Part of the ICU Devices Hub — browse every related guide in one place.
| Type | Insertion Site | Tip Location | Lumens | Common Uses |
|---|---|---|---|---|
| CVC (Central Venous Catheter) | Internal jugular, subclavian, femoral vein | Superior vena cava (SVC); inferior vena cava (IVC) for femoral | 1–5 | CVP monitoring, vasopressors, TPN, multiple infusions |
| PICC (Peripherally Inserted Central Catheter) | Basilic or cephalic vein in upper arm | SVC/cavoatrial junction | 1–3 | Antibiotics, chemotherapy, TPN; longer duration (up to 1 year) |
| Tunneled CVC (Hickman, Broviac) | Internal jugular or subclavian, tunneled under skin to chest exit site | SVC | 1–3 | Long-term home infusion, chemotherapy, dialysis |
| Implanted Port (Port-a-Cath) | Subcutaneous reservoir with catheter to SVC | SVC | 1–2 | Intermittent chemotherapy, blood draws; accessed with Huber needle |
| Hemodialysis Catheter (Permcath) | Internal jugular or femoral | Right atrium / SVC | 2 (arterial + venous) | Hemodialysis only — do NOT use for other infusions without specific orders |
| PA Catheter (Swan-Ganz) | Internal jugular or subclavian | Pulmonary artery | 4–5 | Hemodynamic monitoring (PAP, PCWP, CO, SVR) |
| Bundle Element | Standard | Nursing Role |
|---|---|---|
| Hand hygiene | Before and after all line access; soap and water or alcohol-based sanitizer | Model compliance; speak up if others skip it; never rush this step |
| Maximal sterile barrier during insertion | Sterile gloves, gown, mask, cap, full-body drape for patient | Gather supplies; maintain sterile field; coach patient to turn head; observe for breaks in technique |
| Chlorhexidine skin antisepsis | 2% chlorhexidine gluconate in 70% isopropyl alcohol (ChloraPrep); scrub 30 seconds, allow to dry 30 seconds | Do not wipe off — allow to dry; if CHG contraindicated (premature infant), use povidone-iodine |
| Optimal catheter site selection | Subclavian preferred over jugular; avoid femoral when possible (highest infection + DVT risk) | Advocate for optimal site; femoral requires extra diligence if used |
| Daily review of line necessity | Remove any line that is no longer clinically necessary | Ask at every patient care round: "Does this patient still need this line?" Document the assessment |
| Scrub the hub / disinfect needleless connectors | Scrub with alcohol for ≥15 seconds before every access; allow to dry | Scrub every port cap before every access — every single time, no exceptions |
| Dressing maintenance | Transparent semipermeable (TSM) dressing changed q7 days or when wet/soiled/loose; gauze dressing changed q48h | Document dressing change date/time on dressing; assess site at every shift |
| Line Type | Flush Volume | Solution | Frequency |
|---|---|---|---|
| CVC (active) | 10 mL NS before and after each use | Normal saline | Before/after each use; q8–12h if not in use |
| PICC (active) | 10 mL NS; use pulsatile flush (push-pause technique) | Normal saline | Before/after each use; q8–12h if not in use |
| Tunneled CVC (not in use) | 10 mL NS + heparin lock | Heparin 10–100 units/mL per facility policy | Weekly or per manufacturer recommendation |
| Implanted Port (accessed) | 10 mL NS; de-access with heparin lock | Heparin 100–500 units/mL for locking | q4 weeks when not in use; use Huber needle only |
| Hemodialysis catheter | NS, then heparin lock per dialysis protocol | High-concentration heparin (1,000–5,000 units/mL) | After each dialysis session; do NOT use for other infusions without specific order |
| Problem | Likely Cause | Nursing Action |
|---|---|---|
| Unable to flush (resistance) | Clot, fibrin sheath, kinked catheter, positional occlusion | Check for kinks; reposition patient/arm (especially PICC); have patient raise arm, turn head, take deep breath; do NOT force; notify provider; may need TPA (alteplase) per protocol |
| Sluggish flow / won't infuse at rate | Partial occlusion, fibrin sheath, catheter position | Assess for kinked tubing; check dressing (not compressing line); reposition; notify provider; document |
| No blood return | Fibrin sheath, malposition, small lumen, valve | Flush first; reposition; if still no blood return, do not use for vesicant medications; notify provider; may need imaging or alteplase |
| Leaking at insertion site | Loose sutures, catheter migration, split catheter | Assess leak source; apply pressure if bleeding; notify provider; do NOT tape over a leaking line and continue use |
| Patient develops fever, chills, rigors after line access | CLABSI — bacteria entering bloodstream through line | Stop all infusions except IV antibiotics; notify provider STAT; obtain blood cultures x2 sets (one from line, one peripheral); expect line removal orders; document all line care events |
| Air embolism (sudden chest pain, dyspnea, "mill-wheel" murmur) | Air entered system during line change or break in system | Position patient LEFT LATERAL DECUBITUS + Trendelenburg immediately (traps air in right ventricle away from pulmonary outflow); 100% O2; notify provider STAT; this is a medical emergency |
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