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 A central venous catheter, or vascular
access device(VAD), is a long, thin,
flexible tube used to give medications,
fluids, nutrients, or blood products over
a long period of time, usually several
weeks or more. The catheter is inserted
through the skin into a vein often in the
neck or chest. It is threaded through
the vein until it reaches a large vein
near the heart called the superior vena
 To give long term medication treatment
for pain, infection, cancer, or to supply
nutrition. A central venous catheter an
be left in place far longer than an
intravenous catheter IV, which gives
medications into a vein near the skin
 Give medications that affect the heart,
especially if a quick response is wanted
 Measure the blood pressure in the
superior vena cava, which can help
diagnose certain heart problems
 The type of CVC to be placed will depend upon the
type of cancer that you will treat and the therapy you
will most likely need. The catheter can remain for
weeks to months.
If there are signs of infection or catheter problem, call
doctor immediately.
*Redness, tenderness, drainage, warmth or odor
around the site
*Fever of 100.5F(38C)or greater, or chills present.
*Swelling of the face, neck, chest, or arm on the
side where catheter is inserted
*Leakage of blood or fluid at the catheter site or
the cap
*Inability to flush the catheter or resistance to
flushing the catheter
*Displacement or lengthening of the catheter.
 Do not let CVC exit site get wet until it
is well healed. You may shower 72hrs
after the catheter has been inserted.
When you bathe or shower, you must
cover the site with waterproof
material such as plastic wrap taped
over the dressing
 Do not submerge the CVC site or caps
below the level of water in a bath tub
or swimming pool.
 Store CVC supplies in a clean, dry
place such as a shelf in a closet or a
 Always clean your work area with
alcohol and let it dry completely.
 Use only sterile supplies. Open all
packages carefully without touching
the contents. Handle dressing at the
 Never use scissors, pins or sharp
objects near CVC or other tubings
 Remember to wash hands thoroughly
before and after working with the CVC.
 Bleeding caused by inserting the
catheter into the vein.
 Collapsed lung(pneumothorax).The risk
of a collapsed lung varies with the skill
of the person inserting the catheter
and the site of placement. It is most
likely during placement of a catheter in
the chest, although the risk is small
 Infection requiring treatment with
antibiotics or removal of the catheter.
 Blockage or kinking of the catheter.
Regular flushing of the catheter helps
reduce blockage. A kinked catheter
must be repositioned or replaced
 Pain. You may experience at the
point where the catheter enters your
 Shifting of the catheter. A catheter
that has moved out of place can
sometimes be repositioned. If
repositioning does not work, it must
be replaced
Changing the CVC
 The CVC dressing is changed every 5
days if you are using a transparent
dressing. Change it every 48 hrs. if
you are using gauze or dressing.
 A senior/charge nurse will give
specific instructions to you and your
caregiver about the type of dressing
Flushing the Catheter with

 Some CVC’s have separate tubes.

Each tube is called a lumen. Each
lumen of the CVC needs to be
flushed regularly to keep it clear of
backed-up blood. If you have more
than 1 lumen, it is helpful to have
a routine for flushing lumens in the
same order each time. Flush lumen
once a day using 3cc of heparin
solution (100 units/cc) unless
there are different instructions
 1 vial of heparin (100 units/cc) and a
10cc syringe for each catheter lumen
 Needleless injection cannula(unless your
needless system does not need this) for
each catheter lumen
 Alcohol swabs
 Needle/syringe disposal box

1. Wash hands for 15 seconds with

liquid antibacterial soap. Dry hands
thoroughly with paper towels.
2. Gather all supplies
3. Wipe the rubber stopper of the
medicine vial with an alcohol swab
for 5 seconds.
4. Remove the syringe cover. Twist on
the needless injection cannula or
needle, if it is not already attached.
Remove the cover from the
needleless cannula or needle.
5. Draw 3cc of air into the syringe by
pulling back on the plunger.
6. Push the cannula or needle through
the rubber stopper of the vial
7. Push the syringe plunger to discharge
air into the vial.
8. Turn the vial upside down. Be sure the
tip of the cannula or needle is in the
solution. Draw back on the plunger to
draw up 3cc of heparin into the
9. Before removing the cannula or
needle from the vial, check for air
bubbles. To remove air bubbles,gently
push the heparin back into the vial
10. Remove the cannula or needle from
the vial and replace the cap loosely.
Fill other syringes at this time if more
than 1 lumen will be flushed.
11. Replace the needleless cannula, if that
is what you are using.
12. Use the alcohol swab to clean the
injection cap of the lumen to be
flushed. Rub the cap with an alcohol
swab, rubbing vigorously for 5
seconds, and then allow it to dry. Hold
the end of the catheter so it does not
touch anything.
13. Open the clamp of the lumen
14. Remove the cap from the cannula or
needle and insert into the injection
15. Slowly inject the entire amount of
heparin into the lumen of catheter. If
you meet resistance, check to see if
the clamp is closed. If there is still
resistance, check to see if the clamp is
closed. If there is still resistance, do
not flush that lumen. Call the doctor.
16. If you are using a standard cap, clamp
the catheter as you are finishing the
injection. If you are using a positive
pressure cap, remove the syringe and
then clamp the catheter.Then remove
syringe,place needle in disposal box.
17. Repeat all the above steps for each
lumen to be flushed, using a clean
syringe to flush each catheter.
18. Wash hands for 15 seconds with
liquid antibacterial soap.

 It is changed every 5 to 7 days.

 Supplies:
 1 injection cap for each CVC Lumen
• Steps:
1. Set up a clean work surface
2. Gather all the supplies
3. Wash you hands for 15 seconds with
liquid antibacterial soap. Dry hands
4. Make sure the CVC lumens are
5. Remove the new cap from its
package.Loosen, but do not remove
the cover on the end of new cap.
6. While holding the lumen of the CVC
with one hand, use the other hand to:
• Remove old cap
• Remove the cover from the new
• Screw the new cap onto the open
end of the lumen
Sudden chest, neck, Make sure CVC is
shoulder pain, coughing,or clamped
Accidental removal of Apply pressure on exit site
CVC from chest and chest area with gauze.
Call the doctor
Accidental removal of Make sure CVC is
injection cap clamped.Clean outside
lumen with alcohol for at
least 30seconds. Place new
cap securely into the open
end with gauze.Flush
Fever of 100.5F Inform the doctor
Clamp the CC between
Damage to the CVC such the hole.If necessary
as hole or crack pinch, hold ,or fold it over
Difficulty in flushing the Make sure CVC is
catheter unclamped. Change
patient position by letting
pt. cough or take deep
Loose suture at exit site Tape CVC to skin.If you
do not need to flush CVC,
notify doctor.

CVC displaced/longer/a Do not use CVC,tape CVC

cuff visible at exit site/not to your skin if it’s loose.
working Call doctor

 It is the line inserted to the artery of

the patient for invasive blood
pressure monitoring. It is usually
inserted in the radial and brachial
 Verification of the Arterial Line insertion order
from the anesthesiologist.
 The Nurse will prepare the following
instruments and gadgets:
* Gloves
*Cotton Balls
*Arterial Set (Transducer Set with
Cable)with priming solution (NSS 500cc
for injection + 1000 units Heparin)
*Abbocath IV cannula size 18 or ARROW
Arterial Line set g20

*Tuberculin Syringe
*Arterial Hand support or #3
tongue depressors
*Pressure bag
*Bandage Scissors
*Micropore Tape
*Disposal bag (yellow)
 Do hand washing both for the nurse
and the doctors, then wear gloves
 The nurse will then position the hand of
the patient by hyperextending it to
provide maximum exposure
 After the site is chosen, use the the
cotton balls with alcohol to wipe the
site in circular motion from the inner to
outer. Repeat by using different cotton
balls with 70%alcohol if the site is
dirty or as necessary.
 Encourage patient to take deep breath
as the doctor inject lidocaine 2% until
it forms a wheel.
 Verify the pain status as the doctor
inserts the IV cannula.
 When there is an appearance of blood
in the cannula, the nurse will place 4x4
OS below the opening of the cannula.
The doctor will then withdraw the
stylet while advancing the plastic
cannula to the artery.
 The nurse will connect the tip of the
arterial set to the cannula to aspirate
for blood and ensure patency.Flush the
remainder of the blood back to the
artery since the arterial set is
pressurized by pressure bag.
 In case the insertion was unsuccessful,
nurse will pit digital pressure with the
aid of 4x4 OS to the site for 5mins. This
will prevent bulging and hematoma to
the site that was inserted. The doctor
will select another insertion site.
 The nurse will clean the site and place
transparent dressing.
 The nurse will place 3 tongue
depressors on the prone surface of the
hand for support then place the roll
gauze over the entire hand to ensure
that the hand will not bend.
 The doctor and the nurse will confirm
the tracing on the Cardiac Monitor and
compare the reading to NIBP monitor
 The nurse or the doctor will verify the
patient condition and feelings
regarding the arterial line that was
 Dispose all sharps collector and other
disposable materials in the yellow bag
 Document the procedure