Central Lines

When are central lines used?

• Multiple IV meds/infusions (incompatible drugs)

• TPN

• Chemotherapy

• Long-term antibiotics

• Frequent blood draws/transfusions

• CVP monitoring

• Hemodialysis access

Non-tunneled central line

Short-term, direct to vein, ICU/emergency, highest infection risk

Where is a non-tunneled central line inserted?

Into a large vein (subclavian, jugular, or femoral), exiting the skin near the insertion site.

Tunneled central line

long-term, lower infection risk

Where is a tunneled central line inserted?

Into a large vein (subclavian, jugular, or femoral) and tunneled under the skin to a subcutaneous exit site

PICC line

Med/long-term, meds/TPN, lower infection risk than central lines in chest

Where is a PICC line inserted?

Inserted into a peripheral vein (usually in the arm) and advanced to the superior vena cava.

Implanted port

lowest infection risk, long-term therapy; accessed w Huber needle

Tunneled vs Non-tunneled central lines?

Tunneled: goes under skin → ↓ infection

Non-tunneled: exits near insertion → ↑ infection

Who inserts central lines vs PICC?

CVC → Physician / Radiologist

PICC → Radiologist / Certified nurse

Bedside vs surgery placement?

Bedside = quick lines (PICC, non-tunneled)

Surgery = long-term (tunneled, port)

First step before central line insertion?

Educate + obtain consent

Position for CVC vs PICC?

CVC → Trendelenburg/supine

PICC → Supine

What PPE is required?

Sterile gown, gloves, mask, cap

What is used to prep the site?

Chlorhexidine (Duraprep); let dry

How is the patient draped?

Head-to-toe sterile drape

What dressing is applied after insertion?

Transparent sterile dressing

What must be done before using line?

Confirm placement (X-ray)

When are dressing changes?

q 7 days or prn (transparent)

q 2 days (gauze)

Before accessing the line, how long scrub the hub?

15–30 sec

What size syringe should be used to access a central venous catheter (CVC)?

10 mL syringe or larger

How do you flush line initially?

10 mL NS, start-stop

What do you do after giving meds through the line?

Flush NS again

What does a neutral connector do?

No fluid movement (no push or pull) = No blood reflux → no clamp sequence needed

What happens with positive displacement?

Pushes fluid into catheter when disconnecting → prevents blood backflow

When do you clamp with positive connectors?

Clamp AFTER disconnecting syringe

What happens with negative displacement?

Pulls blood back into catheter when disconnecting → ↑ occlusion risk

When do you clamp with negative connectors?

Clamp WHILE injecting last 0.5 mL

Steps for drawing blood from a central line?

Flush → Aspirate 10 mLs → Discard → Draw specimen

What do you do with first blood drawn?

Discard (dead space blood)

How much is discarded in discard method?

6 mL or more

What are the 2 types of line occlusions?

• Intraluminal → inside line (clot/precipitate)

• Extraluminal → outside line (pinch-off, fibrin sheath)

First nursing actions if line won’t work?

Unclamp → check kinks → reposition patient; notify HCP if still not working

Who can remove and how is patient positioned?

Nurse → PICC, non-tunneled

Physician → Port, tunneled

Position: Supine or Trendelenburg

Basic steps to remove central line?

Non sterile gloves → clean site chlorohexidine → remove sutures → gauze → pull catheter (exhale/Valsalva)

What do you do after catheter is out?

Pressure 2 min, (5 if on blood thinners)

Transparent air-tight dressing

What if infection suspected?

Send catheter tip to lab

Highest infection site?

Femoral; lowest is Subclavian

What is CLABSI?

Bloodstream infection within 48 hrs of central line use.

What is CRBSI?

Lab-confirmed catheter infection.