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Care and maintenance of the central venous catheter (CVC).


Set of activities performed by the nurse in front of the patient carrying central venous access.

Objectives:

– Maintain a permeable central access. – Prevent infections.

Equipment:

– Tray / trolley of cures. – Sterile drapes. – Sharps container.

Material:

– Alcoholic disinfectant solution for hands. – 1 pair of sterile gloves. – 1 pair of non-sterile gloves. – Transparent sterile dressings. – Sterile gauze. – Antiseptic solution. – 2 syringes of 5-10cc. – 2 Intravenous needles. – Waste bag. – Diluted sodium heparin (commercial preparation). – Physiological saline solution. – 3 obturators. – Necessary material for fluid therapy. – Nursing records.

Procedure:

– Perform hand hygiene. – Prepare the necessary material. – Preserve the patient’s privacy. – Inform the patient of the procedure to be performed. – Ask for the patient’s cooperation. Catheter maintenance care: – Sterile gloves and sterile field for insertion, dressing changes and puncture site dressing, infusion system changes and perfusion circuit disconnections.

Dressing changes – Place the patient in the appropriate position. – Change the dressing every 48 hours if it is gauze or every 3-4 days for transparent dressings or when it is stained, wet or detached. – Prepare field and sterile material. Puncture site care: – Monitor the puncture site for signs of infection each time it is used and every 24 hours. – Wash the puncture site with sterile gauze soaked in saline from the inside out and disinfect with antiseptic solution. Allow to dry for 2 minutes. – Observe daily for signs and symptoms associated with local or systemic infection. Change infusion systems and connections: – Wrap connections in gauze soaked in antiseptic solution. – Avoid disconnections as much as possible and limit the use of 3-step taps. – Change the system every 48 hours for fluid therapy and every 24 hours for total parenteral nutrition. – When changing the catheter. – Disinfect the connection / obturators with antiseptic solution before and after use. Change the obturators for sterile ones each time they are removed from the catheter. Maintenance of central venous catheter patency: – Flush with 0.9% physiological saline each time it is used and thereafter. – Heparinize with 5 ml of 20 IU/ml each of the lights that are not used every 24 hours and when used intermittently to administer medication and blood products. – Restrict blood withdrawals, if done, wash the lumen after withdrawal. On Hickman catheter: DRESSING CHANGE: – Shower daily, removing dressing or change every 48-72 hours or when soiled or detached. – Clean the area with sterile gauze soaked in saline, from the inside out. – Clean the exit site with povidone iodine and cover with a clean dressing (gauze and hypoallergenic plaster). CATHETER SEALING: To be done every 5 days. – Put on sterile gloves – Clean the obturator with povidone iodine. – Introduce 3-5cc of heparinized solution for each catheter line.

– Before removing the needle from the plug, clamp the catheter to prevent blood reflux and clot formation. – Change the obturator once a month or every 5 punctures. – Dispose of the puncturing material in the container provided for this purpose. – Collect the material. – Leave the patient in a comfortable position. – Remove gloves. – Wash hands. – Record in the nursing documentation: procedure, reason, date and time, incidences and patient’s response.

Observations:

– If resistance is encountered when infusing lavage solution or heparinized solution do not force. – Ensure the immobility of the catheter according to the most comfortable method for the patient. – Extreme asepsis measures.

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