Central Line Basics for Bedside Nurses

A central line a catheter placed in a large vein in the neck, chest, or groin.  Check out the Wikipedia definition for some good pics and different types of central lines.  Typically, patients who need these are in a critical care environment, but when they get out to the floor, they still will have their line.  They can have anywhere from 1-3 lumens.  You can use them for blood draws, which is phenomenal for the patient and staff, and administer multiple medications simultaneously.

The main complications are a collapsed lung (pneumothorax) , a central line infection (CLASBI), and thrombus formation.

Patient can also have what is called a midline, which is a much shorter catheter that’s inserted in the arm.  Midlines can be inserted by a specially-trained nurse or PA.  It’s basically a big IV, but you care for them and remove them the same way as a central line.  However, certain meds (TPN or vesicant vasoactive drugs) cannot be given through a midline.

NURSEY RESPONSIBILITIES

You need to make sure the dressing is intact.  They are changed every 7 days unless it’s compromised.  If it’s falling off, your patient is at risk for infection.  So, make sure you check and chart the status of the dressing.   When you get report and hear they have a central line, check to see if the dressing is due to be changed.  Now, you don’t want to go changing the dressing every time the antibiotic patch is slightly saturated.  Every time you remove the dressing, you’re exposing that site; which increases your risk for infection.  Check your hospital’s policies and procedures – that will tell you when it is appropriate to change the dressing before it is due.

Another responsibility you have is proper removal.. and if you learn one single thing from my posts, learn this:  never, ever remove a central line with a patient sitting up.  They MUST be lying flat or they can get an air embolism, code, and die before you know it.  And it would be your fault.  Check out this short article about how important this is.  Patients have died from this, as their nurse is removing their central line right before discharge.  Do not make this mistake.  I don’t care what your preceptor says or how they say it’s always been done on your floor.  If you want to protect you and your patient, you will do this!

Make sure the caps are tight.  If one pops off and goes unnoticed, you’ll have a bed full of blood.

Maintain patency of the line.  This means it is to be flushed a regular intervals with saline and typically a heparin flush as well (if clinically appropriate for your patient).   If a port is very difficult to flush or all lumens are completely occluded, call the doctor.  They may give you an order for a tPA/altplase flush to break up the occlusion, if appropriate, so that you can begin to use it again.

Central Line Basics Video