STANDARDS:
* Management and care of CVC may be undertaken by Registered Nurses accredited to give intravenous medication.
* A volumetric flow devise must be used when fluids are being administered through any CVC line ( ie. Gemini infusion pump).
* Central Venous Catheter external tubing changes must be preformed every seventy-two (72) hours, or
- if there is damage to the line
- if line contamination occurs.
* Procedure must be carried out under strict asepsis.
* All infusion tubes to be labelled with the time and date of last change.
* Catheters must not be compressed with clamps containing serrated teeth.


OUTCOMES: The patient will experience no infection through contamination of the CVC line during his or her stay in LBH.


EQUIPMENT: Sterile dressing pack two 10 cm x 10 cm sterile gauze packs
new IV administration set ( Gemini) IV solution, as ordered,
Hibitane solution one pair sterile gloves
Infusion Pump Rubbish bin


R : 29.1 PROCEDURE:
* Explain the procedure to the patient prior to procedure.
* Aseptic preparation prior to commencing procedure.
* Prepare dressing pack at bedside prior to positioning patient.
* Hang new IV solution as ordered by Physician, spike new solution bag with new administration set ( protecting distal end from contamination by placing distal end on open dressing pack).
* Prime IV line with appropriate solution ( remove all air from IVline) and clamp administration set with roller clamp.
* On CVC lumen extension (pigtail) being changed, stop infusion pump and clamp IV line, with roller clamp.
* Clamp off line of CVC pigtail being changed with blue slide clamp.
* Place new IV administration set and IV solution into Infusion Pump.
* Position patient in bed on back.
* Thoroughly swab CVC pigtail and IV line being changed 5 cm on both sides of port connection with Hibitane solution from dressing pack.
* Place cleaned CVC pigtail and IV line on sterile towel from dressing pack and allow solution to dry before proceeding to next step.
* Start Infusion Pump and allow fluid to run into sterile field of dressing pack.
* Disconnect cleaned IV line from CVC pigtail which has been cleaned and place on sterile towel.
* Connect new IV line too CVC pigtail and remove blue slide clamp from CVC pigtail.
* Observe for leakage or blood back up from CVC pigtail connection site.
* Label IV administration set with time and date of change.
* Record date and time of next line change on flow chart.
* Note in patients' chart that the lines have been changed and any problems noted during procedure.






Ref: Maki G (1994), Infection Associated with Indwelling Medical Devices , 2nd ed., Chap 8, pg 186-188
R : 29.2
Reviewed February 1996