CENTRAL LINE INSERTION AND CARE.pptx

Central line insertion procedure

1. CENTRAL LINE INSERTION,MAINTANENCE & CARE PRESENTED BY , Ahmed Abdullah

2. WHAT IS CENTRAL LINE? A central line (or  central venous catheter ) is like an intravenous iv line, But it is much longer than a regular IV and goes all the way up to a vein near the heart or just inside the heart. A patient can get, Fluids, Medicine Blood It also can be used to draw blood. It may stay in place for weeks or months and helps avoid the need for repeated needle sticks.

3. DEFINITION A central venous catheter is a thin, flexible tube that is inserted into a vein, usually below the right collarbone, and guided (threaded) into a large vein above the right side of the heart called the superior vena cava.

4. INDICATIONS

5. CONTRAINDICATIONS

6. Types of catheters.

7. Peripherally inserted central catheter(PICC) Provides an alternative to subclavian or jugular vein catheterization. Inserted via the peripheral vein into the superior vena cava, usually by way of cephalic or basilic veins. Preffered if iv therapy is expected to exceed 6 days.

8. PICC LINE

9. TUNNELED CATHETER Surgically implanted CVC with the tunneled portion under the skin and a Dacron cuff just inside the exit site. The cuff inhibits migration of organisms into the catheter tract by stimulating growth of surrounding tissue,thus sealing the catheter tract used to provide vascular access to patients who require prolonged iv therapy,home infusion therapy or hemodialysis .( eg.Hickman , Quinton catheter).

10. TUNNELED CATHETER

11. NON-TUNNELED CATHETER A non-tunneled central line is a type of short-term IV catheter& most common type of CVC also it is accountable for 90% of CLABSI. The risk of infection depends on the site of insertion femoral>internal jugular> subclavian veins. Examples are PICC line, Sheaths ,Triple lumen etc.

12. TRIPLE LUMEN.

13. SHEATH.

14. Totally implantable device A subcutaneous port or reservoir with self-sealing septum is tunneled beneath the skin and is accessed by a needle through intact skin( eg . Port-a-cath). It has a low rate of infection. Preferred for patients who require long term, intermittent vascular access.

15. Pulmonary artery catheters. Inserted through a Teflon introducer and typically remains in place for an average duration of only 3 days. Most catheters are heparin bonded to reduce catheter thrombosis and microbial adherence to the catheter.

16. SITES

17. Equipment required for central line insertion Ultrasound Sterile trolley Sterile field, gloves, gown and mask Puncture needle. Saline flush Chlorhexidine 2% with 70% alcohol Lignocaine Suture Scalpel Sterile dressing Pressure bag to attach to monitoring Transducer

18. INSERTION Pre-procedure Consent the patient if conscious and it should include complications. Set up sterile trolley Position the patient according to site. If it is neck, head facing away from side of insertion This ensures maximum venous filling Ultrasound if needed.

19. PROCEDURE A central line insertion bundle must be filled up during insertion and follow asceptic techniques Use the bedside ultrasound to identify the target vein. Advanced the needle according to the site. Once venous blood is aspirated, stop advancing the needle and insert guide wire. Advance the CVL over the guide wire. Make sure the distal lumen of the central line is uncapped to facilitate passage of the guide wire. Once the CVL is in place, remove the guide wire. Next, flush and aspirate all ports with the sterile saline. Secure the CVL in place with the suture and place a sterile dressing over the site.

20. POST PROCEDURE. Attach central line to pressure bag to allow CVP monitoring Run a blood gas to ensure a venous sample Chest x-ray to confirm placement and to check for pneumothorax Clear documentation(CLABSI BUNDLE) of date of insertion and monitor for infection

21. COMPLICATIONS

22. CENTRAL LINE-MAINTENENCE & CARE Hand Hygiene Proper Dressing Change Aseptic technique for accessing and changing needleless connector Standardize tubing change Daily review of catheter necessity

23. HAND HYGIENE

24. CATHETER SITE CARE & DRESSING 2% chlorhexidine with 70% alcohol based preparation is the preferred agent Scrub for 30 seconds using back and forth motion & allow to dry completely Use either sterile gauze or sterile, transparent, semi permeable dressing to cover the catheter site Dressing shall be replaced every 48 hours for gauze dressing or earlier when catheter/needle is changed, or when dressing become damp, loosened or visibly soiled. 7 days for transparent dressing

25. CATHETER SITE ASSESSMENT Assess the site for redness, tenderness, pain, swollen, dysfunction, infection or exudate every shift If IV site is judged to be infected, 1.Discontinue the device 2.Swab exudate for culture & sensitivity 3.Notify the physician 4.Document in patient chart 5.Do OVR and refer to IV nurse

26. Asceptic technique for accessing & changing needless connector Catheter Hubs and Needless Connectors are Known sources of CLABSI and recognized sites of bacterial contamination Minimize contamination risk by scrubbing the access port with an appropriate antiseptic ( chlorhexidine 2%with 70% alcohol) and accessing the port only with sterile devices.

27. Replacement of Administrative Sets Replace administration sets that are continuously used, including secondary sets no more frequently than at 96-hour intervals. Replace tubing used to administer blood & blood products every 4 hours. TPN/Intra lipids 24 hours of initiating the infusions. Chemotherapy tubing after each administration. Propofol every 6-12 hours & when vial changed.

28. DAILY REVIEW OF CATHETER NECESSITY Perform a daily review of the necessity of the central catheter Document that the review has been performed. Remove the catheter if no longer needed

29. summary So far we have discussed about, central line Types Indications Contra indications Complications Procedure for insertion and Maintenence & care.

30. conclusion We have understood the necessity of central line in hospital especially on critical areas. As same like maintenance and care of this also taking a huge part to prevent CLABSI. so lets hands together to promote a infection less treatments and improve the wellbeing of the patients. “PREVENTION IS BETTER THAN CURE”

31. REFERENCE POLICY CODE-IPP-IPC-054 Infection control for intravenous catheters and therapy.