central venous access devices (CVADs)

Nursing Management of Central Venous Access Devices
1. Use strict aseptic technique when managing central lines to prevent contamination.
2. Inspect the catheter insertion site routinely for redness, edema, warmth, drainage,
tenderness or pain to identify manifestations of infection.
3. Observe the catheter for slippage or misplacement.
4. Assess for any complaints of chest or neck discomfort, arm pain, or pain at the
insertion site.
5. Always use a 10 ml syringe or larger when accessing a central line or PICC line in
order to prevent excessive pressure in the line.
6. Flush each lumen routinely at least once a shift to maintain patency. Most facilities
use 3-5 ml normal saline for central lines but may use 10 ml for PICC lines. Do not
use force when flushing a catheter as this could result in a ruptured catheter or
create an embolism if thrombus is present. Solutions of dilute heparin may be used
after instilling medication into an implanted port if the port is not being used for a
continuous infusion to prevent clotting in the catheter. Heparin used for flushing
would be in concentrations no greater than 100 units/ml. The use of higher
concentrations could result in hemorrhage causing serious injury or death.
7. Use the push-pause method to flush as this causes turbulence in the line, promoting
the removal of debris that adheres to the catheter lumen. This involves injecting the
saline with a rapid alternating push-pause motion, instilling 1 to 2 ml with each push on
the plunger.
8. When accessing the port of a catheter that does not have a Groshong or positive pressure valve
use the following technique in order to prevent an air embolism and prevent blood from
entering the lumen and causing occlusion:
a. Keep the clamp closed in between accessing the port
b. Attach the syringe prior to unclamping the clamp
c. Unclamp the clamp and instill the flush or medication, maintaining positive pressure at the
end of the instillation while re clamping the catheter.
d. Make sure that it is clamped prior to removing the syringe.
9. When using a positive pressure cap, do not use the clamps as this will damage the
valve, allowing air to enter the tubing.