EP 127: Central Lines in Nursing

Central lines in nursing are any line that is placed into the larger vessels of the heart. Any catheter that is inserted and sitting in the superior or inferior vena cava is considered a central line.

Central Line Insertions

It is an invasive and sterile procedure that requires consent. The pt will be draped and the nurses and physicians will gown up their sterile gowns.

When catheters are placed the patient is lying flat and given a numbing medication called lidocaine and pain medication. Make sure to have some sterile flushes handy in case you need to flush the line.

Your job as a nurse will be to assist the person placing the line which can be an NP, MD, PA, and also monitor vitals. Then the line is being advanced you may see some ectopy on the monitor, this usually happens when the tip of the catheter hits the right atrium (atrial tickle).

If there is some ectopy let the physician know so they can pull back on the catheter. Once placed it is then sutured and anchored in place.

Some common central lines are PowerPICC, Hickman, Broviac, Groshong.

PICC lines

A PICC is a peripherally inserted central catheter.

PICCs are narrow flexible catheters usually inserted through a vein in the peripheral region. It is slid through until the tip reaches a large vessel in the heart called the superior vena cava. They are usually placed in the upper arm [1].

Central lines in nursing can be inserted through:

internal jugular vein
common femoral vein
subclavian veins
basilic vein
brachial vein
cephalic vein

The major benefit to PICCs is that they allow for the administration of drugs that would not be able to be given through a peripheral line. They also give the patients the ability to have a long-term catheter for continuous use, for chemo, hemodialysis, etc…

Uses of Central Lines in Nursing

Central lines can have multiple lumens or be single. The most common ones are a single lumen, double, and triple lumen.

Prolonged IV antibiotic use
Long Term medication infusions
Multiple access was obtained with one line.
TPN, Chemo
Long-term inotropic therapy, vasopressors
Home and sub-acute discharge
Blood draws

Hemodialysis Catheter

Thicker than a PICC and temporarily used for hemodialysis or CRRT. a fistula is preferred over this method. It can be tunneled or temporary and should only be used for dialysis but can be used in emergent situations for medications.

Tunneled vs Non-tunneled Catheters

Tunneled catheters are placed for longer-term use, and many times patients can be sent home with them. These types of catheters are passed under the skin and then fed into a large vein. They also have something called a cuff which facilitates tissue growth to anchor it in place.

Ports

Also used for long-term treatment. It is implanted so that it sits underneath the skin usually in the upper chest. They need occasional flushing but otherwise don’t require much care. It can also be multiple.

Risks and Complications

Central lines are great; they provide critical access during critical times however, there is some risk associated with central lines.

Air Embolism

Rare but can occur during insertion and when giving medications.

Air bubbles enter the bloodstream and can travel to the brain, heart, or lungs causing a MI, stroke, or respiratory failure.

Signs and Symptoms

difficulty breathing or respiratory failure
chest pain or heart failure
muscle or joint pains
stroke
mental status changes, such as confusion or loss of consciousness
low blood pressure
blue skin hue

Infection

Infections leading to sepsis can happen during the insertion period and after if proper maintenance isn’t done [2].

Signs and Symptoms

Fever
Chills
Tachycardia
Fatigue
Hypotension
Redness or swelling on site
Purulent drainage
Elevated WBCs

Phlebitis

Inflammation of the vein where the catheter is inserted.

Signs and Symptoms

Redness, pain, or drainage at the site
Streak formation along the vein

Thrombus Formation

Any catheter that is inserted will be at risk for thrombus formation and then embolism.

Maintenance

After insertion, you will need to get an x-ray to confirm placement. Daily x-rays are not needed unless you are having problems with the catheter. One thing that can happen is catheter malposition, which will be revealed on the x-ray.
A central line can be pulled back if it migrates but should not be pushed further in.
Dressing changes are sterile procedures. Dressings need to be kept dry and changed if wet.
The dressing should be changed per hospital policy, some places change them weekly, and some every 72 hours. Remember that every time you do a dressing change you expose the line to infection, so they should not be done whenever.
Some catheters need to be flushed with heparin.
Keep lumens patent by flushing at least once a shift or keep a KVO going.
Clean lumens with alcohol before using or keep caps on them.
Using a 10 ml syringe generates the proper intra-lumen pressure.
Catheters that have clamps require heparin flushes, if clamps are not present it is a saline-only catheter.
Avoid blood pressure on the side of the line.
Always protect the catheter from tugging.

According to healthypeople.gov the most common HAIs include:

Catheter-associated urinary tract infections
Surgical site infections
Bloodstream infections
Pneumonia
C. diff

CLABSI or Central Line-Associated Bloodstream Infections account for thousands of deaths a year and million of dollars in added costs to the healthcare system.

Know your central lines and click here for more of the episode 👇👇👇

TIMESTAMPS:

0:00 A quick word for the sponsors
0:55 Introduction with the Hosts & Affiliates/Updates
3:09 Central Lines
3:26 Central line insertions
8:03 PICC lines
9:30 Central line uses
11:31 Hemodialysis Catheter
14:13 Tunneled vs non-tunneled catheters
15:22 Ports
22:14 Risks and Complications
22:21 Air embolism
23:56 Infection
26:30 Phlebitis
28:07 Thrombus formation
29:25 Maintenance
37:30 Closing thoughts