“CARE OF THE CATHETER

CENTRAL VENOUS”
Definition:

• It is the aseptic technique performed to

keep the catheter insertion site free of
pyrogens.
 Indications
To all patients who have one or more catheters
Aim installed, every 7 days or sooner if the dressing
Reduce the presence of is detached, not intact or the insertion site is
microorganisms found on the moist, with blood, secretion or local
skin as normal bacterial flora. manifestations of infection.
Material and equipment
1. Pasteur cart.
2. Face mask.
3. Sterile gloves.
4. Healing equipment: 7 gauze pads of 10x10 and two of 5x7.5, 3 swabs or alcohol wipes and 1
Kelly clamp.
5. Antiseptic:
- 70% isopropyl alcohol
- povidone iodine 10% or
- 2% chlorhexidine gluconate with 70% isopropyl alcohol.
6. Sterile transparent dressing or oval cut sterile transparent dressing with reinforced edges and
sterile tapes.
7. Solution with purged equipment, extension and 3-way stopcock.
 Technique
• Put on the mask covering your nose and mouth.
• Wash hands with soap and water.
• Prepare and bring materials to patient area.
• Explain the procedure to the patient.

• Place the patient in a recumbent position. za to the opposite side to the

Double-lumen,
cuffed hemodialysis site of
catheter

Catheter
Catheter cuff

Adapt

• Remove the old dressing without touching the catheter or insertion site.
• Remove the dressing by pulling it gently; do not use alcohol to remove it.
• Subsequently, if you use povidone-iodine, perform the cleaning in three stages or one time if it is
chlorhexidine gluconate; Start from the center to the periphery, covering a diameter of 5 to 10 cm.

• Let the antiseptic sit for 2 to 3 minutes.

• Cover the insertion site with a dry gauze, without applying pressure, and remove the excess
antiseptic around it with another gauze or alcohol swab in the case of povidone-iodine.

• In case of very sensitive skin or in elderly or cancer patients, use alcohol-free protective film in
the form of a sterile swab to protect the skin and prevent damage to it. Apply it to the periphery of
the insertion site, respecting the area that was cleaned with the product. antiseptic.
Wait for it to dry and apply the dressing.
• Apply the transparent dressing to secure
the catheter, covering the insertion site,
without stretching it. Avoid leaving bubbles
under the dressing.
• If you use a transparent dressing with
reinforced edges, use the sterile tapes to
better secure the catheter before placing
the dressing on it.
• Place a letterhead with the date and name
• Secure each of the lumens (at the distal
end) independently with transparent
surgical tape to reduce weight and tension
on the dressing and maintain healing for
longer.
of the person who installed it, as well as
the name and date of the person who
performed the healing.
POST-IMPLANTATION SURVEILLANCE:
• Blood pressure monitoring every 2 hours for the first 8 hours.
• Check the insertion area for bruising. If they occur, apply a compressive dressing and local
cold. Frequently monitor the appearance of bleeding.
• Elevate the head of the bed if tolerated by the patient during the first 6 hours.
• Administer prescribed analgesia if required by the patient.
• Sterile cure after 24 hours.
• Review of the status and patency of the catheter lumens and heparinization with a single-
dose commercial preparation. Each lumen must be Heparinized with a different syringe.
• Control and monitoring record.
Insertion Point Care and Dressing Change
• Arrange the necessary material on an auxiliary table.
• Put on sterile gloves
• Remove the dressing
• Change gloves
• Clean with saline starting at the catheter insertion point in a circular manner.
 Next, proceed with the antiseptic in the same way.
• Observe the puncture site every 24 hours
• Use sterile gauze dressing or transparent, semipermeable dressing (which in this case can
be maintained for 7 days) (Recommendation IA).
• Change dressings whenever they are wet, dirty or loose (Recommendation IB)
• Put the date of the changes in a visible place
• Immobilize the catheter again in case it needs to be changed
• Protect recumbent areas with sterile gauze
• Do not wet the catheter with water when cleaning the patient.
• Do not apply antibiotic ointments to the catheter insertion point
Change of fluid management sets and connections.
• Apply sterile measures in fluid management.
• It is recommended to distribute the lights:
-Distal lumen: Preserve for parenteral nutrition.
-Medium light: serum therapy and drugs
-Proximal light: Intermittent medication.
• Change IV systems every 72 hours unless infection is suspected. Label the system with the
date and time it was changed
• Do not keep infusion solutions for more than 24 hours.
• Change Parenteral Nutrition systems 24 hours after the start of Patellar perfusion . the system
with the date and time it was changed
• Change the lipid emulsion systems 24 hours after the start of the infusion. If the solution only
contains glucose or amino acids, they will be changed every 72 hours.
• Check that the blood perfusion is carried out in a period of no more than 4 hours.
• Flush the catheter lumen with saline each time a medication is administered or discontinued
(as long as it is not a vasoactive drug.
• Know the compatibility of the solutions if they are to be administered through the same lumen
of the catheter.
• If any drug is removed, serum should be drawn from the line with a syringe until blood
appears and then flushed with saline to prevent a bolus of the drug from being administered into
the bloodstream.

CATHETER REMOVAL
EXECUTION
• Inform the patient
• Shut off infusions, three-step stops, and catheter lights.
• Hand hygiene according to general recommendations.
• Put on sterile gloves.
• Remove stitch.
• Remove catheter slowly to avoid breakage; If there is resistance, notify the doctor.
• Take into account the possibility of arrhythmias.
• Apply pressure with a gauze pad to the insertion point until the bleeding stops (approximately
five minutes).
• Check that the catheter is intact
• Change gloves for sterile ones to perform the cure.
• Clean the area and apply antiseptic solution.
• Place semi-occlusive dressing.
• Observe the wound every 24 hours and record in the nursing documents: the day of catheter
removal and the daily monitoring of the healing, and if there is an increase in temperature.
• Catheter culture will be done only in case of suspected infection .