(4) Cover gauze with tape.

(5) Label dressing with initials and date.

(6) Secure IV tubing with tape to prevent tension

on the center (a stress loop can decrease tension

on the catheter).

F. Care of the Catheter When Not in Use for

Continuous Infusion

Indications

To maintain patency and prevent clotting of the catheter

when the line is used intermittently. Only large-bore catheters (2.5 Fr or larger) may be kept patent by this technique.

PICC lines that are 2 Fr or smaller tend to clot easily if continuous infusions are interrupted.

Equipment

1. 3 mL of heparin–saline solution (10 unit Heparin /mL)

in a 10-mL syringe (follow manufacturer’s guidelines

for syringe sizes)

2. Alcohol wipes

3. Catheter clamps (must have no teeth or be padded), or

use clamp provided on catheter (Fig. 32.10)

4. Clean gloves

5. IV injection cap (needleless is recommended)

Chapter 32 ■ Central Venous Catheterization 207

Technique

1. Converting to a heparin lock

a. Wash hands thoroughly.

b. Don clean or sterile gloves.

c. Prepare sterile work area.

d. Using aseptic technique, open sterile injection cap

package and prefill injection cap with heparinized

saline.

e. Clean the outside of the hub–IV tubing connection

with an antiseptic such as alcohol wipes. Work outward in both directions. Allow to dry.

f. Clamp catheter with padded hemostat, or close

catheter clamp.

g. Holding hub with alcohol swab, disconnect catheter

hub from IV tubing.

h. Connect preflushed injection cap into hub of catheter (gently flushing during connecting can prevent

air from entering catheter).

i. Release clamp and flush line with 1 to 3 mL of heparinized saline (depending on size of catheter).

Fig. 32.13. Occlusive dressing for a central venous

line using presplit gauze. A: Placing split gauze over

the skin entry site. B: Covering split gauze and the

catheter with sterile gauze. Entire dressing is then covered with adhesive tape or clear dressing.

j. Reclamp catheter while plunger of heparin syringe

is depressed to prevent blood from backing into

catheter (positive pressure).

k. Secure catheter and tape to chest or abdomen.

l. Flush catheter with heparinized solution every 6 to

12 hours (per institution policy).

2. Flushing catheters

Equipment is same as for heparin lock.

a. Wash hands thoroughly.

b. Put on gloves and prepare sterile work area.

c. Prepare IV injection cap with antiseptic solution.

Allow to dry.

d. If injection cap is part of a needleless system (recommended), connect flush syringe to cap. If the cap is

not a needleless device, insert needle into IV catheter

plug. Always use a 1-inch or smaller needle. A longer

needle can puncture the catheter.

e. Unclamp catheter and slowly inject 1 to 2 mL of heparinized saline (depending on catheter size). Reclamp

catheter while injecting solution to prevent blood

A

B