Last edited: 2/10/2022

CENTRAL VENOUS CATHETER | NCLEX

Central Venous Catheter | NCLEX Medical Editor: Uta Hüning

OUTLINE II.) WHY?

I.) INTRODUCTION Why to put a central venous catheter instead of an IV to

II.) FUNCTIONS AND GUIDELINES arm or hand?
III.) COMPLICATIONS
IV.) REMOVAL
V.) NCLEX TIPS (1) Medications
VI.) REVIEW QUESTIONS Medications will be more diluted
VII.) REFERENCES o Important when they can cause irritation (ex. phlebitis)
Multiple medications
I.) WHAT? o Cather has 2 insertion sites
o Some medications are compatible, can be given
Catheters are inserted to a large vein together
Central = close to heart
High volume of medications
(2) Fluids
(1) Biggest veins in our body
o Superior vena cava (SVC) For hemodynamically unstable patients
o Inferior vena cava (INC) High volume at high pressure
o Large veins can handle high pressure better
(i) Insertion to SVC
(3) Nutrition
 Subclavian v.
 Internal jugular v. (IJ) For hemodynamically unstable patients
Until PEG tube (feeding tube) can be placed
(ii) Insertion to IVC TPN = total parenteral nutrition
 Femoral v. (usually done in emergency, change (4) Temporary hemodialysis
after 24h)
For unstable patient
Figure 1: Insertion points for central venous catheters Until surgical graft is healed and can be used

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 III.) NURSING INTERVENTIONS IV.) DISLODGEMENT
Catheter is pulled out fully or partially
Complication: air embolism
o Displaced catheter opens up entry to SVC
o Air embolism might get trapped in right atrium

Figure 3: Complication - dislodgement. What to do?

(1) Call healthcare provider
(2) Occlusive dressing: put to cover hole in SVC
(3) Oxygen: put patient on non-rebreather
Give 100%, Avoid desaturation
(4) Left lateral Trendelenburg (LLT) position
Figure 2: Nursing interventions - how to maintain the catheter
Turn patient onto their left side, so that right atrium is
(1) Line patency
facing upwards and air does not travel further
Check that the line is clear, flowing good, got a good
(5) Monitor vital signs
return
HR, BP, O2,
(i) 10 ml flushes
 Use saline or heparin flushes
(B) EXCEPTION
(ii) Push and pull
 Ensure that there is blood return
o Check if medications that were running through the
(iii) Do NOT pull blood cultures central venous catheter can be administered
 Don’t pull blood cultures from a line that’s already peripherally
placed o If not, check if medications can be safely switched to
 Can lead to false positive results something that’s better peripherally

(iv) Avoid clots

(2) Dressing
Clean
o Clean area with CHG (chlorhexidine) wipes
o 15s scrub: clean both arms of the catheter for 15s
Dry
o Gauze is placed underneath in case of bleeding,
change asap
o Monitor microbial patch
Intact
o Change dressing when lifts occur on side
o Change pressure caps

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 V.) APPENDIX

Figure 4: Central venous catheter - overview

VI.) REVIEW QUESTIONS

1) Where is a central venous catheter usually inserted? 6) How should you deal with the wound caused by the
a) Femoral v. dislodged catheter?
b) Subclavian or internal jugular v. a) Disinfect immediately
c) Directly to superior vena cava b) Put occlusive dressing
d) Directly to inferior vena cava c) Call healthcare provider
2) Why is a central venous catheter preferred to a d) Take vital signs
peripheral one? Choose the wrong answer 7) How do you ensure the patient’s O2 saturation?
a) Administered medications will be more diluted and a) Non-rebreather oxygen mask
don’t cause as many irritations b) Normal oxygen mask
b) Parenteral nutrition can be given c) Intubation
c) Temporary hemodialysis can be performed d) It is maintained naturally, no support needed
d) Blood pressure is monitored

a) To disinfect it
b) To draw blood cultures
c) To clean it and prevent formation of blood clots
d) No reason, only policy
4) Which complication can happen in case of a
dislodged central venous catheter?
a) Pulmonary embolism
b) Fat embolism
c) Air embolism
d) Atherosclerosis
5) How should you position the patient in case of
dislodgement?
a) Supine position
b) Left lateral Trendelenburg
c) Right lateral Trendelenburg
d) Legs up

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