Central Line Care

Central venous access devices (CVADs) — including PICCs, tunneled catheters, implanted ports, and non-tunneled central lines — terminate in or near the superior vena cava. Because these lines sit in large central vessels, they carry risks distinct from peripheral IVs: air embolism, central line-associated bloodstream infection (CLABSI), and pneumothorax (during insertion). Dressing changes use strict sterile technique with chlorhexidine skin prep and occur every 7 days for transparent semi-permeable dressings or every 48 hours for gauze dressings, or immediately if the dressing becomes damp, loosened, or soiled. Before any line disconnection or cap change, place the client in Trendelenburg position and instruct them to perform a Valsalva maneuver (bear down) to increase intrathoracic pressure and prevent air from entering the catheter. Needleless connectors are scrubbed with alcohol for at least 15 seconds (scrub the hub) before each access. Flush with normal saline before and after each use; heparin flushes follow facility protocol for certain catheter types. Monitor the insertion site every shift for redness, swelling, drainage, or tenderness — signs of infection or infiltration. Post-insertion chest X-ray confirms tip placement before first use for central lines (including PICCs unless an alternative confirmation method such as intracavitary ECG is used). If air embolism is suspected, immediately clamp the line and position the client in left lateral Trendelenburg.