Policy Manual sample

MDT Home Health Care Agency, Inc. CENTRAL VENOUS CATHETER CARE POLICY: Central venous catheters (CVC) will be cared for in a safe and consistent manner. PURPOSE: To provide instruction on the appropriate care and troubleshooting guidelines of central venous catheters in the adult patient. Following Patient’s Physician orders. DEFINITIONS: A. Positive Injection Pressure Technique: Close the slide clamp on the lumen while injecting the final 1cc solution. 1. Single Lumen: Central venous catheter with one lumen. 2. Double Lumen: Central venous catheter with two lumens: a. Proximal 18G white port: for general use. b. Distal 18G red or brown port: for blood draws. 3. Multi-Lumen: Central venous catheter with three lumens. a. Proximal 18G white port: for general use. b. Middle 18G blue port: for general access. c. Distal 16G brown port: for blood drawing, CVP pressure monitoring or general use. GENERAL CONSIDERATIONS: A. Any time a CVC is open to the air, there is a risk of air embolism. If the slide clamp is in the “Off” position, air embolism will be prevented. If the clamp is open, minimize the risk by placing the patient supine, head of bed flat or in trendelenburg position if there are not contraindications. Instruct the patient in breathing techniques and practice them before starting procedures. B. Catheters may be placed in subclavian, internal jugular or femoral vein. C. When using a double or triple lumen CVC, check medication compatibility before initiating infusion due to proximity of infusion ports. Accessing the Line: A. Giving bolus medications, accessing the line for blood draws or accessing for continuous infusions: 1. Close slide clamps before accessing the line, and close when done. 2. To disinfect the injection ports, always remember to perform a 10-15 second friction scrub with alcohol before entering a vascular access device and allow to dry for 30 seconds. 3. Use non-sterile gloves to remove tubing or cap. B. Conversion to Heparin Lock: (Injection cap is changed no more than every 7 days with 10 units/cc depending on how often line will be accessed.) 1. Equipment: positive pressure cap, heparinized saline 10units/ccm two 10ml syringes, normal saline, alcohol swabs. 2. Procedure: a. Wash hands. b. Use the slide clamp to close the lumen(s). c. Prepare syringes with 5ml NS and 5ml of 10units/cc Heparin. d. Clean the junction between the catheter and cap using friction with alcohol and allow to dry for 30 seconds. e. Put on non-sterile gloves. f. Remove the old tubing or cap and apply the new sterile cap. g. Proceed with flush procedure. Home Health Agency Nursing Care & Procedures K-237