To ensure patency of central venous line ports, diluted heparin flushes are used

Q: Which venous access device can be used for less than 6 weeks in clients requiring parenteral nutrition?

Peripherally inserted central catheter (PICC). A PICC catheter is inserted into a vein in your upper arm and threaded into your superior vena cava. The needle port remains outside of your body. PICC can be used when parenteral nutrition is required for less than six weeks.

Q: Which position is best for a patient receiving enteral feedings via gastrostomy tube?

Prior to and after feeds nurses should adequately flush the enteral tube. Position: Lying prone/supine during feeding increases the risk of aspiration and therefore where clinically possible the child should be placed in an upright position.

Q: How would the nurse determine the length of the tube needed to reach the stomach for nasogastric feeding?

Background: Distance from the tip of the nose to earlobe to xiphisternum is commonly used to determine the length of nasogastric tube to be inserted.

Q: Which pH finding would indicate to the nurse that the tube is in the stomach?

Typically, a pH of <6 would indicate an NG tube is in the stomach.

Inhaltsverzeichnis Show

original articlesquality of life and supportive careComparing normal saline versus diluted heparin to lock non-valved totally implantable venous access devices in cancer patients: a randomised, non-inferiority, open trial
Patients and methods
Cited by (0)
What is a central venous catheter?
General guidelines
How to flush the line
Preparing the syringe or cannula
Flushing the line
How to change the cap
When should you call for help?
Where can you learn more?
Which venous access device can be used for less than 6 weeks in clients requiring parenteral nutrition?
Which position is best for a patient receiving enteral feedings via gastrostomy tube?
How would the nurse determine the length of the tube needed to reach the stomach for nasogastric feeding?
Which pH finding would indicate to the nurse that the tube is in the stomach?

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original articlesquality of life and supportive careComparing normal saline versus diluted heparin to lock non-valved totally implantable venous access devices in cancer patients: a randomised, non-inferiority, open trial

Abstract

Background

Heparin has been used for years as a locking solution in totally implantable venous access devices. Normal saline (NS) might be a safe alternative for heparin. However, evidence of non-inferiority of NS versus heparin is lacking.

Patients and methods

We randomly allocated 802 cancer patients with a newly inserted port either to heparin lock (300 U/3 ml) or to NS lock groups in a 1:1 assignment ratio. The primary outcome was the number of functional complications, which was defined as ‘easy injection, impossible aspiration’ at port access. Secondary outcomes included all functional problems and catheter-related bacteraemia. We hypothesised that NS locks do not cause more functional problems and catheter-related bacteraemia than heparin locks. Non-inferiority is established if the upper limit of the confidence interval (CI) for the relative risk of NS versus heparin is <1.4.

Results

Three hundred and eighty-two patients from the NS group and 383 from the heparin lock group were included in the analysis. The incidence rate of our primary outcome (easy injection, impossible aspiration) was 3.70% (95% CI 2.91%–4.69%) and 3.92% (95% CI 3.09%–4.96%) of accesses in the NS and heparin groups, respectively. The relative risk was 0.94% (95% CI 0.67%–1.32%). Catheter-related bloodstream infection was 0.03 per 1000 catheter days in the NS group and 0.10 per 1000 catheter days in the heparin group.

Conclusion

NS is a safe and effective locking solution in implantable ports if combined with a strict protocol for device insertion and maintenance.

Keywords

catheter lock

catheter-related infection

equipment failure

heparin

sodium chloride

Cited by (0)

What is a central venous catheter?

A central venous catheter (CVC) is a thin, flexible tube. It's also called a central line. CVCs are used when you need to receive medicine, fluids, nutrients, or blood products for several weeks or more. The fluids are put through the CVC so that they move quickly into the bloodstream. The line can be used many times, so you are not poked with a needle every time.

A CVC is put through the skin into a vein, often in the neck, chest, arm, or groin. The point where the CVC leaves the skin is called the exit site. Usually about 30 centimetres (12 inches) of the line stays outside of the body. But sometimes the CVC is completely under the skin. The line may have two or three ends so that you can get more than one medicine at a time. These ends are called lumens. The end of each lumen is covered with a cap.

General guidelines

Try to keep the exit site dry. When you shower, cover the site with waterproof material, such as plastic wrap. Be sure you cover both the exit site and the CVC cap(s).
Never touch the open end of the line if the cap is off.
Never use scissors, knives, pins, or other sharp objects near the CVC or other tubing.
If your line has a clamp, keep it clamped when you aren't using it.
Fasten or tape the line to your body to prevent pulling or dangling.
Avoid clothing that rubs or pulls on your CVC.
Avoid bending or crimping your line.
Always wash your hands before you touch your CVC.
Check the CVC every day for signs of infection. These include pain, tenderness, swelling, drainage, pus, redness, or warmth at or near the exit site.

How to flush the line

A central venous catheter must be flushed every day to keep it clear of blood and prevent clotting. If it ends in more than one line (lumen), flush them in the same order each time. Depending on the type of CVC you have, you will flush it with either heparin or saline solution. Your doctor or nurse will probably give you supplies and instructions on how to flush it. A nurse may come to your home to help you at first.

You will usually lie down when you flush the line. This helps prevent air from getting into your vein.

Preparing the syringe or cannula

Be sure you have all your supplies ready. These may include the heparin or saline solution, syringes, needleless injection cannulas, alcohol swabs, and a disposal box. What you need will vary with the type of CVC you have. You may have syringes that are already filled with the solution (preloaded).
Wash your hands with soap and water for 15 to 30 seconds. Dry them with paper towels.
Wipe the stopper of the heparin or saline solution bottle with an alcohol swab for 15 to 30 seconds.
Remove the cover from the syringe, and twist the needle or cannula on to it. (It may already be attached.)
Remove the cover from the needle or cannula. Note: If you have a preloaded syringe, skip to the next section, "Flushing the line."
Pull back the plunger of the syringe, and draw air into the syringe equal to the amount of heparin or saline solution you are using.
Push the needle or cannula through the rubber lid of the solution bottle.
Push the plunger of the syringe to force air into the bottle.
Turn the bottle and syringe upside down. Position the tip of the needle or cannula so that it is below the surface of fluid in the bottle. Pull back the plunger to fill the syringe with the amount of solution you need.
Before you take the needle or cannula out of the bottle, check for air bubbles in liquid in the syringe. If there are bubbles, push the plunger back in and then pull back on it again.
Remove the needle or cannula from the bottle.
Fill other syringes if you need to flush more than one lumen.

Flushing the line

Use an alcohol swab to rub the cap of the lumen you want to flush. Rub for 15 to 30 seconds, and then let the cap dry.
Hold the end of the line so it does not touch anything.
If you have a clamp on the lumen, open it.
Slowly inject heparin, or quickly inject saline solution. If there is resistance, stop. Do not force it. Call your doctor or nurse advice line.
If your CVC has a clamp, clamp the lumen as you are finishing the injection and then remove the syringe. If your CVC has a positive pressure cap, remove the syringe and then clamp the catheter.
Put the syringe in the disposal box.
Repeat the above steps for each lumen you are flushing.
Wash your hands again with soap.

How to change the cap

You need to change the cap on each lumen every 3 to 7 days, or anytime it is leaking, or follow the manufacturer's instructions.

Wash your hands with soap and water for 15 to 30 seconds. Dry them with paper towels.
If there's a clamp on the lumen, be sure it's closed.
Remove the new cap from the package. Loosen, but do not remove, the cover on the end of the new cap.
Hold the lumen with one hand. With your other hand:
- Remove the old cap, and set it aside.
- Remove the cover from the new cap.
- Screw the new cap into place.
Repeat these steps for each lumen.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

You passed out (lost consciousness).
You have severe trouble breathing.
You have sudden chest pain and shortness of breath, or you cough up blood.
You have a fast or uneven pulse.

Call your doctor or nurse advice line now or seek immediate medical care if:

You have signs of infection, such as:
- Increased pain, swelling, warmth, or redness.
- Red streaks leading from the exit site.
- Pus or blood draining from the exit site.
- A fever.
You have a fever over 38°C, or you have chills.
You have swelling in your face, chest, neck, or arm on the side where the central line is.
Your central line is leaking.
You feel resistance when you inject medicine or fluids into your line.
Your central line is out of place. This may happen after severe coughing or vomiting, or if you pull on the central line.

Watch closely for any changes in your health, and be sure to contact your doctor or nurse advice line if:

You have any concerns about your central line.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line (811 in most provinces and territories) if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Where can you learn more?

Go to https://www.healthwise.net/patientEd

Enter N678 in the search box to learn more about "Learning About Your Central Venous Catheter: Flushing the Line and Changing the Cap".

Which venous access device can be used for less than 6 weeks in clients requiring parenteral nutrition?

Peripherally inserted central catheter (PICC). A PICC catheter is inserted into a vein in your upper arm and threaded into your superior vena cava. The needle port remains outside of your body. PICC can be used when parenteral nutrition is required for less than six weeks.

Which position is best for a patient receiving enteral feedings via gastrostomy tube?

Prior to and after feeds nurses should adequately flush the enteral tube. Position: Lying prone/supine during feeding increases the risk of aspiration and therefore where clinically possible the child should be placed in an upright position.