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Institutional UsersAccess through Ovid® Not a Subscriber?Buy Subscribe Request Permissions You can read the full text of this article if you: Log In Access through Ovid I.V. ROUNDS Drawing blood through a central venous catheterMOUREAU, NANCY L. RN, CRNI, BSN Nancy L. Moureau is an educator, consultant, and president of PICC Excellence, Inc. (http://www.piccexcellence.com) in Hartwell, Ga. Nursing: February 2004 - Volume 34 - Issue 2 - p 28
In BriefEndacott, Jevon & Cooper: Clinical Nursing Skills Core and AdvancedInstructionsChoose your answer by clicking the radio button next to your choice and then press 'Submit' to get your score. Question 1When reviewing the results on bloods drawn from a CVC with a Heparinized flush line, which sample may be inaccurate? a) Full blood count. b) Urea and electrolytes. c) Glucose. d) Coagulation studies. Question 2The subclavian vein lies under the _____ close to the _____ artery. a) Under the clavicle close to the subclavian artery. b) Under the clavicle close to the axillary artery. c) Under the common iliac vein close to the axillary artery. d) Under the clavicle close to the popliteal artery. Question 3
a) Apply an occlusive dressing, which should be removed after 24 hours. b) Apply a gauze dressing, which should be left in place for 72 hours. c) Apply an occlusive dressing, which should be left in place for 72 hours. d) Leave open to air once the bleeding has stopped. Question 4What is the recommended method of flushing a CVC? a) The catheter should be flushed with a syringe no bigger than 10 ml, using a pulsated push-pause positive pressure technique. b) The catheter should be flushed using a pulsated push-pause positive pressure technique, with a syringe no smaller than 10 ml. c) The catheter should be flushed with a syringe no smaller than 10 ml, using a smooth not stop technique. d) Use a 2 ml syringe as this will give a higher pressure. You are going home with a central line in place. This is also called a central venous access device (CVAD) or central venous catheter (CVC). A small, soft tube called a catheter has been put in a vein that leads to your heart. This line stays in place until you no longer need it, and then it is taken out. The line carries medicine or nutrition into your body. It may also
be used to draw blood. The central line must be flushed regularly. This will keep it clean and prevent blood clots from blocking the catheter. To flush it, you will use a syringe to inject solution into the injection cap of the catheter. This sheet explains how to do that. Clean the injection cap Inject solution to flush the catheter A central line can let germs into your body. This can lead to serious and sometimes deadly infections. To prevent infection, it’s very important that you, your caregivers, and others around you use good hand hygiene. This means washing your hands well with soap and water, and cleaning them with alcohol-based hand gel as directed. Never touch the central line or bandage (dressing)
without first using one of these methods. To wash your hands with soap and water: Wet your hands with warm water. (Avoid hot water, which can cause skin irritation when you wash your hands often.) Apply enough soap to cover the entire surface of your hands, including your fingers. Rub your hands together briskly for at least 15 seconds. Make sure to rub the front and back of each hand up to the wrist, your fingers and
fingernails, between the fingers, and each thumb. Rinse your hands with warm water. Dry your hands completely with a new, unused paper towel. Don’t use a cloth towel or other reusable towel. These can harbor germs. Use the paper towel to turn off the faucet, then throw it away. If you’re in a bathroom, also use a paper towel to open the door instead of touching the handle. When you don’t have access to soap and water: Use alcohol-based hand gel to clean your hands. The gel should have at least 60% alcohol. Follow the instructions on the package. Your health care team can answer any questions you have about when to use hand gel, or when it’s better to wash with soap and water. When to flush the central line
Avoiding infection while flushing the central lineTo flush the central line, you need to touch the end of the catheter (the lumen) and inject solution into it. The central line provides a direct path into your bloodstream. This makes the risk of infection high. So you must be very careful to keep your work area and supplies clean. Following the steps below will help. You may also get specific instructions from your healthcare team. Supplies for flushing the central lineA general list of supplies is below. Your healthcare team will provide you with a list of specific items and brands to use. Or you may get a kit that has everything you need. Your supplies may include:
To flush the catheterStep 1. Wash your handsWash your hands well with soap and water. Use the method described above. Step 2. Prepare your work area
Step 3. Lay out your supplies
Step 4. Flush the catheter
Step 5. Dispose of used supplies
Follow-up careA home health care nurse or other nurse will follow your progress. Contact this person if you have any questions about the flushing process. Follow up with your healthcare provider, or as advised. When to seek medical careCall your healthcare provider right away if you have any of the following:
What is the flushing protocol?The Infusion Nurses Society's Infusion Nursing Standards of Practice clearly define three purposes of catheter flushing; to assess catheter function, to maintain catheter patency, and to prevent contact between incompatible medications or fluids that could produce a precipitate.
What flushing volume should you use?A 10 mL flushing volume after blood sampling is appropriate because fibrin contact with the catheter wall is limited to some minutes. In contrast, after a blood transfusion a flush of 20 mL is required because fibrin might deposit to the catheter wall during a prolonged time.
How many mL are used to flush a central line?Unclamp the tubing. 1. Flush the fluids slowly. This is usually 3 mL of sodium chloride for infants and 10 mL of sodium chloride for adults.
What technique should be used to flush a peripheral venous access device?FLUSHING TECHNIQUE: A pulsatile flushing technique using a push-pause method involving 10 short 1ml. boluses with short pauses in between. This technique increases turbulence allowing for more effective catheter clearance of residual infusates or blood.
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