How to Safely Administer through a Central Line and Monitor the Infusion
Central vascular access devices (CVADs) are catheters placed in large, central veins, like the superior or inferior vena cava, for long-term infusions of medications, parenteral nutrition, and chemotherapy drugs. From the moment the doctor or specially trained nurse inserts a central catheter, the IV nurse is responsible for ensuring that the line is patent, free of clots, used for appropriate medications, and protected from bloodstream infections. Use the following guidelines to properly administer through and monitor a central line:
Properly administer medications. When administering medications through central lines, you need to make sure you administer them by using an infusion pump and any recommended filters if needed. Designate specific lumens for incompatible medications.
Change the dressing. You should usually change the dressing every seven days or PRN (as needed), if soiled or coming off, to minimize the risk of bacteria-related central line bloodstream infections. When changing the dressing, clean the insertion site with 2 percent chlorhexidine and cover it with a transparent semipermeable dressing. Chlorhexidine dressings are the dressings of choice for the Infusion Nurses Society (INS), and the Centers for Disease Control and Prevention (CDC) specifically indicates chlorhexidine-impregnated sponge dressings to reduce the incidence of bloodstream infections.
Flush the line to ensure catheter patency. To do so, scrub the hub of the catheter for at least 30 seconds with an appropriate antiseptic and let it dry; then administer at least 10 milliliters (mL) of 0.9 percent sodium chloride solution through the catheter hub. Be sure to flush the line after every medication administration to ensure that the line is clear of medications, to prevent drug incompatibility and to reduce the possibility of infection.
Lock central lines that are used intermittently. Locking refers to infusing heparin or normal saline solution to prevent clots and maintain patency in central lines that are used intermittently (less often) while the CVAD is in.