Changing needleless connectors and administration sets can sweep this debris into the catheter lumen.Īlthough numerous reports cite the catheter hub as the source of infection, no studies have examined the best method for cleaning the threads. Blood, drug precipitates, and tape residue can accumulate in the luer-lock threads and provide a medium for organisms to grow. Microorganisms can be transferred into the catheter lumen from the luer-lock threads of the catheter hub and from the surface of the needleless connector used for attaching syringes and administration sets. These dressings reduce the risk of catheter colonization, exit-site infections, CRBSI, and costs of care. But in general, never apply alcohol-containing agents directly to a CVAD's external portion unless you know it's acceptable for that brand of catheter.Ĭhlorhexidine also can be applied to the insertion site in the form of a round dressing impregnated with chlorhexidine. Because of this variation, your facility's policies and procedures for cleaning insertion sites should be based on instructions for the specific brands of catheters in use. However, this isn't true of all polyurethane CVADs. The available chlorhexidine products also contain isopropyl alcohol, which can be problematic because some brands of CVADs made of certain types of polyurethane may not tolerate alcohol exposure. 4 Although whether chlorhexidine should be used on nonintact skin is somewhat controversial, clinical evidence points to a lower risk of CRBSI when this antiseptic is used to clean the skin during dressing changes. Chlorhexidine gluconate is the preferred agent for skin preparation at the insertion site. If a catheter tip's intended location is distal to the diaphragm, it's not considered a CVAD. If a CVAD is inserted via the femoral vein, obtain a chest X-ray to confirm placement in the inferior vena cava above the diaphragm. 1īesides tip location, you need to document the CVAD insertion site-most often an upper extremity vein, subclavian vein, or jugular vein. 2 The Infusion Nursing Standards of Practice recommends that all members of the healthcare team collaboratively address CVAD tip location if the superior vena cava isn't used. Guidance documents from the FDA state that the intracardiac tip location isn't recommended. So far, no research has established which site is better however, national standards of practice, Food and Drug Administration (FDA) guidelines, studies, and CVAD manufacturers' instructions recommend placement in the superior vena cava. Others prefer to place it in the right atrium, as it may cause less fibrin formation, but this position also raises the patient's risk of dysrhythmias. Most practitioners prefer to place it in the distal end of the superior vena cava, at or near its junction with the right atrium. 1Įxactly where the CVAD tip should rest is controversial. If the patient has been transferred from another facility with a catheter in place, confirm tip placement with a chest X-ray. Although a written report may take days to appear on the patient's medical record, obtain and document verbal confirmation of the tip's correct anatomic location. If it was inserted in the radiology department, fluoroscopy may be used to confirm tip location.Ī statement from the radiology department that the CVAD is in a good location isn't sufficient. If the CVAD was inserted at the bedside, obtain a chest X-ray. After a CVAD is inserted and before anything is infused through it, verify and document the anatomic location of the CVAD tip.
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