Now let's take a special look at
considerations for central line care.
So some things that can occur when you're talking about
dealing with a central line is what we call phlebitis.
That could be inflammation,
irritation, edema of that vein.
That could mean potentially that we could
have an impending central line infection
so we need to investigate.
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.
And many times if someone has a
central line, they could be pretty ill.
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.
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.
Occasionally, we're going to have to address
this with a certain type of medication
to reopen up that line and the flow.
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.
Again, with it being a foreign object
in our body, there are some other things
that can be setting in that line.
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.
We want to pull it directly from our patient.
There's a couple of other things
we need to consider as well.
So make sure in regards to the line occlusion,
that we are flushing that regularly.
This is really important for maintenance of the line.
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.
Many times after blood draws, your facility's policy
may say to flush with 20 mls of normal saline.
So just make sure you're using the
right amount and the right method.
So to keep out infection, remember to
double check that central line dressing.
These can get wet, soiled, the edges can peel back.
So if that's the case, we need
to make sure we replace this.
And lastly, always assess the need for your line.
Removing the line early is the best
way to reduce central line infection.
Let's look at a few more important considerations
when we're talking about dealing with a central line.
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.
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.
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.
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.
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.
So central line dressing should be
dated when changed and documented.
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.
So when collecting your blood samples, just
note that the tubes and the amount will vary
so make sure you check your physician orders.
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.
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.
Now because we're talking about
central lines, as you know,
central lines, you have a risk for infection here.
So keep in mind all of the associated equipment
that goes along with maintaining a central line.
So of course you may have IV tubing or
infusions infusing into that central line.
So you want to ensure that you label
and date that IV tubing as well.
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.
And again, this is very specific
according to your agency's policy.