Patient care

Health care professionals must use caution to prevent life-threatening complications when inserting and maintaining a central line. The subclavian approach to the placement of a central line is preferred, because femoral placements may be complicated by deep venous thrombosis, and internal jugular sites carry an increased risk of infection. Sterile technique is a requirement during insertion. The skin should be prepared with chlorhexidine-gluconate (2%) or povidone-iodine. Ultrasound guidance improves the likelihood of entering the desired vein without injury to neighboring structures. With or without radiological guidance, the best results are obtained by practitioners who perform the procedure frequently. After the catheter is inserted, it should be firmly sewn to the skin to keep it from migrating in and out of the insertion site. An antibiotic impregnated patch covered by a sterile dressing should be placed at the insertion site. The catheter should be manipulated as infrequently as possible during its use. Dressing changes are carried out using sterile technique. IV tubing and solutions and injection caps also should be changed as required by the agency’s protocol. Health care professionals are responsible for preventing, assessing for, and managing central venous therapy complications (e.g., air embolism; cardiac tamponade; chylothorax, hemothorax, hydrothorax, or pneumothorax; local and systemic infections; and thrombosis). Documentation should include preprocedure and postprocedure physical assessment of the patient, catheter type and size, insertion site location, x-ray confirmation of the placement, catheter insertion distance (in centimeters), and the patient’s tolerance of the procedure. Maintenance care procedures also should be fully documented. The site should be carefully inspected for inflammation, and any drainage should be cultured. When catheter-related infections are suspected, the catheter tip provides valuable information about infection sources in cases of sepsis. The tip should be cut off with sterile scissors and dropped directly into a sterile specimen container.