Central Line Care: Special Considerations (Nursing)

00:04 Now let's take a special look at considerations for central line care.

00:09 So some things that can occur when you're talking about dealing with a central line is what we call phlebitis.

00:14 That could be inflammation, irritation, edema of that vein.

00:20 That could mean potentially that we could have an impending central line infection so we need to investigate.

00:26 Now the difference here, when we're talking about a central line infection, as you can imagine, you've got something foreign in your body.

00:33 And many times if someone has a central line, they could be pretty ill.

00:38 Now this puts us at high risk would have in that foreign object in our body with a really serious infection that can spread to other organs of our body and lead to something we call 'sepsis', which can lead to mortality rates.

00:53 The other thing that can occur when you're talking about dealing with a central line, sometimes that line can get occluded to where when we're trying to aspirate blood, it's not working, when you try to flush the line, it also doesn't work.

01:06 Occasionally, we're going to have to address this with a certain type of medication to reopen up that line and the flow.

01:14 Now, a few other things to remember, when you're talking about a central line, we actually don't want to take our blood cultures from here.

01:21 Again, with it being a foreign object in our body, there are some other things that can be setting in that line.

01:27 So we're testing for blood cultures, we're trying to see if there's there's an infection in the blood so we don't want to pull it from a foreign object.

01:35 We want to pull it directly from our patient.

01:39 There's a couple of other things we need to consider as well.

01:43 So make sure in regards to the line occlusion, that we are flushing that regularly.

01:48 This is really important for maintenance of the line.

01:51 So it depends on the line that you're dealing with but usually you're gonna flush with normal saline at least once a shift.

01:58 Many times after blood draws, your facility's policy may say to flush with 20 mls of normal saline.

02:06 So just make sure you're using the right amount and the right method.

02:11 So to keep out infection, remember to double check that central line dressing.

02:15 These can get wet, soiled, the edges can peel back.

02:19 So if that's the case, we need to make sure we replace this.

02:23 And lastly, always assess the need for your line.

02:26 Removing the line early is the best way to reduce central line infection.

02:31 Let's look at a few more important considerations when we're talking about dealing with a central line.

02:36 Now, anytime you're talking about the sampling, make sure that we verify those client labels and they are correct and we apply those to the specimen at the actual clients bedside.

02:49 This will help eliminate any errors that we put the wrong label and we want to make sure that is the right specimen for the right patient.

02:57 Because you can imagine if we put the wrong label that goes to another patient's chart where they're going to be treated off those labs.

03:04 So again, we want to make sure we've got the right label, you're going to label it at the bedside when you collect it and verify that information.

03:13 Now one thing to consider is anytime, I know we're talking about central line blood sampling, but when you go in as a nurse to obtain that sample, you want to make sure that you're diligent to assess that line and that dressing as well.

03:27 So central line dressing should be dated when changed and documented.

03:31 So again, when I go in to look up my central line, maybe obtain a sample, I want to see the last time that dressing was changed because this should occur at least every seven days, or when soiled, or again, check your facility protocol for the best practice and their policy.

03:49 So when collecting your blood samples, just note that the tubes and the amount will vary so make sure you check your physician orders.

03:58 Now you may want to get a specific test that's ordered by the doctor, make sure you verify that you've got the right tube for the right test.

04:06 A lot of times on your unit, there may be a cheat sheet or a chart for that or of course you can always verify with lab.

04:13 Now because we're talking about central lines, as you know, central lines, you have a risk for infection here.

04:20 So keep in mind all of the associated equipment that goes along with maintaining a central line.

04:26 So of course you may have IV tubing or infusions infusing into that central line.

04:31 So you want to ensure that you label and date that IV tubing as well.

04:35 And of course, if we've got IVs in that tubing running into our central line, we need to check about every 72 to 96 hours that we change out that tubing to decrease the risk for infection.

04:48 And again, this is very specific according to your agency's policy.