVC lines with drugs or fluids …etc ,to
minimize the risk of accidental boluses.
Dressing should be changed whenever soiled ,loose
or as per date of dressing.
(Tegaderm with Cholrhexidine gel to change after 7
days or whenever soiled)