Central Line Nursing is the insertion, care, and maintenance of Central Line Catheters by trained nurses. Highly skilled nurse specialists typically will place the Central Lines, lines that end in a large vein above or below the heart, and other nurses will be responsible for the care and maintenance of the lines. Some studies have shown that nurse-placed Central Lines lead to better outcomes such as low complication rates and reduced infection rates. Other benefits of Central Line Nursing include better efficiency in Interventional Radiology (IR) and Operating Room (OR) departments, cost savings, and reduced delays of therapy for patients. Central Line Nursing consists of a very small number of specialized trained nurses relative to trained nurses in general.
Central Line Catheter
| CVAD Line
Central Line Catheter, also known as a CVAD Line (Central Venous Access Device Line), can be either a standard or an advanced line that is placed in a vein for access. Vein access points for a standard central line which is a PICC Line, and even for a non-central Midline, are generally in the upper arm and for advanced central lines such as Axillary lines, Internal Jugular lines, or Femoral lines may include the chest, neck, or mid-thigh areas, respectively. To help mitigate infection risk, best practices recommend avoiding the groin or bend areas where bacteria tends to reside and can gain entry.
Regardless of the access point, a Central Line Catheter is a line that ends in a large vein either in the Superior Vena Cava (SVC), that is just above the heart, or the Inferior Vena Cava (IVC), which is just below the heart. Since the endpoint is near the heart, the Central Line Catheter provides more treatment options for medications that are caustic or require longer infusion plans such as IV antibiotics, chemotherapy, and IV nutrition because the medication gets delivered, diluted, and spread through the body quickly. Central line Catheters are available in multiple lumens (i.e., tubing and cap) including single, double, triple, and quad, enabling them to be used for delivering multiple medications separately. Further, certain large bore lines such as Vas Caths for Dialysis provide additional flexibility for specific treatment.
Central Line Catheter placement is usually performed using an Ultrasound as a reliable way to visualize and guide the needle. The Modified Seldinger Technique (MST) is mostly used for correct placement and some Central Line Nurses use needle guides and others use the preferred needle visualization, as this allows more flexibility and agility in difficult cases. Central Line Catheter insertion can be confirmed via Electrocardiogram (ECG) Tip Confirmation technology or X-Ray. When clinically appropriate and available, ECG is more convenient and efficient as it often removes the need to wait for the Xray to be done and evaluated enabling faster therapy.
Central Line Care
| Central Line Care for Nurses
Central Line Care is a very important part of line maintenance to help mitigate the risk of infection and other line complications, which could require the line to be removed before treatment is completed. In such a situation, a new line may need to be placed increasing costs and delaying treatment. Infection risks include Central Line Associated Bloodstream Infections (CLABSIs) which are bloodstream infections via central lines when bacteria from the skin can access the body at the Central Line insertion site. As noted, this is the main reason for avoiding the groin and bend areas.
Central Line Care for Nurses is incorporated in the training on central lines and in nurse training generally, as care and maintenance are usually performed by nurses not trained in the placement of such lines. Central Line Care generally includes the practice of changing the dressing, flushing the catheter with fluids, and changing the cap on the end of the catheter. Central Line Care for Nurses includes specific training on these central lines such as flushing guidelines, troubleshooting clogged or clotted lines, determining and addressing catheter positioning, and assessing symptoms of CLABSIs. Other training includes how to develop and implement the Centers for Disease Control (CDC) recommended Central Line Care Bundles, select products for optimal Central Line Care, and how to reduce accidental pull-outs. This kind of training can be attained from Vascular Access Companies such as Vascular Wellness, and in the case of Vascular Wellness, can be customized to address specific concerns and conditions. Training from a practicing Vascular Access Company tends to be more effective, as many times, the trainers are nurses who place central lines regularly.
Central Line Care at Home
Central Line Care at Home is just as important as in the hospital, skilled nursing facility, infusion center, or other treatment clinics to maintain the catheter. Most facilities will give the patient the necessary supplies and instructions to keep the line in working order and prevent infections. To keep the line sanitary, hands must be thoroughly washed with soap and water before and after touching any part of the catheter or surrounding area.
Central Line Care at Home includes changing the bandage (dressing), flushing the catheter with fluids, and changing the cap on the end of the catheter. Dressing changes are usually performed once per week using sterile techniques. However, a patient must check the dressing daily and change it sooner if the dressing gets dislodged, wet, or soiled. Central Catheter Care also includes not letting the tubing hang freely and the patient refraining from pulling at the tubing or heavy lifting, as that may cause the tubing to migrate out.
Further, Central Line Care requires watching and observing for problems with the catheter. If the catheter is red, tender, or has swelling at the insertion site, it may be infected. If the catheter line is difficult to flush, it may be blocked as sometimes blood can flow back into the tubing and form clots or the line may kink. If the catheter seems to be increasing in length outside the skin, it may be coming out of the vein. Watching for the problems such as these is critical to ensuring the patient is receiving the prescribed therapy as directed.
Vascular Access Experts
| Vascular Wellness
Vascular Wellness is a team consisting of Vascular Access Experts that have elevated the role of nurses in the placement of Central Lines. Clinicians skilled in the insertion and placement of Central Lines have tremendously effective CVAD options when Midlines and PIVs are not clinically indicated. Vascular Wellness specializes in all aspects of vascular access device (VAD) placement including assessment, insertion, maintenance, difficult placements, and possible removal. Vascular Wellness clinicians are W2 employees who complete comprehensive training that can involve placing 50 to 100 lines per procedure type, follow best practices for line placement for vein preservation and to prevent side effects, and utilize the best equipment and supplies from Bard, a leading supplier to hospitals. Vascular Wellness clinicians can place Ultrasound-Guided Extended Dwell PIVs, Midlines, and PICCs, and many clinicians can place advanced devices including Small Bore Central Catheter Lines (such as Internal Jugular Lines and Femoral Lines) and Large Bore Central Catheter Lines (such as Vas Caths for Dialysis and Quad Lumens). Vascular Wellness also provides vascular access training, infection control, and comprehensive administrative support including quality reports and detailed patient records for The Joint Commission surveyors. Vascular Wellness clinicians are Vascular Access Experts.
Learn more about Central Line Nursing here.
Learn more about care and maintenance of PICCs and Midlines
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