POST-INSERTION MAINTENANCE

Once a CVC has been placed and the terminal tip position radiologically confirmed in either the superior or inferior vena cave, proper care and maintenance is crucial to preserving the catheter's integrity and patient safety. Catheters and insertion sites are to be assessed daily. This daily assessment should include a visual inspection of the dressing covering the catheter, palpation of the insertion site for tenderness and confirmation of the actual function of the catheter through flushing and aspiration.

During the daily assessment, you should:

• Inspect the insertion site, skin color and condition along the catheter route
• Check the length of the external catheter
• Verify the integrity of the dressing
• Investigate edema, erythema, and drainage or leakage
• Resolve any difficulty with the performance of the catheter
• Verify the infusion rate, pump occlusion alarm setting and quantity of fluid infused each hour
• Check the IV tubing connections, status of solutions hanging and presence of precipitate or color change in the tubing

When flushing:

• Follow the facility's policies and procedures as well as the manufacturer's recommendations for the particular device.
• Ensure flush volume is at least twice the volume capacity of the catheter and add-on devices.
• Use a pulsatile or stop-start method, which may produce greater turbulence, reducing clot formation along the catheter wall.
• Refer to facility policy in regards to heparin flush
• Ensure blood flow from each lumen, if unable to draw blood reconfirm catheter position and order appropriate declotting agent. Occluded lumens increase the risk of catheter related infection and should be declotted or the catheter should be removed.