IV Management

Jan Bazner-Chandler RN, MSN, CNS, CPNP

Central Venous Catheter

Central Line Bundle

• Hand Hygiene• Maximal barrier precautions upon insertion• Chlorhexidine skin antisepsis• Optimal catheter site selection; subclavian

vein is the preferred site for non-tunneled catheter

• Daily review of line necessity with prompt removal of unnecessary lines

CA-BSI

• Central venous catheter-associated blood stream infection

• Three criteria for diagnosis

Criterion I

• A recognized pathogen in the blood found from one or more blood cultures, and the pathogen is not related to an infection at another site.

Criterion 2

• Patient has at least one of the following signs or symptoms: fever (over 100.4 F or 38 C, chills, hypotension and

• Positive laboratory results not related to infection at another site

• Common skin contaminant identified in two separate cultures taken within 48 hours of each other.

Criterion 3

• A patient less than one year old has at least one of the following signs or symptoms: fever (over 100.4 F or 38 C) or hypothermia (under 98.6 F 37 C) apnea, or bradycardia and

• Positive laboratory results not related to an infection at another site

• Common skin contaminant found in two blood draws – within 48 hours

Risk Factors

• Three lumen catheters• TPN running through central line• Inexperienced physician inserting line• Low patient – nurse ratio• Long – term catheter• Special care units

Total Parental Nutrition

Whaley & Wong

A tunneled catheter should haveAn occlusive dressing in place.

TPN Therapy

• TPN provides complete nutrition for children who cannot consume sufficient nutrients through gastrointestinal tact to meet and sustain metabolic requirements.

• TPN solutions provide protein, carbohydrates, electrolytes, vitamins, minerals, trace elements and fats.

TPN: care reminder

caREminder:• The TPN infusion rate should remain fairly

constant to avoid glucose overload. The infusion rate should never be abruptly increased or decreased.

• Bag and tubing need to be changed every 24 hours.

Complications of TPN

• Sepsis: infection• Liver dysfunction• Respiratory distress from too –rapid infusion

of fluids