Page 1 of 25 DESCRIPTION/OVERVIEW The purpose of this ...

Applies To: All HSC Hospitals, CRTC, or UNMH 

Component(s): UH 

Responsible Department: ALL 

Title: Venous Access Devices 

Procedure 

Patient Age Group: ( ) N/A ( ) All Ages ( ) Newborns ( X) Pediatric ( X) Adult 

DESCRIPTION/OVERVIEW 

The purpose of this procedure is to standardize care in the insertion and use of venous access 

devices by their appearance, assist in the selection of catheters based on length of therapy, to 

outline the care and maintenance of venous access devices, and provide strategies for 

troubleshooting the venous access device difficulties or complications. 

CROSS REFERENCES 

• EMLA (Eutectic Mixture of Local Anesthetic Cream) 

• Intravenous Therapy 

• Alteplase for Catheter Occlusion 

• Patient Education and Documentation 

• Medication Administration 

• Patient Identification 

• Policy: Tissue Plasminogen Activator (tPA) for Catheter Occlusion 

AREAS OF RESPONSIBILITY 

Patients may have the catheter inserted while in the Emergency Room, in their hospital room, 

Operating Room, Interventional Radiology department, Cancer Research Treatment Center, 

Pediatric Intensive Care Unit, or in the Pediatric Procedure/Treatment Room. Nurses who are 

assigned to work in any of these areas must be familiar with this procedure. 

Interested Registered Nurses will be specifically trained and deemed competent prior to 

initiating the insertion of a Peripherally Inserted Central Catheter (PICC) on adult patients. 

Members of the PICC team may be able to place a PICC in a child over 10 years of age. 

Pediatric Hospitalists and Pediatric Intensivists will be specifically trained and deemed 

competent prior to initiating the insertion of a PICC on pediatric patients. 

PROCEDURE 

1. Determining appropriateness of Long Arm Catheter therapy: 

1.1. See attached competency for insertion procedure. 

1.2. Per EMLA policy: EMLA may be placed after obtaining a physician's order 

and after ensuring that patient has no lidocaine or EMLA allergies. 

1.3. Placement of an infusion catheter requires a physician's order. The order must 

specify the requested tip placement. 

1.4. The Health Unit Clerk notifies the PICC team member. 

1.5. The decision on whether and where to place an infusion catheter and the 

position of its tip must be a collaborative decision. Those involved in the 

_________________________________________________________________________________________________________________ 

Title: Venous Access Device 

Owner: Clinical Education Department 

Effective Date: 07/27/05 

Page 1 of 25

decision are the patient, the patient's family, the physician, and the nurse 

assigned to the Vascular Access Resource Team (VART). Appropriateness of 

the candidate, the prescribed therapy, expected outcomes, as well as the 

potential benefits and risks will be determined. 

1.6. The PICC team member evaluates the patient for the placement of the PICC at 

the bedside. 

1.7. If the PICC team member determines that a PICC cannot be placed at the 

bedside, a physician’s order is required for placement of the PICC in 

Interventional Radiology. 

1.8. A request is sent to Interventional Radiation (IR) for placement of the PICC. 

Scheduling proceeds from the IR. 

2. Qualifications for selection of a VART candidate: 

2.1. Selection Criteria: 

2.1.1. Registered nurse with current New Mexico licensure 

2.1.2. IV module completed. 

2.1.3. Recommended by Unit Director. 

2.1.4. Successful completion of Long Arm Catheter (LAC) training process 

as verified by the University Hospital Education Department 

2.1.4.1. Completion of competency checklist and receipt of form by 

the Education Department. A certificate of completion is 

awarded to the individual. 

2.1.4.2. Successful placement of five long arm catheters in the 

presence of a preceptor during training. 

2.2. Maintaining Qualification: 

2.2.1. Successful placement of 10 LAC per year. 

2.2.2. Participate in annual VART update 

2.2.3. Development of unit in-services and updates. 

2.2.4. Participation in the Performance Improvement Patient Safety 

Committee 

3. Long Arm Catheter Insertion Procedure- Attachment A 

4. Long Arm Catheter Removal Procedure- Attachment B 

5. Long Arm Catheter Length Selection Guidelines- Attachment C 

6. Care Of Pediatric Central Catheters- Attachment D 

7. Venous Access Port Addendum- Attachment E 

8. Care Of Adult Central Catheters- Attachment F 

9. Quick Reference Guide For Venous Access Devices- Attachment G 

10. Care of the VAD in the Post Anesthesia Care Unit- Attachment H 

11. Evaluation 

11.1. After VAD inserted, chest xray required for line placement. This is to be done 

wherever the patient had the catheter inserted. Adult midline PICCs do not require an 

xray prior to use. If PICC inserted in the IR, it is in the correct position and is okay to 

use, no xray is required. A physician’s written order is required for permission to 

infuse fluids. 

11.2. After xray evaluated by physician or radiologist, a written order is required for 

administration of fluids into this line. 

11.3. Ensure the dressing over the catheter is secure. 

_________________________________________________________________________________________________________________ 





12. Patient Education 

12.1. Instruct patient/family regarding the procedure. 

12.2. Instruct patient/family regarding any local anesthetic/sedation needed to 

perform the procedure. 

12.3. Instruct patient/family on care of the catheter after placement. 

13. Discharge Planning 

13.1. Discharge planning begins with the plan to place a VAD. 

13.2 The Discharge Planner Nurse needs to meet with patient/family to order supplies 

and equipment for home use 

13.3. Provide education to patient/family with return demonstration of dressing 

change prior to discharge. 

13.4. Discharge education to include flushing the catheter with heparin, dressing 

changes with end cap changes, and signs and symptoms of infection, line occlusion, 

and line breakage. 

AGE OR DEVELOPMENTAL VARIATIONS 

1. Pediatric patients- see Attachment D, Care of Pediatric Central Catheters 

2. Neonatal patients- see Policy: Venous & Arterial Line Management - SCN 

COMPONENT/AREA/UNIT SPECIFICS 

1. In units using positive pressure devices, do not clamp VAD prior to disconnect. 

2. Behavioral Health 

a. Behavioral Health Inpatient Nurses: 

i. Maintain PICC lines per UH procedure 

ii. May use the PICC line for blood draws per UH procedure 

iii. May NOT administer any medications, other than heparin and saline used for line 

flushes, through the PICC or other VAD. 

KEY DOCUMENTATION 

1. With any VAD, document the following: 

1.1. Type of device and where located 

1.2. Insertion site of catheter or insertion site of needle and the characteristics of the skin 

(i.e. redness, edema, drainage) 

1.3. Number of lumens or ports 

1.4. Type and rate of infusions 

1.5. Date of dressing change or site care 

2. Document complications or problems in the following manner: 

2.1. Thrombus or mechanical phlebitis 

_________________________________________________________________________________________________________________ 





2.2. Device related infection 

2.3. Interventions implemented 

2.4. Date and time that physician was notified 

2.5. Annotate all VART team contacts and consultations in the medical record 

2.6. Assist VART team members in Quality Assurance documentation. 

3. Document all patient/family teaching, patient/family understanding and discharge 

planning in the Multidisciplinary Teaching Form and on nursing flowsheet. 

DEFINITIONS 

Central Venous Catheter (CVC) This is a catheter that is threaded through the internal jugular, 

antecubital, subclavian, or femoral vein usually with the tip resting in the superior vena cava or 

the right atrium of the heart. It is also used to administer fluids or medications. Blood may be 

withdrawn for diagnosis and laboratory analysis. 

Long Arm Catheter (LAC) This is a catheter inserted into a peripheral vein of the upper arm. It 

may be inserted into a central vein. This catheter is inserted by a trained RN, member of the 

VART team or by a physician. Blood may be drawn from any catheter larger than 3 Fr. 

Peripherally Inserted Central Catheter (PICC) Same as LAC. 

Vascular Access Resource Team (VART) This is a specially trained team of individuals who are 

competent with the insertion and removal of a PICC line. There is a course designed to train 

individuals (nurses and doctors) who wish to do this procedure. There is a yearly competency to 

check the skill level of these individuals. 

Venous Access Device (VAD) This is a central line that is placed in a patient under sterile 

conditions of an operating room or interventional radiology. It can be tunneled through the skin 

into the central venous circulation (broviac, groshong, or hohn) or placed in a pocket of skin on 

the chest (infusaport) or arm (PASport), into the central venous circulation. 

SUMMARY OF CHANGES 

1. This was changed from a policy to a procedure and placed into the new format. 

2. Any wording that included the use of betadine as the antiseptic skin cleanser was changed 

to the wording of chlorhexidine. 

3. Policy cross-references were increased to be more inclusion of current practices. 

4. A statement addressing location of patient when the venous access device was inserted 

was added. 

5. References were updated. 

6. Within the Attachment D: Care of the Pediatric Central Catheter, changes were made to 

catheter access, irrigations, frequency of dressing and needle less access cap changes, and 

whom to call with a central line break. 

7. The procedure for accessing an infusaport (portacath) has been added. 

8. Information regarding caring for a patient in the Post Anesthesia Care 

Unit (PACU) when the vascular access device was placed in the Operating Room was 

added. 

_________________________________________________________________________________________________________________ 





KEY WORDS 

Broviac Catheter, Central Venous Catheter, Device, Groshong Catheter, Hickman Catheter, 

Hohn Catheter, Infusaport, Long Arm Catheter, PasPort, Peripherally Inserted Central Catheter, 

PortaCath, Sub-Clavian Catheter, Vascular Access Resource Team, Venous Access Device, 

Venous Access Port 

PROFESSIONAL REFERENCES 

(Indicate if reference is R = Research; NS - National Standard; 

or L = Literature) 

NS: Center for Disease Control. (2002). Guidelines for the Prevention of Intravascular Catheter- 

Related Infections. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5110a1.htm 

R: Chalyakunapruk, N., Veenstra, D., Lipsky, B., & Saint, S. (2002). Chlorhexidine compared 

with Povidone-Iodine solution for vascular catheter-site care; A meta-analysis. Annals of Internal 

Medicine, 136 (11). Pp792-801. 

L. Dougherty, L. (2000). Central venous access devices. Nursing Standard, 14(43), pp. 45-50, 

54-55. 

L: Perry, A. & Potter, P. (2004). Inserting a peripherally inserted central catheter. In Clincal 

Nursing Skills and Techniques, 5 th Ed. pp. 577-582. 

L: Taketomo, C., Hodding, J., & Kraus, D. (2003). Lexi-Comp’s Pediatric Dosage Handbook, 

10 th Ed., p. 558-561. 

RESOURCES/TRAINING 

Training programs, classes, HSC offices, other University or HSC documentation, telephone numbers, and other 

sources of help completing forms or carrying out procedures. 

_________________________________________________________________________________________________________________ 





Resource/Dept 

Sheena Ferguson, RN, MSN, CNS, 

Clinical Education, Interim Chief 

Nursing Officer 

Jo Anne Wright, RN, MSN, CNS 

Pediatrics 

Internet/Link 

DOCUMENT APPROVAL & TRACKING 

Item Contact Date Approval 

Owner 

Clinical Education Department 

Jo Anne Wright, RN, MSN, CNS, Pediatric Specialty Care Unit 

Sherman Henderson, RN, BSN, PICC/Conscious Sedation Team 

Rebecca Mc Kernan, RN, MSN, APN, Pediatric ENT 

Consultant(s) 

Ninon Adams, RN, Pediatric General Surgery 

Cathy Chavez, RN, BSN, Pediatric Oncology, Research Nurse 

Shirley Mc Graw, RN, BSN, MBA, Unit Director, PACU 

Committee(s) 

NCOC Policy and Procedure Subcommittee 

Nursing Clinical Operations Council 

Nursing Officer Sheena Ferguson, Interim Chief Nursing Officer Y 

Medical Director/Officer 

NA 

Human Resources 

NA 

Finance 

NA 

Legal 

NA 

Official Approver Sheena Ferguson, Interim Chief Nursing Officer Y 

Official Signature 

2 nd Approver (Optional) 

Signature 

Effective Date 07/27/05 

Origination Date 08/2002 

Issue Date Clinical Operations Policy Coordinator 07/27/05 

Y 

ATTACHMENTS 

Attachment A: Long Arm Catheter (LAC) Insertion 

Attachment B: Removal of a Long Arm Catheter (LAC) 

Attachment C: Long Arm Catheter Length Selection 

Attachment D: Care of the Pediatric Central Catheters 

Attachment E: Venous Access Port Addendum 

Attachment F: Care of the Adult Central Catheters 

Attachment G: Quick Reference for VADs 

Attachment H: Care for the VAD in the Post Anesthesia Care Unit (PACU) 

_________________________________________________________________________________________________________________ 





ATTACHMENT A: 

LONG ARM CATHETER (LAC) INSERTION 

1. The LAC qualified Registered Nurse collaborates with the physician to identify patients who 

may benefit from LAC placement. 

2. A physician's order is secured indicating the desired placement of the catheter tip. 

3. The patient and/or family is provided with information as to the indications, risks, benefits, 

and care that a LAC placement entails, as well as, the possibility that placement may not be 

successful. 

4. Assessment of the veins is completed with the identification of the basilic, median 

antecubital, and cephalic veins. The brachial artery is also palpated. The decision to proceed 

is made if the patient is a candidate and if informed written consent is obtained. A consent 

form is not required with a midline placement. 

5. The patient is assessed for medical conditions or medications that may be a contraindication 

for LAC placement. Examples: sepsis, A-V fistulas, Coumadin, uncontrolled hypertension. 

Any concerns that the RN may have with regard to potential contraindications must be 

brought to the attention of the physician. 

6. Medication allergies must be checked. EMLA may be placed per policy and procedure. If 

an allergy to EMLA or Lidocaine exists, consult with the patient's nurse for alternative 

medications per physician's orders. 0.9% Sodium Chloride (NaCl) may be used as the 

preservative acts as an anesthetic. 

7. Place the patient in a recumbent position to facilitate venous filling of the dependent 

extremity. A three-minute scrub from hands to elbow area is done. 

8. The RN measures the patient for the desired length of the catheter using the non-sterile tape 

measure with the patient's arm at a ninety-degree angle from the body. 

9. The RN also measures the upper arm circumference midway between the shoulder and the 

elbow. 

10. The RN dons personal protective equipment to include hat, mask, sterile gloves, and a yellow 

gown in setting up the LAC field with the contents of the tray and other necessary supplies. 

The patient should wear a mask, but may be omitted if the patient is unable to tolerate it. 

11. The skin is prepped using chlorhexidine swabsticks using a scrubbing motion back and forth. 

Allow the chlorhexidine to dry. 

12. Depending on which kit is utilized; two or three drapes are placed for maximal protection of 

the field and to allow the catheter to uncurl. Take the second tape measure (sterile) from the 

tray and position it in such a way that the catheter may be straightened onto it using the 

_________________________________________________________________________________________________________________ 





forceps for the tip. Your gloved hand may be used to hold the catheter hub while placing it 

on one end of the tape measure. Do NOT touch the catheter with your gloves as the powder 

from the gloves may precipitate a sterile phlebitis. 

13. Draw up ten to twenty milliliters of 0.9% NaCl. Flush the catheter before adjusting the 

guide-wire. Examine the catheter for any perforations other than at the tip. Withdraw the 

guide-wire to the length of the catheter plus one additional inch or two additional 

centimeters. At the same time, pull the wire down at a firm angle against the hub. This will 

cause the wire to curl for easier manipulation. 

14. The catheter insertion technique is per the manufacturer recommendations (see LAC Tray 

insert). The catheter is trimmed straight across. Do not cut the guide-wire. Under NO 

circumstances should a damaged guide-wire be used. If the guide-wire is damaged, discard 

the catheter/guide-wire unit. 

15. Discard gloves and apply the tourniquet. Don a new pair of sterile gloves. Apply the 4X4 

gauze over the tourniquet end to allow the nurse to release the tourniquet as needed in a 

sterile manner. 

16. Perform the veni-puncture with the needle/introducer unit at a shallow angle (approximately 

twenty degrees). Note that the tip of the needle may be in the vein while the shorter 

introducer is not. At this point, if the needle is removed or if the cannula is pushed forward, 

the cannula will be positioned outside the vein. After obtaining a blood return, lower the 

angle of the needle/introducer unit making it more parallel to the vein. Advance the unit 1/4 

to 1/2 inch into the vein and then advance the introducer while holding the needle in position. 

The tourniquet may be released at this point and the needle safely withdrawn and placed in 

the tray. In some patients, it may be necessary to maintain the tourniquet until the catheter 

has been advanced several inches. 

17. Using the forceps, grasp the catheter approximately one centimeter from the catheter tip. 

Advance it in small sections through the introducer. Work quickly to minimize blood loss. 

Do not force the catheter if resistance is met as this could result in vein or catheter damage. 

18. If central placement is desired, have the patient turn his head away from the nurse and tuck 

the chin to the chest. This will assist the catheter to move into the proper position. 

19. When three inches of the catheter remains exposed, withdraw the introducer using the 

breakaway technique. Take great care to avoid splitting the introducer while still in the vein. 

Advance the catheter to leave one to two centimeters exposed. 

20. Withdraw the guide-wire with one hand using a gentle pulling action while stabilizing the 

hub with the other hand. Wrapping the guide-wire around a finger will provide steady 

tension. 

21. Aspirate for a blood return then flush with twenty milliliters of 0.9% NaCl. Follow-up with 

the 100 units/milliliter Heparin flush. 

_________________________________________________________________________________________________________________ 





22. Clean and apply a dressing to the site allowing the chlorhexidine to dry. Use a single layer of 

a folded 2X2 as a wick. Do NOT cover the insertion site. Prep the skin with the pledgett 

provided. Cover with the occlusive dressing. The butterfly strips are difficult to remove. 

Preferably, use hypafix tape above and below the catheter to insure an occlusive dressing. 

Do not allow extension connectors to hang unsecured. 

23. Dispose of all sharps properly and in accordance with appropriate hospital policy. 

24. Assess the patient for untoward reactions or complications. Have the physician order a chest 

x-ray for mid-clavicular and central placements. Notify the physician when the x-ray is 

completed. The catheter can only be used after receiving a written order from the physician 

or the PICC team member has received the order from the Radiologist. 

25. If the PICC is placed in Interventional Radiology, no chest x-ray is needed, as this was 

placed in the correct position. Doctor order stating, “PICC may be used” must be written. 

26. Document the following in the progress notes: 

- date and time of procedure 

- catheter brand and size (also document in patient Kardex) 

- lot number 

- patient allergies 

- skin prep 

- local anesthetic if used 

- use of sterile procedure and inserter cover 

- measurement of upper arm circumference 

- total length of catheter after trimming (also document in patient Kardex) 

- length of catheter exposed (also document in patient Kardex) 

- insertion site and vein used 

- number of insertion attempts 

- quality of bloodflow and if it is non-pulsatile 

- estimated catheter tip location 

- procedural complications 

- patient response to procedure 

- patient/family teaching 

- completion of patient booklet 

- retain LAC tray insert and attach cut catheter for chart 

- document disposal of all sharps 

I.e. 10/31/01 Midline, 4 Fr., 20 cm length, 2 cm exposed 

_________________________________________________________________________________________________________________ 





ATTACHMENT B: REMOVAL OF A LONG ARM CATHETER (LAC) 

1. LAC's are removed by a LAC-qualified Registered Nurse when the patient no longer requires 

the catheter, the duration of recommended use is met, or a complication occurs. A 

physician's order must be obtained to remove a LAC. 

2. Explain the procedure to the patient/family. 

3. Wash hands and don clean gloves. 

4. Soak hypafix tape and dressing edges with alcohol to loosen dressing. Remove the dressing 

after it is loosened. Cleanse the site with chlorhexidine swabsticks to remove debris and skin 

prep. 

5. Remove the catheter with a steady, gentle, hand-over-hand technique. Withdraw catheter 

approximately four inches at a time. Avoid rapid, jerky movements as they may cause 

venospasm. Note the length at which the catheter is cut. Prepare catheter tip for culture in 

the event that a culture is required. 

6. If resistance is met, do not tug or pull forcefully. Excessive tension may rupture the catheter. 

Attempt to remedy this eventuality by applying warm, moist heat to the upper arm for fifteen 

to twenty minutes. In the meantime, secure the catheter with tape in an extended position. If 

venospasm is the suspected cause, an extended period of warm packs or straightened tape 

tension may be required. 

7. Apply pressure to the site until bleeding stops. Affix a dressing until signs of healing (scab) 

occurs. 

Document all interventions utilized, the catheter length removed, complications, patient 

toleration of procedure, and whether or not the tip was sent for culture. 

_________________________________________________________________________________________________________________ 





ATTACHMENT C: LONG ARM CATHETER LENGTH SELECTION 

CATHETER TIP 

LOCATION 

MIDLINE 

DEEP BASILIC 

MID- 

CLAVICULAR 

PROXIMAL 

AXILLARY OR 

DISTAL SUB-CLAVIAN 

CENTRAL 

SUPERIOR VENA 

CAVA 

LENGTH 8 INCHES or 20 

CENTIMETERS 

DURATION 

TWO to FOUR 

WEEKS 

15-19 INCHES or 

38-48 

CENTIMETERS 

TWO to FOUR 

MONTHS 

24 INCHES or 60 

CENTIMETERS 

UP TO ONE YEAR 

MEDS 

MANY 

ANTIBIOTICS 

ANTIBIOTICS 

CHEMO-THERAPY 

DEXTROSE < OR = TO 10% PPN TPN 

WRITTEN 

CONSENT 

REQUIRED 

NO YES YES 

PHYSICIAN'S 

YES YES YES 

ORDER 

REQUIRED 

X-RAY REQUIRED NO YES YES 

_________________________________________________________________________________________________________________ 





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ATTACHMENT D: CARE OF PEDIATRIC CENTRAL CATHETERS 

Type of Line CVC Catheter Broviac Catheter Groshong Catheter Venous Access Ports Peripherally Inserted 

Central Catheter (PICC) 

Appearance of Catheter 

Double Lumen CVC is 

white and has 2 lumens 

and 2 ports labeled distal 

and proximal on the 

catheter. 

Site is in the subclavian, 

femoral, or jugular vein. 

Broviac: Catheters are 

white and are either single 

or double lumen. The 

double lumen lines have 2 

ports: red and white 

Exit Site: is usually upper 

or mid-chest area. 

Toddlers may have exit 

site in the back. 

A dacron cuff and vita 

cuff is on the catheter but 

are not visible after 

placement. The dacron 

cuff is on the catheter just 

under the skin near the 

exit site. Its acts as an 

anchor holding the line in 

place and as an infection 

barrier. The vita cuff 

(made of silver iodide) is 

proximal to the dacron 

cuff. It dissolves in about 

3 weeks, and helps 

prevent infection in the 

newly placed line. 

Groshong: Catheter is 

clear with a blue stripe. It 

can be either single or 

double lumen. Double 

lumen lines have 2 ports: 

red and blue. 

Exit Site: is usually upper 

or mid-chest area. 

A dacron cuff and vita 

cuff is on the catheter but 

are not visible after 

placement. The dacron 

cuff is on the catheter just 

under the skin near the 

exit site. Its acts as an 

anchor holding the line in 

place and as an infection 

barrier. The vita cuff 

(made of silver iodide) is 

proximal to the dacron 

cuff. It dissolves in about 

3 weeks, and helps 

prevent infection in the 

newly placed line. 

Venous access ports are 

totally implanted in a 

subcutaneous pocket of 

the chest. Therefore, there 

no external line is seen. 

The port shape may be 

square or circular. It has a 

titanium base with a 

silicone dome for venous 

access. The dome may be 

either raised or flat. 

Venous access ports may 

be connected to a Broviac 

or Groshong catheter. 

A PICC line is inserted via 

the basilic or cephalic 

vein. It is threaded so that 

the tip lies in the superior 

vena cava (SVC). 

There are a variety of 

PICC catheters. Most are 

white in appearance, made 

of soft flexible material 

(silicone, polyurethane). 

Exit Site: is usually just 

above or just below the 

antecubital space of the 

arm. 

_________________________________________________________________________________________________________________ 





CARE OF PEDIATRIC CENTRAL CATHETERS 



Purpose 

Used for short-term 

central line access. 

Used for long-term 

(months to years) central 

line access. 



line access. 



line access. 

Used for intermediate 

length therapy – not to 

exceed 120 days. 

Lumen/Port Size 

Port Utilization 

Used for fluid 

administration, blood 

product administration, 

blood drawing, parenteral 

nutrition, and CVP 

monitoring. 

Catheter size varies from 

4-7 Fr. And length varies 

from 5-30 cm. Check 

catheter lumen for dead 

space volume. 

#1 (distal): blood product 


draws, and CVP 

monitoring. 

#2 (proximal): parenteral 

nutrition and maintenance 

fluids. 





nutrition, and long-term 

medications such as IV 

antibiotic therapy and 

chemotherapy. 

Broviac Catheter: there are 

multiple sizes used – 2.7, 

4.2, 6.6 and 9.6 Fr. Sizes. 

Double lumen line 

Red Port (distal): blood 


blood draws, and CVP 

monitoring. 

White Port: parenteral 


fluids. 





nutrition, and long-term 

medications such as IV 

antibiotic therapy and 

chemotherapy. 

There are multiple sizes of 

Groshong catheters used – 

3.5, 5.5, 7.0 and 8.0 Fr. 

Sizes. 

Double lumen line 

Red Port (distal): blood 


blood draws, and CVP 

monitoring. 

White Port: parenteral 


fluids. 




and blood drawing. 

Parenteral nutrition may 

be administered as well as 

long-term medication and 

chemotherapy. Pas-ports 

are placed in antecubital 

and used for CF patients. 

They may be double 

lumen. 

The size of the port 

depends on the size of the 

catheter placed. Most 

ports used for pediatric 

patients have a 6.6 French 

catheter size 

Double lumen ports: 

occasionally an older child 

will have a double port 

placement. May also be a 

pass-port 

Use the larger port for 

blood product 

administration and draws. 

The smaller port can be 

used for parenteral 

nutrition, medications and 

maintenance infusions. 


administration, long-term 

antibiotics and blood 

product administration. 

Blood drawing may be 

done if the catheter is 

larger than 3.0 Fr. Most 

pediatric catheters are less 

than 3.0 Fr. 

TPN and IL may be 

administered as long as 

the tip of the catheter is in 

the SVC. 

The catheter sizes vary. 

The Fr. Size ranges from 

1.9 to 5.0 (16-22 gauge). 

Most pediatric patients 

have Fr. Size 1.9 (infants) 

to 2.8. The internal 

volume ranges from 0.04 

ml to 0.34 ml. 

PICC’s are single lumen 

ports only. 

_________________________________________________________________________________________________________________ 








Catheter Access 

Irrigation 

Irrigate each port with 

Heparin flush 

concentration between 10- 

100 units/cc. 

Determinations based on 

patient’s weight and 

diagnosis. 

All central lines should have a needle-less access cap on each access port. Only 

access lines through the needle-less access cap. The needle-less access cap should be 

cleansed with three alcohol swabs for 60 seconds prior to access. 

Maintenance Flushing: 

CVC: Heparin flush 

1 cc/port every 24 hours. 

Medications: 1-3 cc flush 

with NaCl before and after 

medication. Follow with 

Heparin flush (CVC 1 cc). 


Heparin flush 

1-3 cc/port every 12 

hours. 

Medications: 5 cc flush 



1-3 cc Heparin flush. 


NaCl 10 cc flush every 7 

days when not in use. 

Medications: NaCl 10 cc 

flush before and after 

medications. 

Only use a non-coring 

(Huber) needle for access. 


Heparin flush 5 cc every 4 

weeks when not in use. 

Medications: 10-20 cc 

flush with NaCl before 

and after medication. 

Follow with 5 cc Heparin 

flush. 

See access for CVC, 

Broviac, and Groshong 

catheters. 


Heparin flush 1 cc q 12 

hours. 

Medications: 5 cc flush 



1 cc Heparin flush. 

Utilize pulsatile flushing 

to prevent clot and fibrin 

formation. 

TPN: (discontinuing) 

Flush with 5-10 cc of 

NaCl followed by Heparin 

flush (1 cc). 



NaCl followed by 1-3 cc 

Heparin flush. 


Flush with 20 cc of NaCl 

before and after 

medications. 



NaCl followed by 3-5 cc 




NaCl followed by 1 cc 


Blood (draw or 

administration): flush with 

3-5 cc NaCl followed by 

Heparin flush ( 2 cc). 




1-3 cc Heparin flush. 



10 cc NaCl before and 

after blood draw or 

administration. 



20 cc NaCl followed by 5 

cc Heparin flush. 




1 cc Heparin flush. 

PSCU, PEDS, PICU 

PICC lines will have a 

continuous heparin 

infusion (1 unit/cc) at 

2cc=2 units/hr. if no other 

fluid is infusing. 

From Lexi-Comp’s Pediatric Dosage Handbook, p. 559, “Line flushing: When using daily flushes of heparin to maintain patency of single lumen or double lumen central 

catheters, 10 units/ml is commonly used for younger infants,(i.e.




Dressing: Use central line 

dressing kit. 

Type of Dressing: use a 

bio-occlusive (Op-site, 

Tegaderm, etc.) type of 

dressing. Place a BioPatch 

over the insertion site. 

Frequency of Dressing 

Change: change every 7 

days or PRN loss of 

occlusiveness. Change 

BioPatch every 7 days. 

Change non-occlusive 

gauze dressings every 72 

hours and PRN if dressing 

is soiled or wet. 




dressing unless otherwise 

ordered. Place a BioPatch 

around the catheter at 

insertion site. 




occlusiveness. Change Bio 

Patch every 7 days. 








dressing 




occlusiveness. 





Type of Dressing: 

New Port Placement: 

when the port is new, 

steri-strips should be 

applied to the incision and 

the site should be left open 

to air. After the site heals, 

no dressing is necessary 

unless port is in use. 

Port in Use: when the 

port is in use, the noncoring 

(Huber) needle 

must be secured and a bioocclusive 

dressing should 

be applied and left in 

place until the needle is 

changed. The needle is 

left in place for up to 7 

days. 



tegaderm, etc.) type of 

dressing. Place a BioPatch 

around catheter at 

insertion site. 


Change: the initial 

dressing should be 

changed within 24 hours. 

After the initial dressing 

change, the dressing 

should be changed every 7 

days or PRN. Change 

BioPatch every 7 days. 

Remove the dressing from 

distal to proximal to avoid 

pulling out the catheter. 

For all catheter sites, clean the site with chlorhexidine prepstick in a scrubbing motion, working from side to side for 30 seconds. Also, clean the catheter with chlorhexidine. 

Apply the dressing – be sure to coil the line before placing the tegaderm– up to – but not including the access ports. Observe the site for signs and symptoms of infection. Be 

sure to date, time, and initial the dressing. Do not use BioPatch on Pediatric Oncology patients at this time. 

Patients on the Pediatric Hematology/Oncology Service with broviac central line catheters will have the dressing changed every seven days, with the line coiled on top of a 

sterile 2x2 gauze covered with a bio-occlusive dressing as per procedure listed within this document. If catheter is covered by a 2x2 gauze, the dressing will be changed every 

72 hours. 

Cap and Cap Changes 

Frequency of Cap Changes: for all types of lines, needle-less access caps should be on all ports. Needle-less access caps should be changed 

every 72 hours (3 days). If a hub-to-hub access is done for a blood draw or CVP reading, a new injection cap should be placed on the line when 

finished. 

Changing the Cap: Clamp all lines (except Groshong). Prep the cap/catheter hub for sixty seconds with an alcohol or chlorhexidine. Remove the 

old cap and apply the new cap using sterile technique. Unclamp the line (if in use) and place a courtesy tab on the cap/hub. Be sure to date, 

time, and initial the cap change on the courtesy tab. 

_________________________________________________________________________________________________________________ 








Blood Drawing 

Blood Administration 

Complications: 

1. Possible blood clot 

occlusion 

Use the distal port. 

Stop all infusions. Using 

the needle-less system, 

aspirate 3-5 cc of blood 

and discard. (For blood 

cultures, do not discard) 

In second syringe, aspirate 

the amount needed for 

specimen and place in 

blood tube. Immediately 

flush line with 3-5 cc 

NaCl and 1 cc Heparin, if 

not being used with an 

intravenous infusion. 

Use the distal port. 

Flush with 3-5 cc NaCl 

and 1 cc Heparin after 

infusion of blood is 

complete, if not being 

used with intravenous 

infusion. 

Broviac: Use red port if 

double lumen. 

Stop all infusions. Using 

the needle-less system, 

aspirate 3-5 cc of blood 

and discard. (For blood 

cultures, do not discard) In 

second syringe, aspirate 



blood tube. Immediately 

flush line with 5-10 cc 

NaCl and 3 cc Heparin, if 

not being used with an 


Use the red port if double 

lumen. 

Flush with 10 cc NaCl and 

3 cc Heparin after infusion 

of blood is complete, if 

not being used with 


Use red port if double 

lumen. 

Stop all infusions. Access 

the line hub-to-hub. Flush 

first with 10 cc NaCl, then 

aspirate 6 cc of blood and 

discard. (For blood 

culture, do not discard) 

Attach second syringe 

directly to the hub; 

aspirate the amount 

needed and place in blood 

tube. 

Immediately irrigate the 

lines with 10 cc NaCl. 

Apply a new injection cap 

to the hub. 

Use the red port if double 

lumen 

Flush with 10 cc NaCl 

following administration 

of blood, if not being used 

with intravenous infusion. 

Stop all infusions. If 

accessing the line for 

blood draw, use a noncoring 

needle. (For blood 

cultures, do not discard) 

Aspirate the first 5-10 cc 

of blood and discard. In 

second syringe, aspirate 



blood tube. 

Immediately irrigate the 

line with 20 cc NaCl and 5 

cc Heparin, if not being 

used with an intravenous 

infusion. 

Access the port with an 

appropriate sized noncoring 

needle. 

Flush line with 20 cc NaCl 

and 5 cc Heparin 

following blood 

administration, if not 

being used with 

Must have at least a 3.8 Fr 

PICC. A 5 cc NaCl flush 

prior to blood draw may 

be of help. Never use a 

vacutainer as excessive 

pressure from the draw 

can cause the catheter wall 

to collapse. 

Aspirate 2 cc of blood and 

discard and then obtain 

sample. 

Vigorously flush with 5- 

10 cc NaCl followed by 1 

cc Heparin flush. 

Flush with 5-10 cc NaCl 

and 1 cc Heparin flush 

following blood 

administration, if not 

being used with 



1. Change the position of the patient. This may change the position of the central line. Ask the patient to change from sitting to lying/lying to 

sitting position; put hands over their heads; do valsalva maneuver or to cough. 

2. Aspiration. Attempt to aspirate the line, but do not irrigate. If able to aspirate blood, then irrigate with NaCl. If unable to aspirate, identify 

the port occluded and notify physician. 

3. Contact physician for tPA order. Typical dose should be 1 unit/ml of line dead space volume. Use ½ cc more than the catheter filling 

volume. After administration of tPA, leave in catheter for 1 hour. After 1 hour, aspirate for blood. This may be repeated. 

2. Fibrin Sheath A fibrin sheath is a mucous-like plug which building up around the tip of the catheter. It is manifested by easy infusion of fluids, but the inability 

to aspirate blood. In the case of a fibrin sheath, tPA (see above) may be beneficial. 

3. Broken Line If the central line breaks or is damaged, immediately clamp the line (except Groshong) proximal to the line break. 

Contact the Surgeon , Pediatric Surgery Nurse or the Pediatric Clinical Nurse Specialist for repair of this line. 

If a PICC line breaks, it 

must be removed. 

_________________________________________________________________________________________________________________ 





ATTACHMENT E: VENOUS ACCESS PORT ADDENDUM 

1. Identify the correct patient. Confirm gauge and needle length of non-coring (Huber) needle. 

2. Explain the procedure to the patient/parent using age appropriate language. 

3. Approximately 45-60 minutes prior to accessing the infusaport/PASport apply a layer of EMLA cream over the site. Cover with bio-occlusive dressing. 

4. After the allotted time, prepare to access the infusaport/PASport using the appropriate size non-coring (Huber) needle. 

5. Remove the bio-occlusive dressing from the patient. Remove all remaining EMLA from the site with a dry 4 x 4 gauze. 

6. Allow the patient to assume comfortable position. Child may sit on parent’s lap. Supine position is preferable. 

7. Wash hands. Open the prepackaged Skin Prep tray with Chloraprep. Use this as your sterile field. Place the sterile non-coring (Huber) needle, a sterile needle-less access cap 

(Clave), and 10cc syringe on the field. Put on the mask. Use alcohol pad to cleanse the top of the NaCl vial. 

If accessing the port for lab draws only, you do not need to use the Skin Prep tray. You will need a sterile field, non-coring (Huber) needle, and a chloraprep sponge, and a 

mask. Proceed as listed below. 

8. Don sterile gloves. (You can do this with one sterile glove on the dominant hand, and the other hand is used for non sterile procedures) 

9. As you maintain sterility, have a second person assist with drawing up 10 cc NS from vial. 

10. Maintaining sterility, place the needless access cap (clave) onto the non-coring (Huber) needle, prime with the NS. You may use the prepackaged NS syringe, but realize the 

outer part of the syringe is not sterile, just the fluid inside. Set aside on the sterile field. 

11. Prep the skin over the infusaport/PASport using the chloraprep (3 ml). Using a scrubing motion, starting at the port site and working outward to a 4 to 5 inch diameter for 30 

seconds. Do not retrace steps. Allow to dry. 

12. Locate the port septum by palpation. Triangulate the port between the thumb and first fingers of the non-dominant hand. Aim for the central point of these fingers. 

13. Insert the non-coring (Huber) needle perpendicular to the port septum, and advance the needle through the skin and the septum until reaching the back of the port. 

14. Verify correct placement by aspiration of blood. If blood cannot be aspirated, use NS and pull/push technique to attempt to initiate blood flow. If blood return still cannot be 

obtained, pull back and attempt to reposition the needle. If needle is withdrawn from the skin, a new prep and new non-coring needle must be used. 

15. Proceed with desired procedure. If the needle is left in place, apply a bio-occlusive dressing securing the needle and tubing coil. (May place folded 2x2 gauze or Biopatch, 

under wings of needle if needed, for support of wings). Coil excess tubing under bio-occlusive dressing. Connect to ordered IV fluids. To heplock, instill 10U/ml in young infants 

ATTACHMENT F: CARE OF ADULT CENTRAL CATHETERS 

Type of Lines 

Appearance of Catheter 

Subclavian Catheters: 

• CVC Catheter 

• Hohn Catheter 

Triple Lumen CVC: white 

and has 3 ports: brown, white, 

and blue 

Hohn Catheter: white and 

may be either single or double 

lumen. Double lumen lines 

have 2 port: red and white 

Long-Term External 

Catheter: 

• Hickman & Broviac 

• Groshong Catheter 

Hickman & Broviac: These 

lines are white and may be 

either single or double lumen. 

The double lumen lines have 

two ports: red & white. 

Hickman differs from Broviac 

only in lumen size; Hickman 

is larger than Broviac. 

Groshong: is clear with a blue 

stripe: it may be either single 

or double lumen. Double 

lumen lines have 2 ports: red 

& white. 

Venous Access Ports: 

• Port-A-Cath 

• PAS port 

Port-A-Cath: This is tottaly 

implanted in a subcutaneous 

pocket of the chest. 

PAS port: This is totally 

implanted in a subcutaneous 

pocket either in the medial 

aspect of the upper arm or just 

above the antecubital space. 

The port may be square or 

circular with a metal base and 

silicone dome for venous 

access. 

Long Arm Catheters or 

PICC 

LAC Catheter: is white and 

may be either single or double 

lumen. The catheter is made 

of a silicone material. It is 

inserted through the basilic or 

cephalic vein and is threaded 

so that the tip lies in the 

axillary subclavian or superior 

vena cava. 

Exit site: is usually in the 

upper chest or in the neck. 

Purpose CVC: used for short-term (7- 

10 days) central line access. 

Hohn: used for intermediate 

length (up to 12 weeks) 

central line access. 

Exit site: is usually upper or 

mid-chest area. 

Used for long-term (months to 

years) central line access. 

Exit site: no exit site. Catheter 

is totally implanted and not 

seen 

Both used for long-term 

(months to years) central line 

access. 

Exit site: is just above or just 

below the antecubital space of 

the arm. 

Used for intermediate length 

(months) venous access. 

See Long Arm Catheter 

Length Selection Guide. 

Used for the administration of: 

IV fluids, IV medications, 

parenteral nutrition, and blood 

products. Also can be used 

for blood drawing, and CVP 

monitoring. 

Used for the administration of: 

IV fluids, short and long term 

IV medications, parenteral 

nutrition and blood products. 

Can be used for blood 

drawing. 

Used for the administration of 

IV fluids, short and long term 

IV medications, parenteral 

nutrition and blood products. 

Can also be used for blood 

drawing. 

*Long term infusions of 

vesicant chemotherapy agents 

should not be given through 

ports. 

_________________________________________________________________________________________________________________ 






Lumen or Port Size 

Subclavian catheters: 



CVC Catheter: 

White port: 18G, dead space 

vol. 0.3cc 

Blue port: 18G, dead space 

vol. 0.36cc 

Brown port: 16G, dead space 

vol. 0.48cc 

Hohn Catheter: 

Red port: 16G (7Fr) 

White port: 18G (5Fr) 

CARE OF ADULT CENTRAL CATHETERS 


Catheter: 



Hickman Catheter: 

Single lumen: 16G 

Double lumen: both at least 

16G, but the red port is 

slightly larger. 

Broviac Catheter: 







• PAS port 

Port-A-Cath: most are 

attached to at least a 26G 

catheter. Fill volume for both 

prot and catheter is 0.80cc 

PAS port: most are attached 

to at least an 18G catheter. 

Fill volume for both port and 

catheter is 0.73cc 


PICC 

May be either single or double 

lumen. Catheter sizes vary. 

Most range between 19 to 20G 

(3.0 to 5.0 Fr). The internal 

fill volume ranges from 0.04 

to 0.34 cc. 

Port Use 

CVC: 

White port: (proximal) use for 

maintenance solutions & IV 

meds. 

Blue port: (medial) use for 

nutrition. 

Brown port: (distal) use for 

blood draws or administration 

Groshong Catheter: 





Double lumen lines: 


nutrition, IV medications and 

maintenance fluids. 

Red port: (distal) use for blood 

draws or administration 

Double lumen ports: 

Some patients will have a 

double port placement. Use 

the larger port for blood 

administration and draws, the 

smaller port can be used for 

maintenance infusions, IV 

meds and nutrition. 

Double lumen lines: 


nutrition, IV medications, and 

maintenance fluids. 


draws or administration. 

Hohn Catheter: 


nutrition, IV medications, 

maintenance fluids 


draws or administration. 

_________________________________________________________________________________________________________________ 






Irrigation: use Heparin flush 

concentration of 100U/cc. 

Patients receiving excessive 

flushes, Heparin 10U/cc may 

be used 

To avoid reflux, maintain 

positive pressure in line 

Clamp line as irrigation is 

completed. 

To avoid catheter rupture, do 

not exceed pressure of 30 PSI. 

Use a 10 cc syringe to irrigate. 




Maintenance Flush: 

CVC: Heparin flush 1cc/port 

q24 hours. 

Hohn: Heparing flush 

2cc/port q24 hours 

Medications: 10cc flush with 

NS before and after 


Heparin flush (CVC 1cc/Hohn 

2cc). 

TPN: 20cc flush with NS 

followed by Heparin flush 

(CVC 1cc/Hohn 2cc) 

Blood in Tubing: with any 

blood draw or administration, 

flush with 20cc NS followed 

by Heparin flush (CVC 

1cc/Hohn 2cc). 

CARE OF ADULT CENTRAL CATHETERS 


Catheter: 




Hickman/Broviac: Heparin 

flush 3cc q24 hours. 

Groshong: vigorously flush 

10cc NS q7 days when not in 

use. 

Medications: 

Hickman/Broviac: 10cc flush 

with NS before and after 

medis followed by 3cc 



with 10cc NS before and after 

medications. 

TPN: 

Hickman/Broviac: flush with 

20cc of NS followed by 3cc 




TPN. 

Blood in Tubing: 

Hickman/Broviac: flush with 

20cc of NS followed by 3cc 






• PAS port 


Heparin flush 500U/5cc NS 

q4 weeks when not in use. 

Medications: 10cc NS flush 

before and after medications 

followed by a 5cc Heparin 

flush. (Home infusion may 

use 5cc NS flush the Heparin) 

TPN: Flush with 20cc NS 

followed by 5cc Heparin 

flush. 

Blood in Tubing: with any 

blood draw or administration, 

flush with 20cc NS followed 

by 5cc Heparin flush. 


PICC 


If Bard PICC: Heparin flush 

2cc q8-12 hours. 

If Boston Scientific PICC: 

20cc NS flush q12 hours. 

Medications: If Bard PICC: 

20cc flush with NS before and 

after medications followed by 

a 2cc Heparin flush. 


flush with 20cc NS. 

TPN: If Bard PICC: flush 

with 20cc NS followed by 2cc 




Blood in Tubing: If Bard 

PICC: with any blood draw or 

administration, flush with 

20cc NS followed by 2cc 




LACs become clotted very 

quickly if not flushed within 

5 minutes of completion of 

IVPB. 

Important to use 10cc or 

larger syringe when flushing 

or withdrawing blood. 

_________________________________________________________________________________________________________________ 






Blood Drawing 




CVC: Use brown port 

Hohn: Use red port 

CARE OF ADULT CENTRAL LINE CATHETERS 


Catheter: 

• Hickman/Broviac 


Hickman/Broviac: use red 

port (if double lumen) 

Groshong: use red port if 

double lumen; may access the 

line hub-to-hub as opposed 



• PAS port 

Use a 19 or 20 G non-coring 

(Huber) needle for port access 


PICC 

LAC or PICC should be at a 

3.0 Fr or larger. 

A 10cc NS flush prior to 

blood draw would be helpful 

through interlink. 

Stop all infusions. Using a needleless system, aspirate 6cc of blood (2cc for LAC and midlines) in syringe and discard. In second syringe, aspirate the amount 

needed for the specimen and place in a blood tube. Vigorously flush line immediately with 20cc NS and appropriate amount of Heparin (if indicated) as directed 

under irrigation section. 

Blood Administration 

CVC: use the brown port 

Hohn: use red port 

Hickman/Broviac: use red 

port (if double lumen) 

Use a 19 or 20 G non-coring 

(Huber) needle for port access. 

LAC or PICC: Use at least a 

3.0 Fr or larger. These are not 

optimal gauge given long 

lengths. 

Administer blood through the needleless injection cap with a needless syringe cannula. After transfusion, vigorously flush catheter with 20cc NS and appropriate 

amount of Heparin (if indicated) as directed in the irrigation section. 

Catheter Access 

All central lines should have a needleless cap on each access port. Only access 

the lines through the injection cap, with a few exceptions. The injection cap 

should be cleaned with alcohol for 60 seconds prior to access. Use only a 

needleless syringe cannula to access the injection. 

Cap Changes 

For venous access ports, use only a non-coring (Huber) needle. See venous 

access attachment. 

Frequency of cap changes: for all types of lines, needleless injection caps should 

be used on all ports. Caps should be changed every 72 hours (3 days) or PRN. 

If a hub-to-hub access is done for a blood draw or CVP reading, a new injection 

cap should be placed on the line when finished. In the home setting, cap changes 

should occur once a week. 

Changing the cap: clamp all lines (except Groshong). Prep the cap/catheter hub 

with a 60 second chloraprep scrub. Remove the old cap and apply new cap using 

sterile technique. Unclamp the line (if in use) and place a courtesy tab on the 

cap/hub. Be sure to date, time and initial the cap changed on the courtesy tab. 

Clave Adapter special note: Clamp venous access device before final syringe of 

flushing solution used. Betadine should never be used to cleanse the Clave 

Adapter. Cleanse it with alcohol or chloraprep, only. 

_________________________________________________________________________________________________________________ 





ATTACHMENT G: QUICK REFERENCE FOR VADs 

VADS FLUSHING DRESSING CHANGE CAP CHANGE REPAIR KIT 

Hickman/Broviac 

3 cc Heparin flush (10 u/cc) q Every seven days or as needed. Every 2 weeks or after 50 Yes 

24 hr or after each use 

sticks whichever comes first. 

Groshong 

5 cc NaCl q 7 days or after Every seven days or as needed. Every 2 weeks or after 50 Yes 

each use. 


Hohn 

3 cc Heparin flush (10 u/cc) q 

12 hour or after each use. 

Once daily for life of catheter 

(these stitches do not come 

Every 2 weeks or after 50 


No 

PICC 

Port-A-Cath 

P.A.S. Port 

If Bard PICC: 2 cc heparin 

flush (100 u/cc) q 12 hour or 

after each use (if a Groshong 

PICC line use 20 cc of NaCl 

after each use or q 7 days). 


20cc NaCl flush 

5 cc Heparin flush (100 u/cc) q 

4 weeks or after each use. If 

Groshong port-a-cath, flush 

with 20 cc NaCl q 4 weeks or 

after each use. 

Flush with Heparinized saline 

10 u/cc (5cc) after each use 

when Heparin locked; when 

not in routine use flush with 

heparinized saline 100 u/cc (5 

cc) q 4 weeks 

out). 

Transparent dressing change 

24-hour post insertion by a 

PICC team member, then q 7 

days. If gauze dressing is used 

then q 48 hours (stitches do not 

come out if sutured). Any RN 

may change the PICC dressing 

after the initial dressing 

change at 24hrs. 

No dressing needed after site 

heals. 

If Heparin locked change q 48 

hours for gauze dressing and 

every seven days for occlusive 

dressing. 

No dressing needed after site 

heals. 

If Heparin locked change q 48 

hours for gauze dressing and 

every seven days for occlusive 

dressing (non-coring needle is 

changed q 5 days). 

Every 7 days 

Every 5 days if Heparin 

locked. 

Every 5 days if Heparin 

locked. 

No 

No 

No 

_________________________________________________________________________________________________________________ 





ATTACHMENT H: CARE OF THE VASCULAR ACCESS DEVICE IN THE 

POST ANESTHESIA CARE UNIT (PACU) 

All Central Venous Catheters placed in the OR by the Anesthesia staff or the surgeon will 

have a stat chest x-ray done in the PACU to confirm placement without complication. Chest x- 

ray for central venous catheter placement will be added to the anesthesia standing orders for 

PACU. 

PACU personnel will not use the line until verifying that an x-ray for placement without 

complication has been confirmed. DO NOT stop the infusion, but slow the infusion to a To 

Keep Open (TKO) rate until confirmation has been completed. Anesthesia staff will review x- 

ray for placement of the central venous catheter and inform the PACU nurse so the intravenous 

(IV) rate can be adjusted. Anesthesia staff will document on the PACU Physician Order Sheet, 

“Confirmation of catheter placement without complication, after review of x-ray”. 

Anesthesia may occasionally request that PACU continue to use the central line at current 

infusion rates, because no other IV access is available on this patient. PACU will document this 

order on the anesthesia order form and in the nurses notes. The above protocol will be followed. 

All changes to the IV rates and confirmation of central line placement will be documented in 

the PACU nurse notes. 

_________________________________________________________________________________________________________________ 





_________________________________________________________________________________________________________________ 




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