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Central Venous Catheters and CVP Monitoring Nursing Competency Presented by: Jonna Bobeck BSN, RN, CEN.

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Presentation on theme: "Central Venous Catheters and CVP Monitoring Nursing Competency Presented by: Jonna Bobeck BSN, RN, CEN."— Presentation transcript:

1 Central Venous Catheters and CVP Monitoring Nursing Competency Presented by: Jonna Bobeck BSN, RN, CEN

2 Objectives Define indications and contraindications Discuss complications Articulate nursing management and care Discuss prevention of intravascular catheter related blood stream infections per CDC

3 Introduction Common modality Typical sites CVC devices

4 Insertion Site Selection Subclavian Internal jugular Femoral

5 Indications Monitoring of the central venous pressure (CVP) Long term medications Parenteral nutrition Caustic medications Dialysis Need for frequent intravenous access

6 General Distorted local anatomy Extremes of weight Vasculitis Prior long-term venous cannulation Prior injection of sclerosis agents Suspected proximal vascular injury Previous radiation therapy Bleeding disorders Anticoagulation or thrombolytic therapy Combative patients Inexperienced, unsupervised physician Subclavian Vein Chest wall deformities Pneumothorax on the contralateral side Chronic obstructive pulmonary disease Jugular Vein Intravenous drug abuse via the jugular system Femoral Vein Need for patient mobility

7 Contraindications for Central Line Subclavian Placement Include? Pneumothorax on contralateral side Pneumothorax on contralateral side Need for normal saline infusion Need for normal saline infusion A patient who requires CVP readings A patient who requires CVP readings The need for frequent blood sampling The need for frequent blood sampling

8 Correct

9 Sorry, Try Again

10 TechniqueAdvantagesDisadvantages Basilic (peripheral puncture) Low incidence of complications Performed under direct visualization Allow large quantities of fluid at a rapid rate. Greater incidence of minor complications Hinders movement of arm Increase difficulty for CVP monitoring Internal jugularGood external landmarks Malposition is rare Nearly a straight course to superior vena cava on right side Useful alternative to cutdown on children <2 years of age Slightly higher of failure compared to subclavian More difficult to secure Possibly higher infection risk than subclavian

11 TechniqueAdvantagesDisadvantages Femoral punctureGood external landmarks. Useful alternative to other supradiaphragmatic approaches in patients with coagulopathies or superior vena trauma. Difficult to secure in ambulatory patients. Generally not reliable for CVP measurement. Potentially a “dirty” site Higher risk of thrombus. SubclavianGood external landmarks. Practical method of inserting a central line in cardiorespiratory arrest Unable to compress bleeding vessels. “Blind” procedure. Should not be attempted in children younger than 2 yr.

12 Anatomy of Internal Jugular

13 Anatomy of Femoral Vein

14 Anatomy of the Subclavian

15 Hand Washing Fingernails Hand hygiene

16 Patient Positioning Jugular access Subclavian access

17 The Central Line Bundle Hand hygiene Maximal barrier precautions Chlorhexadine skin antisepsis Optimal site selection Prompt removal

18 Skin Prep Chlorhexadine side to side scrub x 2 Clip hair, do not shave

19 Maximal Barrier Precautions Strict sterile conditions Maximum Barrier Precautions ▫Full bed drape ▫Sterile Gown ▫Sterile Gloves ▫Surgical mask for anyone with in three 3 feet of insertion site ▫Head cover for anyone with in 3 feet of insertion site

20 Equipment

21 Procedure Wash hands Prepare IV flush Prepare pressure tubing Monitor patient Obtain appropriate equipment degree Trendelenberg Flush ports Obtain CXR

22 Post Procedure CONFIRM placement Distal lumen Adjust scale

23 Documentation Patient and family education Vital signs Hard copy of waveform Catheter location Date and time Nursing interventions Patient tolerance dressing

24 Ports

25 Central Venous Pressure

26 Measuring CVP Gather equipment Plug transducer cable into red port Prepare pressure tubing - Use heparin 1000 units/500 ml

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29 T he central venous waveform seen on the monitor reflects the events of cardiac contraction; the central venous catheter “sees” these slight variations in pressure that occur during the cardiac cycle and transmits them as a characteristic waveform. There are three positive waves (a, c, and v) and two negative waves (x and y), and these correlate with different phases of the cardiac cycle and EKG.

30 CVP Assessment 2-6 mm Hg Elevated CVP Low CVP

31 Port a Cath and PICC Lines Click link to review PRH policy -IV Therapy PolicyIV Therapy Policy

32 Reading CVP Waveforms is Fun!!

33 References Lynne-MChaleWiegard, D., Carlson, K., Initials. (Ed.). (2001). Aacn procedure manual for critical care. United States: Elsevier Saunders. Proehl, J. (Ed.). (2004). Emergency nursing procedures. United States: Elsevier Saunders


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