Central venous catheters

Use of central venous catheters in the acute care setting is an integral approach to deliver fluids, blood products, nutrients, medications, obtaining blood specimens, maintaining emergency vascular access, and for haemodynamic monitoring.

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Risk factors:

Mechanical complications (malposition, occlusion, dislodgement, tamponade), infection, pneumothorax, thrombosis

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Insertion:

Ask nurse to complete the checklist and to stop you if you are about to breach the rules!

• Maximal sterile barriers for insertion
• Use chlorhexidine lollipops – the use of liquid in pot is absolutely forbidden!
• Dedicated equipment cart easily accessed
• Use of a procedural pause “stop the line” if barrier precautions are breached
• Use of chlorhexidine impregnated patch at insertion site
• Appropriate dressings used over insertion site
• Radiographical confirmation of catheter tip position
• Always transduce pressure waveform (with heparin)
• Details of insertion documented in patient record

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Maintenance:

• Commence heparin 10 U/kg/hr in patients <5 kg
• Daily review of lines with prompt removal of unnecessary lines
• Use of closed needless mechanical valve on each lumen

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References:

[1] http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5110a1.htm

[2] The Pediatric Infectious Diseases Journal, 2010; Sept 29(9): 812 -815: Prasad et al: Risk Factors for Catheter-associated Bloodstream Infections in a Pediatric Cardiac Intensive Care Unit.

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