AKAL COLLEGE OF NURSING,

BADUSAHIB

PROCEDURE

ON

CARE OF CVP LINE

SUBJECT: - MEDICAL AND SURGICAL NURSING

SUBMITTED TO: - SUBMITTED BY:-

DR. PRIYANKA CHAUDHARY CHANDAN SHARMA

ASSOCIATE PROFESSOR MSC. NURSING 1ST YEAR

ACN, BADUSAHIB ACN, BADUSAHIB

SUBMITTED ON:

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CENTRAL VENOUS CATHETER

DEFINITION

A central venous catheter (CVC), also known as a central line, central venous line, or central
venous access catheter, is a catheter placed into a large vein.

REGULAR SITES

Catheters can be placed in veins,Neck (internal jugular vein),Chest (subcalvin vein or axillary
vein),Groin (femoral vein),Peripherally inserted central catheters.(PICC)

MEDICAL USES

 Administer medication
 Fluids that are unable to be taken by mouth
 Would harm a smaller peripheral lines
 Obtain blood tests
 Measure central venous pressure

INDICATIONS

 Long-term intravenous antibiotics, parenteral nutrition in chronically ill persons

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 Long-term pain medications &Chemotherapy
 Drugs that are prone to cause phlebitis in peripheral veins such as:
 Calcium chloride Chemotherapy
 Hypertonic saline
 Potassium chloride (KCI)
 Frequent blood draws
 Monitoring of the central venous pressure (CVP).

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CONTRAINDICATIONS FOR TUNNELED AND NON- TUNNELED CATHETER

 Local cellulitis
 Low platelet counts
 Local infection
 Avoid in raised intracranial pressure- aim for a femoral approach if required
 Patient non-compliance
 Systemic sepsis is an absolute contraindication for central venous access via tunneled
catheter because it can lead to line infection.

COMPLICATIONS

 Bleeding
 Infection
 Puncture of adjacent structures (such as other veins or arteries)
 Air embolism (air in the veins)
 Collapse of the lung (pneumothorax)
 Bleeding into the chest (hemothorax)
 Catheter breakage (when it is being removed)

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PATIENT EDUCATION :

 Explain the procedure to the patient and family members.

 Explain the need of central line and benefits, risk and complications.

EQUIPMENT REQUIRED FOR CENTRAL LINE (CENTRAL VENOUS

CATHETER) INSERTION

 Sterile trolley( cvp tray )

 Sterile field, gloves, gown and mask
 Central line kit
 Saline flush
 Chlorhexidine
 Lignocaine (4ml (2 vials) of 2% is reasonable)
 Suture
 Scalpel
 Central line fix

SELDINGER TECHNIQUE:

The Seldinger technique, also known as Seldinger wire technique, is a medical procedure to
obtain safe access to blood vessels and other hollow organs.

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PRE-PROCEDURE

 Consent patient if conscious otherwise document why the procedure is in the patient's
best interests.
 Consent should include. Infection, bleeding (arterial puncture, haematoma, haemothorax),
pain,failure,
 Set up sterile trolley.
 Position patient with head down if they can tolerate it, with head facing away from side of
insertion
 This ensures maximum venous filling
 Having a nurse or assistant is helpful.

PROCEDURE FOR CENTRAL LINE (CENTRAL VENOUS

CATHETER) INSERTION

 Wash hands and wear sterile gown and gloves.

 Clean the area and apply sterile field. Make sure to have some spare gauze swabs ready.
 Apply sterile sheath to the ultrasound probe
 Confirm anatomy .
 Under ultrasound guidance insert lignocaine cutaneous, subcutaneously and around
preferred site .
 Ensure caps are available for the lumens.
 Under ultrasound guidance take Seldinger needle attached to syringe and insert into
 the internal jugular vein
 When blood is freely aspirated remove syringe and immediately inset Seldinger wire.

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 This should pass easily.
 Keeping hold of the inserted wire, remove the needle. Ensure the wire stays in the vein as
you do this.

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 Use scalpel to make an small incision in the skin (approx 3mm). This should be done
cutting away from the wire so as not to damage it pass the dilator over the wire and gently
but firmly dilate a tract through to the internal jugular.
 At this stage there may be some bleeding so ensure to have some swabs ready
 Remove the dilator and pass the central line over the Seldinger wire. Do not advance the
line until you have hold of the end of the wire
 Once the central line is in place, remove the wire
 Aspirate and flush all lumens and re clamp and apply lumen caps
 Suture the line.
 Dress with a clear dressing so the insertion point can be clearly seen

DOCUMENTATION

 Patient is educated about the need

 Site assessed and marked

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 All lumens clamped
 Inserted by Physician, assisted by
 Tip position confirmation via fluoroscopy OR chest X-ray • Date and time of insertion,
assess the site for extra bleeding.
 Anatomical location .
 Catheter depth according to catheter reference.

CVP MONITORING

 Central venous pressure (CVP) is the blood pressure in the venae cavae, near the right
atrium of the heart. CVP reflects the amount of blood returning to the Heart and the
ability of the heart to pump the blood back into the arterial system.
 The normal range for CVP is 0 to 5 mm H20

CARE OF CVP LINE : CARE AND MAINTENANCE

 Assessment: - Insertion Site - Catheter Tract - Adjacent Skin

 Site Care: - Skin Disinfectant - Clean, dry, and occlusive dressings
 Dressing Gauze or Transparent Semi-Permeable

PROCEDURE FOR SITE CARE AND DRESSING CHANGE

DURING PROCEDURE

 Remove dressing from VAD insertion site.

 Inspect Site and catheter.
 Disinfect the catheter-skin junction using antiseptic solution 4. Dress access site

AFTER PROCEDURE

 Discard used supplies

 Remove gloves
 Wash hands
 Label new dressing
 Document

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 BIBLIOGRAPHY

BOOK REFERENCES
1. Babu, K. M. Ganesh, B. A. Joshi, and Nisith K. Ray. "Medical Management of
Surgical Appendix." New Indian Journal of Surgery 7, no. 3 (2016): 269–71.
2. Rachel, D. Anita, and A. Subashini. "Vetiver Finish in Surgical Medical
Products." International Journal of Trend in Scientific Research and
Development Volume-3, Issue-1 (December 31, 2018): 1166–69.
3. Inder, Dr Deep, and Dr Pawan Kumar. "Recommendations for Medical and Surgical
Chemoprophylaxis." Indian Journal of Applied Research 2, no. 2 (October 1, 2011):
124–26.
4. Marine, Jeremey, and Jeremey Marine. "Self-Assessment of Medical-Surgical Nurses’
Behavioral Healthcare Competency." Diss., The University of Arizona, 2018.

INTERNET REFERENCES
1. Joshi. A. Care of CVP line; 2024; Available from:
https://www.slideshare.net/slideshow/care-of-cvp-line-pptx/266215790
2. Sona. T. Care of CVP line; 2020; Available from:
https://www.slideshare.net/slideshow/central-venous-catheter-care-a-nursing- skill/
237236227

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