Administration of Medication or Flush Through Central Venous Line

<< CARDIOVASCULAR


  • Determine the need for assistance of another person to hold or comfort the student while performing the procedure to ensure that sterile technique is used
  • A single use syringe should never be used more than once (even on the same lumen)

Considerations:

  • Be sure to take steps to ensure student’s privacy when performing procedure
  • Determine the need for assistance of another person to hold or comfort the student while performing the procedure to ensure that sterile technique is used
  • A single use syringe should never be used more than once (even on the same lumen)
  • A 10 ml syringe filled with normal saline should not be divided into several doses and used for multiple lumens
  • Student should have an emergency kit readily available at all times (including field trips)

Supplies:

  • Gloves
  • Student’s healthcare provider’s order
  • 70% isopropyl alcohol pads
  • 10 ml syringes filled with normal saline
  • Vanco-Heparin flush
  • Spare chlorhexidine dressing kit
  • Emergency Kit:
    • Chlorhexidine wipes or swabs
    • Stat lock
    • Catheter cap
    • Clean gloves
    • Flushing supplies:
      • Alcohol wipes
      • 10 ml syringes
      • Vanco-Heparin flush
  • Chlorhexidine catheter dressing kit:
    • Sterile gloves
    • Mask
    • 2% chlorhexidine gluconate in 70% isopropyl alcohol, Povidone iodine swabsticks, or student specific cleaning supplies
    • Alcohol wipes
    • Sterile gauze
    • Transparent occlusive dressing
    • Adhesive tape
    • Hand sanitizer
    • Adhesive remover
    • Extra clamp

procedure download skill competency

  1. Review healthcare provider’s order
  2. Check for authorization forms/record
    1. Medication Administration Form
    2. Medical Provider
    3. Parent/Guardian
  3. Check for the Five Rights
    1. The right student
    2. The correct time
    3. The medicine container matches authorization form and records
    4. The dose on the medication container matches authorization for and records
    5. The medication is in the correct route as identified on medication container, medication authorization forms and medication record
  4. Ensure that the medication has not expired
  5. Gather supplies and place on a clean surface
  6. Explain the procedure to the student at his/her level of understanding
  7. Position student
  8. Wash hands
  9. Put on gloves
  10. Assist student in removing clothing to uncover the dressing
  11. Examine tubing and cap to ensure that all components of the system are compatible and secured, to minimize leaks and breaks in the system
  12. Scrub the access cap for a time of no less than 15 seconds, using 70% isopropyl alcohol (or cleaning agent as prescribed) and vigorous scrubbing
    • Allow access cap to air dry for at least 15 seconds, do not blow or fan
  13. Unclamp the line
  14. Inject prefilled 1oml normal saline syringe into center of the cap
    • A smaller syringe may push too much pressure into the catheter and cause it to burst
  15. Push the normal saline into the catheter
  16. Disconnect syringe from injection port after flushing
  17. If medication is to be administered, administer medication per healthcare provider’s orders
  18. After medication is administered,  flush the line using prefilled 10ml normal saline syringe
  19. Disconnect syringe from injection port after flushing
  20. Insert prefilled Vanco-Heparin syringe into the center of the cap
  21. Administer the Vanco-Heparin flush to cap each lumen
  22. Disconnect syringe from injection port after flushing and then close the clamp
  23. Discard used supplies in appropriate receptacles
  24. Remove gloves
  25. Wash hands
  26. Assist student in dressing
  27. Document assessment, intervention and outcome in student’s healthcare record
  28. Follow up with student’s parents/guardian and healthcare provider as needed

Problems Flushing Line:

If there is trouble flushing the line (inability to flush or sluggish line), the following steps should be taken:

  1. Assess for possible causes of catheter occlusions
  2. Have the student change positions by lifting the arm on the side of the insertion site, turning from side to side, coughing, or other maneuvers to change body/catheter position
    1. If still unable to flush after completing the above steps, contact parents/guardians and healthcare provider

Emergency care:

If the catheter comes out:

  1. Wash hands
  2. Put on gloves
  3. Hold firm pressure over the site for at least 5 minutes
  4. Apply antibacterial ointment and cover it with gauze and tape
  5. Call parents/guardian and student’s healthcare provider

References:

Casey, A.L. & Elliott, T.S.J. (2010).  Prevention of central venous catheter-related infection: update.  British Journal of Nursing,  19,2.

Children’s Hospitals and Clinics of Minnesota.  (2010).  Central Venous Catheter: Care at Home.  Available at:  http://www.childrensmn.org/manuals/pfs/homecare/018325.pdf

Connecticut State Department of Education.  (2012).  Clinical Procedure Guidelines for Connecticut School Nurses.  Available at:  http://www.sde.ct.gov/sde/lib/sde/pdf/publications/clinical_guidelines/clinical_guidelines.pdf

O’Grady, N.P., Alexander, M., Burns, L.A., Dellinger, E.P., Garland, J., Heard, S.O., Lipsett, P.A., Masur, H., Mermel, L.A., Pearson, M.L., Raad, I.I., Randolph, A., Rupp, M.E., Saint, S.  (2011).  Healthcare Infection Control Practices Advisory Committee (HICPAC). Guidelines for the prevention of intravascular catheter-related infections, 2011. Atlanta (GA): Centers for Disease Control and Prevention (CDC), 83,  370

National Institute for Health and Clinical Excellence (NICE). (2012).  Infection. Prevention and control of healthcare-associated infections in primary and community care.  Available at: http://www.nice.org.uk/nicemedia/live/13684/58656/58656.pdf

Nebraska Medical Center. (2012).  Standardizing central venous catheter care: hospital to home. Omaha (NE): The Nebraska Medical Center; 2012. 8 p. 9.

Simmons, S.,  Bryson, C., Porter, S. (2011).  “Scrub the Hub” Cleaning Duration and Reduction in Bacterial Load on Central Venous Catheters.  Critical Care Nursing Quarterly, 34; 1, 31–35.


Acknowledgment of Reviewers:

Meghan Belongia, MSN, APNP, CPNP
Pediatric Hematology/Pediatric Oncology
Children’s Hospital of Wisconsin

Rachel Gallagher, RN, MSN, CPNP, NCSN
Director of Health Services
Milwaukee Public Schools

Renee Harteau, RN
Pediatric Hematology/Pediatric Oncology
Children’s Hospital of Wisconsin

Jill Krueger, RN, BSN
Director/Health Officer
Forest County Health Department


Page last reviewed: December 22, 2015
Page last updated: December 22,2015