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Central venous catheter care

  • Procedure

A central line is handled with strict aseptic technique: an intact dressing, a disinfected connector, flushing without force and removal once it is not needed.

Updated

What it is

A central venous catheter ends in a large vein near the heart. It allows long therapies, high-osmolarity solutions, vesicants, resuscitation and haemodynamic monitoring. The main types are the peripherally inserted central catheter (PICC), the non-tunnelled, the tunnelled and the implanted port. Its main risk is central line-associated bloodstream infection; the prevention bundle and a daily review of whether it is still needed are the core of its care (CDC 2011 guideline).

Indications

  • Long-term IV therapy.
  • High-osmolarity solutions or vesicant drugs.
  • Emergency access for fluid resuscitation.
  • Haemodynamic monitoring.
  • Scheduled care: dressing and connector changes, flushing, blood sampling and site assessment.

Contraindications and precautions

  • Aseptic non-touch technique; a mask for you and the patient during the dressing change.
  • Chlorhexidine allergy: use the alternative the protocol names (povidone-iodine, 70 % alcohol).
  • Under two months of age, the antiseptic is set by the paediatric protocol.
  • Do not submerge the catheter in water; cover it with an impermeable cover to shower.
  • Do not draw blood from a lumen running parenteral nutrition.

Equipment

  • Sterile dressing kit with sterile gloves and masks.
  • Chlorhexidine in alcohol and a sterile transparent semipermeable dressing.
  • A new needleless connector and antiseptic caps or pads for the connector.
  • Prefilled saline syringes of the size the protocol sets.
  • A label for date, time, initials and the next change date.

Step by step (and why)

  1. Check the site, dressing and external catheter length every shift — detects infection and migration.
  2. Hand hygiene; a mask for you and the patient, who turns their head away — avoids contaminating the site.
  3. Remove the dressing without pulling the catheter and look for redness, discharge or swelling — a finding changes the plan.
  4. Clean with chlorhexidine in alcohol, scrubbing for 30 seconds, and let it dry — dry antiseptic works better.
  5. Apply the sterile transparent dressing and label it — you can see the site and know when to change it.
  6. Scrub the connector for at least 15 seconds and let it dry before every access; enter only with sterile devices.
  7. Aspirate for blood return and flush with saline using a pulsatile push-pause technique — helps clear the lumen.
  8. Never force against resistance; look for kinks and follow the protocol — force can rupture the catheter.
  9. Clamp according to the connector type and change sets and connectors as often as the protocol says.
  10. Ask every day whether it is still needed and document — timely removal is the best prevention.

Complications

  • Central line-associated bloodstream infection: fever, chills, redness or discharge at the site.
  • Occlusion: resistance on flushing and poor blood return.
  • Air embolism: sudden breathlessness, persistent cough, chest pain, altered mental status or a neurological deficit.
  • Pneumothorax after insertion: pleuritic pain, breathlessness, tachypnoea, cyanosis, dry cough.
  • Catheter migration (the external length changes) and thrombosis (with a PICC, a larger arm circumference).
  • Catheter breakage.

Next step: when to call for help

  • Air embolism: clamp the catheter, place the patient left side-lying with the head down, give oxygen and call the rapid response team.
  • Call for fever, chills, redness or discharge: expect blood cultures.
  • Call if there is resistance or no blood return; do not force it.
  • Call if the external length changes or the arm circumference grows with a PICC.
  • Breakage: clamp between the exit site and the break, cover with sterile gauze and call. Complete dislodgement: rapid response.

Test yourself

Think of the answer, then tap the question to see it.

Which measure prevents central line-associated bloodstream infection the most?

Removing the catheter as soon as it is not needed, with a daily review of its need, together with aseptic technique, an intact dressing and connector disinfection.

How often is the transparent dressing of a short-term central catheter changed?

At least every 7 days (gauze every 2 days), and sooner if it is damp, loose or soiled.

Which position is used if an air embolism is suspected?

Left side-lying with the head down, after clamping the catheter; oxygen is given and the rapid response team is called.

Why is a central catheter not flushed with small syringes?

Because they create more pressure inside the lumen and can rupture the catheter. Use the syringe size the protocol sets.

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Nursing Advanced Skills, 4.2 Manage Central Lines: Basic Concepts (Open RN (Chippewa Valley Technical College), LibreTexts, 2023); Nursing Advanced Skills, 4.3 Manage Central Lines: Applying the Nursing Process (Open RN (Chippewa Valley Technical College), LibreTexts, 2023); Guidelines for the Prevention of Intravascular Catheter-Related Infections (2011): Summary of Recommendations (Centers for Disease Control and Prevention, 2011).

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Representative model, for educational purposes only.