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
  • Heparin flush
  • Spare chlorhexidine dressing kit
  • Emergency Kit:
    • Chlorhexidine wipes or swabs
    • Securement device, if applicable
    • Catheter cap
    • Clean gloves
    • Flushing supplies:
      • Alcohol wipes
      • 10 ml syringes
      • Heparin flush
  • Chlorhexidine catheter dressing kit:
    • Sterile gloves
    • Mask
    • No sting barrier
    • 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
    • Biopatch
    • Extra clamp
Procedure Download
Skill Competency Download

Procedure:

  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 medication administration record
    4. The dose on the medication container matches authorization form 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 their 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. Insert prefilled 10ml normal saline syringe into the center of the cap
    • A smaller syringe may push too much pressure into the catheter and cause it to burst
  14. Unclamp the line
  15. Push the normal saline into the catheter
  16. Clamp the line
  17. Disconnect syringe from injection port after flushing
  18. If medication is to be administered, administer medication per healthcare provider’s orders
    • Insert medication syringe
    • Unclamp line
    • Administer medication per healthcare provider’s orders
    • Clamp line
    • Remove medication syringe
  19. Insert prefilled 10ml normal saline syringe
  20. Unclamp line
  21. Flush with 10ml normal saline
  22. Clamp line
  23. Disconnect syringe from injection port after flushing
  24. Insert prefilled Heparin syringe into the center of the cap
  25. Unclamp line
  26. Administer the Heparin flush to cap each lumen
  27. Clamp the line
  28. Disconnect syringe from injection port after flushing
  29. Discard used supplies in appropriate receptacles
  30. Remove gloves
  31. Wash hands
  32. Assist student in dressing
  33. Document assessment, intervention and outcome in student’s healthcare record
  34. 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
    • 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.  (2021). Central line (tunneled): Care at home. https://www.childrensmn.org/educationmaterials/childrensmn/article/15539/central-line-tunneled-care-at-home/

Children’s Hospitals and Clinics of Minnesota.  (2021).  Peripherally inserted central catheter picc care at home.  Available at: https://www.childrensmn.org/educationmaterials/childrensmn/article/15558/peripherally-inserted-central-catheter-picc-care-at-home/

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 Update Reviewers:

Katie Sullivan, RN
Alyse Selz, RN
Stacy Allen, RN
Allison Grady, APNP, PPNP-BC
Milwaukee Hospital-Children’s Wisconsin

Acknowledgment of Original 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: September 1, 2021
Page last updated: September 1, 2021

The information and materials presented in this Website are intended for informational purposes only and are not designed to diagnose or treat a health problem or disease, or assist in diagnosis or treatment of the same.  The information is not intended to substitute for, supplement or replace clinical judgment.  If there are any concerns or questions about or relating to a nursing or medical procedure, contact the individual’s healthcare provider.  The information provided on this Website is not intended to be a substitute for medical orders and persons without the proper education, training, supervision and/or licensure should not perform the procedures.