Pediatric emergency medicine trisk 4348 4348

1. Chlorhexidine
2. 3-mL syringe with heparin 10 U/mL
3. 5-mL normal saline flush
4. Two 5-mL Luer-Lock syringes

Procedure
Tunneled Central Venous Catheters
Maintain sterile technique when accessing a CVC. Clamp the catheter with the
catheter line clamp (do not use a hemostat). Hold the CVC tubing with a 4 × 4 in
the nondominant hand and remove the cap. Place a 10-mL syringe flushed with
normal saline, unclamp, and flush with 5 mL; then withdraw from the CVC to
ensure patency. Discard 3 to 5 mL of blood, and then clamp the catheter.
Administer medication or fluids as ordered once the syringe or IV tubing is
securely attached to the catheter. Set the medication/fluid rate and volume using
an infusion pump, unclamp the catheter, and begin the infusion.
When not in use, the CVC should be clamped with the catheter line clamp.
When drawing a blood sample, first clean the catheter cap per institutional
protocol. Once the needleless access cap is cleaned, attach a Luer-Lock syringe,
unclamp, and withdraw 3 to 5 mL of blood to discard. Attach a second syringe
and withdraw the necessary amount of blood. Flush the catheter with 5 mL
normal saline and 3 to 5 mL of heparin (100 U/mL). In small infants, in patients
with severe anemia, or when frequent sampling is required, consider reinfusing
the initial blood sample to clear the line prior to the saline flush and heparin.
If difficulty occurs withdrawing blood from the catheter, this may be caused by
catheter placement, clot, or malfunction. Certain maneuvers that may aid in blood
flow include placement of the patient in reverse Trendelenburg position, placing
slight tension on the catheter, holding the patient’s arms over their head, or use of
a Valsalva maneuver. Withdrawing with force will only collapse the catheter
tubing. If the aforementioned maneuvers are not successful, gently flush the
catheter with 3 to 5 mL of heparin solution (100 U/mL). If this attempt fails,
alteplase may be used (see below).

Implantable Venous Access Catheters
Maintain sterile technique at all times ( Fig. 130.10 ). Prepare the overlying skin
with antiseptic solution as per institutional protocol. If time allows, consider
placement of topical anesthetic over the port site 30 to 40 minutes before access is
planned. Connect the Huber needle to extension tubing and flush the tubing and
needle lumen with normal saline, then clamp. Stabilize the circular reservoir with