Short Communication
Year: 2021 | Month: September | Volume: 8 | Issue: 9 | Pages: 252-260
DOI: https://doi.org/10.52403/ijrr.20210935
Role and Responsibility of Nurses in Central Line – Insertion and Maintenance
R. Surendra Naik1, Avadhesh Kumar Yadav2, Rajendra Kumar Sahu3, Ram Niwas Sharma4
1Nursing Officer-A (MHM) (Officer In-Charge Surgical ICU), Mahamana Pandit Madan Mohan Malviya Cancer Centre Varanasi Uttar Pradesh 221005.
2Nursing Officer-B, Officer In Charge (Pediatric and Laser Surgery), Mahamana Pandit Madan Mohan Malviya Cancer Centre Varanasi Uttar Pradesh 221005, (A Unit of Tata Memorial Centre Mumbai, Department of Atomic Energy)
3Nursing Officer-A, M.Sc. (MHN), Mahamana Pandit Madan Mohan Malviya Cancer Centre Varanasi Uttar Pradesh 221005.
4Nursing Officer-B, Officer In Charge, Mahamana Pandit Madan Mohan Malviya Cancer Centre Varanasi Uttar Pradesh 221005, (A Unit of Tata Memorial Centre Mumbai, Department of Atomic Energy)
Corresponding Author: Rajendra Kumar Sahu
ABSTRACT
Introduction -A central venous catheter (CVC) is thin, a flexible tube (catheter) that is placed into a large vein above the Heart. It may be inserted through A vein in the Neck, (internal jugular) chest (subclavian vein. Axillary vein) groin (femoral vein), or through veins in the arms known as a PICC, or peripherally inserted central catheters.
Site- Internal jugular vein, subclavian vein, axillary vein, femoral veins, the best approach or access point for Central line insertion.
Indications - The indications for central venous access are broad and are often situational. Inability to obtain venous access in emergent situations, chemotherapy administration, medications administration (Vasopressors. inotropic administration Total Parental nutrition administration, Hemodynamic monitoring are common indications for CVC insertion.
Contraindication- Local cellulitis, Low platelet count, Local infections, Thrombocytopenia, Congenital anomalies, Trauma are common contraindications of CVC insertion.
Complications - Numerous potential complications can occur during the procedural placement of a central venous catheter, but also as a result of the indwelling equipment. Arrhythmias, Arterial puncture, Pulmonary puncture with or without resultant pneumothorax, Bleeding – hematoma formation, which can obstruct the airway, Tracheal injury, Air emboli during venous puncture or removal of the catheter, Pulmonary embolism, Local cellulitis, Catheter infection, Cardiac tamponade, Intravascular loss of guidewire, Hamo thorax, Phrenic nerve injury, Brachial plexus injury, Cerebral infarct from carotid artery cannulation, Bladder perforation, Bowel perforation, Sterile Thrombophlebitis.
Post-procedural complications: Catheter-related bloodstream infections – bacterial or fungal, Central vein stenosis, Thrombosis, Delayed bleeding with multiple attempts in a coagulopathic patient Clinical
Significance - Ensure that sterile products are not contaminated and that there is no evidence of damage to the packaging. Follow sterile procedures at all times. Central line infections can be a serious and life-threatening illness. Always ensure that the catheter is appropriately placed through one or several methods: radiographic evidence, measurement of CVP, or by analyzing a venous blood gas. Never use excessive force during any part of this procedure. It will lead to damage to local structures.
Nursing Responsibility - After a CVC placement, nurses are responsible for maintaining, monitoring, and utilizing central venous catheters. The assigned nurse must check complications such as infections, hematoma, thrombosis of the catheter, and signs of pneumothorax and bleeding. Nurses are also responsible for ensuring that the site is maintained in a clean and sterile fashion. Daily inspection of the access site and device patency should be performed during nursing rounds. In particular, nursing officers must disinfect injection ports, catheter hubs, and needleless connectors with institutionally approved antiseptics. Intravenous administration sets should be changed regularly per hospital policy. The site should be checked for bleeding, hematoma formation, and signs of cellulitis, which include erythema, purulent drainage, and/or warmth. Dressings should be changed if visibly soiled. This must be performed with proper sterile technique.
Keywords: CVC, Central Line, Central venous catheter.
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