Skill 56

Peripherally Inserted Central Catheter Care

The need for safe and convenient intravenous (IV) therapy has led to the development of vascular access devices (VADs) designed for long-term access to the venous or arterial systems. A central vascular access device (CVAD) has a final tip location in the lower third of the superior vena cava and the junction of the right atrium (INS, 2011). For CVADs placed in the femoral region the final tip placement should be in the inferior vena cava above the level of the diaphragm (INS, 2011). CVADs can have single or multiple lumens. The choice of the number of lumens depends on a patient’s condition and prescribed therapy.

Primary complications associated with CVADs are usually related to infections commonly referred to as central line–associated bloodstream infections (CLABSIs) caused by contamination of the catheter from the skin of the patient or poor infection-prevention practices during insertion or care and maintenance (Alexander et al., 2010). The Institute for Healthcare Improvement (IHI, 2011) recently introduced a CLABSI bundle. The IHI Central Line Bundle is a group of evidence-based interventions for patients with intravascular central catheters that, when implemented together, result in better outcomes than when implemented individually (IHI, 2011).

Delegation Considerations

The skill of caring for a CVAD cannot be delegated to nursing assistive personnel (NAP). Delegation to licensed practical nurses (LPNs) varies by state Nurse Practice Act. The nurse instructs the NAP to:

▪ Report the following to the nurse immediately: patient’s dressing becomes damp or soiled, catheter line appears to be pulled out farther than original insertion position, IV line becomes disconnected, patient has a fever, or patient complains of pain at the site.

▪ Help with positioning patient during insertion and care.