Central Venous Catheters
A central venous catheter (CVC) is inserted by a practitioner for a variety of reasons. Some of these include vasopressor infusions, long-term medication or fluids, chemotherapy, long-term nutrition, repeated blood draws, and dialysis. The type of CVC inserted depends on the emergency and necessity of the IV line. Peripherally inserted central catheters (PICC) are inserted for more long-term care including nutrition and chemotherapy. More invasive CVCs inserted into the subclavian or jugular veins are for shorter term use like vasopressor therapy or short-term dialysis.
Central Line Insertion
As a nurse, your responsibility is helping the doctor to set up for the CVC insertion. This is a sterile procedure so once the preparation starts, you will be wearing a cap and mask. The main priority you have during this procedure and most procedures is to monitor vital signs. The only abnormal thing to expect is some ectopy (heart rhythm abnormality) as the doctor finishes inserting the catheter. It may hit the right atrium and "tickle" the inside of it causing the heart rhythm abnormality usually premature ventricular or atrial contractions. I usually tell the doctor that the patient is having some ectopy. At that point, the doctor will slightly pull back the catheter and then suture it into place.
There are two videos shown below showing central line insertion procedures. The first video is short, sweet, and very informative. It's an animated video put together by Amerra Medical. The second video is a live video of a CVC insertion by Mount Sinai Medical Center in New York. This one is more lengthy, but it is what you will be actually seeing when assisting with CVC insertion. Look at this article to find out what to do if your CVC clots off.
Blood Sampling From A Central Line
When drawing a blood sample from a central line, be sure to use good hand hygiene to avoid causing a central line associated bloodstream infection (CLABSI)! Adding a CLABSI to your patient's hospital list, isn't the best of ideas. Make sure to follow your hospital's policy when drawing blood. I will review our hospital's general policy for drawing blood from a CVC or PICC line. First, gather your supplies. You will need the following:
- Two 10 mL saline flushes
- 10 mL empty syringes for your actual samples. Look at your lab tubes to see how much volume each tube will require.
- Lab tubes (for information about which test goes into which tube, see www.tricore.org)
- Blunt tip needles for each empty syringe
Steps For Central Line Blood Sampling
1. Wash your hands and put on clean gloves.
2. Stop all medications that are infusing. If you have high dose vasopressors running, use your best discretion about whether or not to turn them off.
3. Attach one of your saline flushes to the port and flush your line. I like to take the cap of the saline (keeping it sterile) and put it on the end of the tubing I just disconnected from the port I'm drawing from. This keeps your tubing sterile and frees up your hands.
4. With the flush still attached, draw back and get your waste (10 mL).
5. Attach your empty syringe(s) and draw back your blood sample(s).
6. Remove syringe and attach saline syringe. Flush line with the full 10 mL saline flush. Reattach prior tubing to line (if applicable) and restart IV drips.
7. Attach blunt needle to your syringes and fill up your lab tubes. They are vacuum sealed so they will suck the blood right out of your syringe if you poke it with a needle. Be care of needle sticks!
There are also vacutainers that can be used to draw blood. I definitely prefer these to using an empty syringe and filling the lab tubes as listed above. With the vacutainers, your flushing and wasting process are still the same regardless. You just attach the vacutainer after the waste is done and push the lab tube into the vacutainer (filling it with blood). Keep filling each lab tube until you are done. Then flush the line as talked about above.