Nurses encounter a variety of central line types during their day-to-day practice. Though RNs are savvy enough to know Hickman, Groshong, and subclavian isn’t the name of a law firm, it never hurts to review and perfect central line technique.

Many hospitals have instituted policies and procedures detailing how nurses should care for every type of central line. While central lines go by numerous names, RNs will find that most central lines (with PICC lines being one notable exception) are tunneled beneath the skin, providing patients with protection against infection.

Aseptic technique is the general principle of care for central lines. When patients emerge from the OR with a central line, gauze typically covers the central line site. The gauze dressing should be used for 24 to 48 hours or until the site stops oozing. After that time, a new dressing that is transparent must be applied so nurses can visualize the puncture site for signs of infection.

Types of IV catheters

Nurses work with venous catheters on a daily basis, with the major categories being peripheral, midline, and central line. Midline catheters are used for therapies with a duration of 7-28 days, while central-line catheters may be used for longer-term therapies that involve irritants. Other types of catheters nurses are likely to encounter include single/multilumen, subclavin/jugular, Groshong/open-ended PICC, venous access ports, Hickman (can be a duo), and Groshong. Midline catheters are not true central lines because the catheter tip reaches only to the axillary region (not the superior vena cava). Midline catheters present the least-expensive means to achieve desired results, and they can be used for up to four weeks. Total parenteral nutrition, however, cannot be administered through a midline catheter.

Dressing changes, flushing

When removing a central line dressing, always gently tug toward the insertion site and not away from it to avoid pulling out the central line. Wear sterile gloves and a mask, and remember to clean the skin with antiseptic and let it dry before applying the transparent dressing. Do not use ointment; ointments can serve as a breeding ground for bacteria. Check your hospital’s policies and procedures to determine the appropriate frequency for dressing changes.

To flush the central line, scrub the cap with antiseptic and let it dry. Always use
a 10-ml-or-larger syringe. The barrel must be large enough to minimize force applied against the central line. Use the “push and pause” technique to flush; this creates more turbulence and is believed to prevent fibrin sheath formation. Check your hospital’s policy and procedure manual to determine the amount of flush to use.

Nurses often wonder if heparin can be used with certain central lines. Once again, consult your hospital’s policy manual and consider the variety of central lines in use at your facility. Certain manufacturers’ end caps used on central lines negate the need for heparin flushes, for example, and help to maintain positive pressure on the line so blood does not back up and clot.

In addition, if a patient’s central line is accessed for administration of antibiotics every six hours, it is wise to have an IV running at a KVO rate to reduce the chance of breaking sterile technique. A KVO rate may not be appropriate for renal and CHF patients who have fluid restrictions, however. Ordinary IV pumps pose no problem, but do not use a high-pressure device on a central line because the line could rupture.