Central Intravenous Therapy

PERIPHERALLY INSERTED CENTRAL CATHETER

CHAPTER 5 Central Intravenous Therapy

"

A prot«h'" , .. o, .... rile

drape;,

ploctd un<ktthe pat","",.-rn.

A .in~ ... """"'>qIIt1 i .. ppli<d 10 the pac;'",', "I'Jl<f .-rn

i"" 1><'-'

the u;l~ ' It ;. ffl'PliN

"th"y

e""",!h 10 panially ^obotrui;,

",:I,''''' "-'

^{but not}

If)

lith' ..

¹⁰ obwuf:1 ""';aI Row. 'The pac;. ... ,hea i.

danVed

^{in •}

drp<ndmt

p".""'"

for opptW., ... ,y 1-2 " " _ A roll ""'y be pIao<d ... the poI>tnI'. UP!'"" arm. 'The pol;' ..

may

be

"",ned

^{to nub.} ~" II>

f..nh« mrou . . ,...,... d, ... _ .

'The VftfU. ... If) d>oI .... ...,..

can

r..I • ~ .. tc ... it1bIc fOf'

oocn&. 'The ,~, ... "'- .... preform! for _ ,""' .... the booili<. modim cubotal. ~ <q!IWoo ~ ... ' .. 'lid .., "'-'~ ift B .. 5·2, S" .. .., ...

II> detcmwoe ...,...,.,. 'hoi

mop

fttl _ _ T _ ... ~I, ....

...odrd" Ahro the ... Ienrd. die ~ it ~k_.

If, .i .. i. R~ ~ theft ;. OIl

<'"'" or_y_.

^{,he h,,,}

""y ""

clipped .. itlo " " ' - J but .:II .... vcd. S ... ,,,,, .... y I=b ift ~

~ """""'" the .opmod cl """""'I ... "

Thr ... ~Iy ~ I r""" IIWII Oft , .... polornt ODd ""'" <10m , ~ ....

""" .... ODd f""" m><k.

A ..mk tirld .. """ ... """ ~u'pm<'" ,1>01 ;, pock«! "<rik is dropped onto "'" ,,<rile !;old. Thi, .... y ;""Iude I*kcu of ,o",e. ~

.. mipo""uble ... mb<aneo. 100mL .yri"!d-ond IICrile.po<k«! ow. of

, ,

, I

FIpr< 5·1 ... _ 1 O l - . (Uoed .. lilt ... ,,01 _ _

w, ....

SE;

IIunoIar

_.u_ ^{-"v, _ "--.} "" ....

St.1..<Ioh: lobby. '_:.M_I

.. I.V. Therapy Demystified

lidoc .... and .a1ioe, Some agenci •• and hoopilal. >lock , . . dy_mode <:en.""

,'eoo,," """" .. tits with all the ~ equipment pa<k..t in.ide!he Slerile_pa<ked kit.

1he "ur>< don. "'" fi", pair of Slerile ~k",.es .00 prepare. !he catheter"" the .. erile field by fluming it vi. a11Ill""'ns willl ... rile >.ali"" (i .•.• 0.9% NS).

1he eXl<n,ion tube. likewi .. are flushed and capped.

A "erile dnpe i. plored

"!>de,

the POI;""", arm.

1he I""i.ot". iden,ifi..J ,..,"",,, or"" ... ite i. "",pared by c!e.".ing it with .Icohol ... bs in • eircular motion from Ill< <:ente, portion of the intended ,""""ss .ite Ott,ward to a total di ... '., of 10 'OChe>. Thi. mu" be

"'1""'00 throe to fi, .. 'i ... Th;, i. foll"""oo by <lnn.ing ,lie .ite .... illl an

"",imicrobial

".,.b

of povidone-iodine solution ",inB the """'" motioo •.

n..

.ite i •• 1I0wed to dry fC4" "' Ie"" 60 >ec<>nd>,'

1he

""""iq"'"

^{i .... applied. the first}

^!"'i'

^{of glc,,,} is remo",d. and • second pair of ,terile glove. is donned,'

TIle !",'ien,',.rm i. dr.ped with •• 1<ril. fOD<,lntoo d'2l"'. leaving on

"""ning 0><' tbe in'ended >CeO . . . ite.

11>< .ite i .... ,tbcti",d with an injertioo of I % lidocaine 0< with derm.1 one>th<ti<

<"''''''.

n.e

",Iected .ite is

"""."sed

^{u.in~ the "} .. he .... , introducer need"" Or.ce

""""'" i. gaiood. the "ylet i •• m'ly pulloo bod until it i. ",,,,,,,-ed.:md the introd"""r i. "h .. need,

n.e

t"",niqUft i • .-.1<..00,

n.e

< .. he .. , is od,,,,,,,,oo ,m'ly over • period of ~_IO} minu .... <beclin~ ..

intermittent in"""..1s by oltcrn ... ly aspir-.ting foI blood retum.oo Hushing with .. line. When the c.theter 11M od,~ h.lf,,'.y. the p"tient 5hoold be .. led to tum hi. 0< her heod to .... rd the r.houlder of the in_ion ,ite. ",,:I the introdocer then i, ",me.oo,

n.e

""minin~ length of the <atheter then is ad....oced. and the guidev.'ire is removed ,1",,'ly,"

Bk .. d i, ooce more "'l'intoo from the <otheter, .00 more ",Ii"" i, Hushed throu~h the 'f"em.

n.e

e"e""ion tube(,) of the oeIup thot i5(...,) primed with .. line are <>pped,

n.e

>i .. either is secured "'ith the m:"lOfac'u",,', PlCC ,tmili"'tion device

0< i. 5Utu.m into ploce, A ,terile dre .. ing i. placed 0"" the >il£ .... h"'h may ioclLJde • sterile gauz.e dres.in~ with. trallSp""'nt .. mipermeable membrane.

Acre .. potU are Hushed with heparinized Hush solution.

CHAPTER 5 Central Intravenous Therapy

"

Tho ... ..Jbm< ol ... ...,. and k""" ol.o<httt< iM<fl<d ..J initial.

at ...

,,-ho .. or1<d "'" PICe . . " ... i~ i", OIl "'" dte<oin;r; IobrL'

c _

pbccmmIo< "",/iod

", "".<hat

^{~"'Y pri<Ir lDi} .... ....,., oll.V. _ . Tho proccdUR is

documrn .... "I'P"'I'ri.,ety

^i~ ,he pol ... ·• 1KOI'd.'

Malnulnlng Venous Acens

PICe a<c:no ilia do _ ... 10 be roIlIed "" ...

_on

Ihrombooic ...

~ .. susponod ... ~ is •

_rre

of

;.fecI-.

If. PlCC ~ ...

11«"".,.

partially">IocIpd. i, sboulel _ be fnd.--ed .• Cau.oe

dra.oI"" "-lei

be ... ,...

~ 48 boo .. and

,,1><, .... ,

they..., Ioo«-ned Of ""ltd.

c;-.., _ " " ...

... ve • ~

>c""""

II ... "'Inn< overlay .... ~ .. if they _

pour.n..u.p

and dwot!"'~48

_ .

^~

... _ .

~....,;-",'u"_ " ..

",tUB< .. i _

pu ..

""'Y

he .~ .. "'f ... y .. ~ 1

doy'''Ion! ..

they "'''''',~ ontaa and _ _ led.

Tho ... ipmrnt . -'0 """"'" • PlCC ... '" i""l ... "'" folkMi""

Mm

One pail ol

"",,,,.,,100 I"""'"

and """ po"

o(""';k ,low>

AkoIooI ... ..,.

P"· ..

idone·iodi,,. .""""

o..,..i",

• 4" 4

"""Ie

^puu and top< or

• Tl2iloparcn' "'m'pt'm<obl~ .... mbranc

Many liW\.fa<1"",r". mm:., "'lI<ly.m .... ~n' .. 1 l. V. I, .. d", .. ing ki ..

,ho,

^lend

,,, i""lud<

.n

the pn:cNin!! '"Wi;" ,n • "'lI<ly.«~,., pock •• e_

Tho fol .... ·i"l! ,1<1" ok«ribe 0

prot"'.'"

thol mi,hl be fol ... to chong • • PlCC d~ .. inl;

Tho nu"", 1horou~ly .nd

"i,,,,,,,,,,y

^"'io<he!. hi, Of he, boM. for at 10""

6Osecon<h.

Tho n".~ 0( the

prot"'.'"

^{i ...}

"I ..

^ned

'0

^the poI"Ri. and any que";"",

.... ~1Ii may hove ... "r«I. Tho poI"nl i, ... ,nlO • oIorul IKUmbelli pooitioo. and ,II< po1itnl', heod is ,"' ... .., ... ~"f.<in' ... y from "'" PICC onocnion " .. .

Tho ,<erik """ipone'" i • ...,. ... '" 0I0eri1e t « h _ and art ... f ...

fut~_.

Tho ... appI;'" "'" nIaoII and"""""';k

Jl<wu.

" I.V. Therapy Demystified

11>< n" ... gen'ly "''''''' .. " ,he dre .. ing. o"",fully lining it from ,be in",nion .;Ie 50 as 001 to di<lodge tt.. c,,"'Ie,.

n.e

;.""rtion .i .. and <.the"" are in,pected fo< .ny evideoce of drifting,

<""'king. infection. Of p/llebiti,.

n.e

nu,,", remo',,,, lhe IlOIISIeriIe glo,-", and doo. the storile glo,-e>.

n.e

.ite i. ole.nsed ,,-ith .Irobol .wab. from ,he <enter of the ;"",nion .it.

ou, .. "2Ill "'ing > <ircular mo<ion. n..lioe ,Ilen i. dean",d willi an .lcohol .".b from the insen,OII ,ite to the end. If .. lIu, . . are

pre"'"'.

,hey ore .1", cleansed with alcohol.

n.e

.kobol i •• I""'ro to dry.

11>< .i,o

,he"

^i. cleansed with povidone_iodine .wID. "'ing (he """'"

tochnOq"" ., describOO previo .... ly fa" cle"".ing

,,'i'"

^{.Icobol .wab •.}

n..

.ite is dr .... d per "S"OC)' Of hospital policy using .itber • lI"uz.e d", .. ing or • lnUI'J>af"n' ><mipe""".ble membrane, If. gouze dre .. ing i. used. the ."... of the d", .. ing must be ",>led rompletoly with tape Of •

tr=parent oemipem .. ,.Me meml>r.me.

n.e

<ble and time lhat the dre .. ing ,",'as ch2ngoo. the gauge .od length of the c.lI>e1 .. i"5ef1..t. and initials of nune ,,'he performed tbe dressing change .... written in ink 011 the dre .. ing label.

11>< procedure i. documented appropriately in tbe patient". record,'

1here are some octivity .nd proceW",1 re>lrictions tIIat patients ... kl be cautioned to adhere to 1""""'" functioo of tbe

Pia::

fC4" the Iooge" time p""ible. Blood pre»<>re reading • .00 ,'enip'lIl<1w<o> ... Id DOt be pcmtined 011 tbe """ that 1= the PICC line. Patients ","51 be c ... tioned DOt to get the Pice dre>.>.ing wet 0< diny.

Dr ... inS' should be ro",,,,d with. prot""ti...., banier ,,'ben patients take ... "" 50 thai they co""", gel wet 01 O!herwisoo ""'t2minated. Activities like"i .. should be

",>Iricted that cook! either d:omage the cadr"', 0< c ... the calbctcr to drift. n..".

include lifting of objects ",.ighing nx>re than 10 poonm ond any orn:,'ities thai migt-.

entail r"p''''lod u .. of the """ 01 thai mighl cau", the el_' to fie> repeatedly.