Part of the ICU Devices Hub — browse every related guide in one place.
| Device Type | Insertion Site | Duration | Primary Use |
|---|---|---|---|
| Non-tunneled CVC (Central Venous Catheter) | Internal jugular (IJ), subclavian, femoral | Short-term (days to weeks) | Hemodynamic monitoring (CVP), vasopressor/inotrope infusion, rapid volume resuscitation, multi-lumen medication administration, emergent access |
| PICC (Peripherally Inserted Central Catheter) | Basilic, cephalic, or brachial vein → tip at superior vena cava/right atrial junction | Medium-term (weeks to months) | Long-term IV antibiotics, chemotherapy, TPN, medications not compatible with peripheral IV; lower infection risk than non-tunneled CVC at same dwell time |
| Tunneled catheter (Hickman, Broviac, Groshong) | Subclavian or IJ → tunneled under skin to chest exit site | Long-term (months to years) | Long-term chemotherapy, dialysis (Mahurkar), chronic medication infusion; tunnel reduces infection risk significantly; Dacron cuff promotes fibrous ingrowth at skin exit site |
| Implanted port (Port-a-Cath, mediport) | Subclavian or IJ → port reservoir implanted under skin | Long-term (years) | Oncology patients requiring intermittent chemotherapy or blood draws; no external components when not accessed; requires Huber needle for access (standard needles damage the port membrane) |
The CLABSI bundle is a set of evidence-based practices that, when applied together consistently, reduce CLABSI rates by 65–70%. Bundles are effective not because each element alone is transformative, but because their consistent simultaneous application eliminates the multiple failure points that lead to CLABSI.
Hand hygiene before insertion. Maximum sterile barrier precautions: inserter wears cap, mask, sterile gown, and sterile gloves; patient draped with full-body sterile drape. Chlorhexidine gluconate (CHG) skin antisepsis — applied in a back-and-forth scrubbing motion and allowed to dry completely (minimum 30 seconds, ideally 2 minutes). Subclavian or jugular site preferred over femoral (lower infection risk; femoral is highest CLABSI risk). Nurse role: assist the procedure while maintaining sterile field, halt the procedure if sterile technique is broken, ensure the "stop and check" bundle compliance is documented.
Daily necessity review: Every day, the nurse must advocate for removal of central lines that are no longer necessary. The single most effective CLABSI prevention intervention is removal when no longer needed. Ask on every rounding: "Does this patient still need this central line? Can we transition to peripheral IV or PICC?"
Dressing changes: Every 5–7 days for transparent semi-permeable membrane (TSM) dressings, or when the dressing is no longer occlusive, moist, or intact. Every 2 days for gauze dressings. Chlorhexidine-impregnated dressings (Tegaderm CHG) are preferred over standard TSM in facilities where CLABSI rates remain above benchmark. Sterile technique for all dressing changes — sterile gloves, mask, sterile field.
Dressing change procedure: Don non-sterile gloves; remove old dressing carefully (lift edge, stabilize catheter to prevent dislodgement); discard old dressing and non-sterile gloves; inspect insertion site for redness, swelling, purulent drainage, or tenderness; hand hygiene; apply CHG scrub to site for minimum 30 seconds; allow to dry; apply new sterile dressing per facility protocol; secure catheter to prevent tugging; document site assessment and dressing change.
Needleless connector (cap) changes: Change every 72–96 hours per most protocols, or immediately if contaminated or after drawing blood cultures. Scrub the hub with CHG or alcohol pad for 15–30 seconds before every access (scrub-the-hub protocol). Allow to dry before connecting tubing. This single practice — hub scrubbing before every access — is one of the most impactful CLABSI-prevention behaviors.
Blood tubing changes: Change blood administration sets after each unit or every 4 hours. Change other IV tubing every 72–96 hours. Change TPN tubing every 24 hours. Change lipid tubing every 12 hours.
Flushing technique: Flush with 10 mL normal saline before and after each medication administration through a central line. Use a 10 mL or larger syringe — small syringes (1–3 mL) generate excessive pressure and can damage the catheter or cause vessel damage. Flush using a pulsatile (push-pause) technique: push 1 mL, pause, push 1 mL, pause — creates turbulence that better clears the lumen than a smooth flush.
Blood draws from central lines: Discard 5–10 mL of blood (or 2x the dead space volume) before drawing samples; blood samples for coagulation studies discard 10 mL. Flush vigorously after draws. Use the distal lumen for blood draws when possible. Do not use the lumen running TPN for blood draws — fat emulsion interferes with most laboratory assays.
Locking catheters: Catheters not in active use are locked (filled with a solution to maintain patency). Heparin lock or normal saline lock per facility protocol. Groshong valved catheters use saline lock (no heparin needed — valve prevents backflow).
| Complication | Signs | Nursing Action |
|---|---|---|
| CLABSI (infection) | Fever, chills, new onset hypotension without obvious source, purulent drainage at insertion site | Notify provider immediately; blood cultures x2 (one from each lumen, one peripheral); do NOT remove catheter without provider order (culture first); prepare for possible catheter removal per provider decision |
| Catheter occlusion (clot) | Cannot aspirate blood, resistance to flushing, infusion pump "occlusion" alarm | Do NOT force flush; try repositioning the patient (arm position for PICC, head position for CVC); if no resolution, notify provider; alteplase (tPA) catheter-directed thrombolytic per order |
| Air embolism | Sudden onset chest pain, dyspnea, hypotension, "mill wheel" murmur | Immediately place patient in Trendelenburg, LEFT lateral decubitus position (traps air in right ventricle, away from pulmonary outflow tract); high-flow O2; call for emergency team. This is rare but rapidly fatal — prevention is critical: always clamp lines before disconnecting, use Luer-lock connections |
| Catheter dislodgement/migration | Resistance to infusion, inability to aspirate, arm pain or neck pain, swelling at insertion site | Stop infusions; do not flush; notify provider; X-ray to verify catheter tip position |
| Phlebitis/thrombophlebitis (PICC) | Arm redness, warmth, swelling, tenderness along the vein | Notify provider; warm compress; elevation; possible removal; Doppler ultrasound for DVT assessment |
Related guides: Infection precautions | Medication safety | Hemodynamic monitoring | Nursing documentation
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