Infusion Therapy – Central Venous Catheter: Temporary Repair of BreakageSECTION: 25.13
Strength of Evidence Level: 3__RN__LPN/LVN__HHA
PURPOSE:
To maintain patency and prevent complications of a damaged central venous catheter (CVC) until permanent repair can be done.
CONSIDERATIONS:
1.Should breakage of CVC occur, notify patient's physician immediately and follow this procedure as indicated.
2.Repair kits are available for most CVCs. Instructions from the manufacturer are included with the kit.
3.It is important during initial teaching to instruct the patient/caregiver ofsteps to be taken should catheter breakage occur. Consult the patient's physician as to what instructions are to be given. An example of the instructions could include:
a.Immediately, clamp catheter between the exit site and the break.
b.Cover the broken area with a sterile 4x4 gauze sponge and tape securely to the chest wall.
c.Notify your homecare nurse immediately and wait for the return call. Keep the phone line clear to facilitate the nurse's call.
- Per Joint Commission recommendations, all tubes and catheters should be labeled to prevent the possibility of tubing misconnections. Staff should emphasize to all patients the importance of contacting a clinical staff member for assistance when there is an identified need to disconnect or reconnect devices.
EQUIPMENT:
Gloves
Alcohol applicator (wipe/swab/disk/ampule)
Antimicrobial applicator (wipe/swab/disk/ampule)
Blunt needle or over the needle catheter without stylet
Repair kit
Non-serrated or smooth clamp
Suture removal kit (used for sterile scissors)
Suture material
Tape
4x4 gauze sponge, sterile (optional)
Heparin solution (100 units/mLor as prescribed)
10mLsyringe with needle or needleless adaptor
Injection port
Puncture-proof container
Impervious trash bag
PROCEDURE:
1.Adhere to Standard Precautions.
2.Explain the procedure and purpose to the patient/caregiver.
3.Assemble the equipment on a clean surface close to the patient.
4.Place patient in comfortable position, ensuring that site is accessible.
5.Ensure adequate lighting.
6.Immediately, clamp the catheter between the exit site and break, closest to the exit site.
7.Procedure should be sterile so prepare equipment and supplies. Don sterile gloves, mask and prepare sterile towels and repair kit supplies.
8.Clean the area of breakage with alcohol applicator using friction. Allow to air-dry. Follow by cleaning with antimicrobial application. Allow to air-dry.
9.Open suture removal kit and using sterile scissors make a clean cut just above the break. Cut off only enough catheter to remove the jagged edges of the break.
10.Insert the sterile blunt needle into the catheter and tape or tie with suture material for security.
11.Attach pre-filled injection port (See Infusion Therapy- Central Venous Catheter: Intermittent InjectionPort Change.) Attempt to heparinize.(See Infusion Therapy- Central Venous Catheter: Flushing/Heparinization.)
12.Instruct patient per physician's orders.
[NOTE:When a blunt needle orover the needle catheter without a stylet is unavailable, follow Steps 1-6.]
13.Cover broken area with a sterile 4x4 gauze sponge and secure to the chest wall with tape.
14.Instruct patient to proceed to emergency room unless other orders have been given.
15.Discard soiled supplies in appropriate containers.
AFTER CARE:
- Document in patient's record:
a.Date, time, procedure and observations.
b.Type and appearance of venous access site.
c.Patient's response to procedure.
d.Instructions given to patient/caregiver.
- Communication with physician.
REFERENCE:
Centers for Disease Control and Prevention (CDC), Guidelines for the Prevention of Intravascular Catheter-Related Infections