Module 5: Tunneled Central Catheters (Hickman ... - Mghpcs.org

Nursing Management ofVenous Access Devices:Tunneled CentralCatheters(Hickman ® / Broviac ® / Small Bore /Groshong ® )Mimi Bartholomay, RN, MSN, AOCNDenise Dreher, , RN, CRNI, VA-BCTheresa Evans, RN, MSNSusan Finn, RN, MSN, AOCNSDebra Guthrie, RN, CRNIHannah Lyons, RN, MSN, AOCNJanet Mulligan, RN, MS, VA-BCCarol Tyksienski, , M.S.,R.N.,N.P.

Tunneled catheter (Hickman)‣ Types: Hickman ® , Broviac ® ,Groshong ®, Small bore‣ Features: Dacron cuff lies underthe skin near the exit site.Adhesions form around the cuff tostabilize the catheter as well asprovide a mechanical barrier tomicroorganisms, therebyminimizing the risk of ascendinginfection.‣ Refer to MGH Nursing Policiesand Procedures Trove 05-0303-0404Retrieved from Images.MD atTreadwell Library 12/11/09Dacroncuff which isplaced alongthe tunnelabovethe exit siteRetrieved from http://www.bardaccess.com/with permission 12/11/09

‣ Benefits:Tunneled Catheters• long-term access‣ Infusion Guidelines:• SMALL LUMEN: Designated for TPN or if noTPN anticipated use for medications & fluids• LARGE LUMEN: blood, high-volume or viscousfluids, meds, and blood sampling‣ Contraindications/Risks• Infection• Invasive procedure• Thrombosis

Tunneled Catheters: Flushing‣ Adults/Adolescents:• 10-20ml saline, then• 5ml (10 units/ml) heparin = 50 units• flushed daily to once weekly when used intermittentlyor not in use‣ Toddlers/Infants:• 2ml (10 units/ml) heparin = 20 units‣ Neonates:• 1-2ml (10 units/ml) heparin = 10-20 units

Flushing Groshong ® Catheters‣ Valved catheter‣ Heparin not required‣ 20 ml saline flushafter every use‣ Flushed with 10 mlsaline every 7dayswhen not in use asroutine flush‣ Not generally used inpediatricsRetrieved from http://www.bardaccess.com/with permission 12/11/09