Intravascular Catheters
Surgically Placed Central Lines

 

 Authorised by:
Charge Nurse - Newborn
May 2006
Clinical Guidelines Back Newborn Services Home Page
Insertion of a surgically placed CVL Removal of a surgically placed CVL Dressing a surgically placed CVL CVL repair kit
CVL Pressure Information CVL Pressure

Insertion of a Surgically Placed Central Venous Line (CVL)

Step

Action

1

 The baby remains on NPM 4 hours pre-operatively.

2

 The gastric tube is aspirated immediately pre-operatively.

3

 Lavage and suction of endotracheal tube should be carried out preoperatively if required.

Step

Action

1

 Baby is placed on a radiant heat table.

2

 Blood pressure transducer or Dinamap is attached.

3

 Cardiac electrodes and skin probe are placed away from surgical site.

4

 The diathermy machine is obtained through the operating theatres at Starship Hospital.

5

 We have available if necessary:
  • Central line pack.
  • Catheter introducer.
  • Catheters (Cooks).
  • Repair kits (Cooks).
  • Suture material 5-0 dexon plus and 3-0 dexon ties

The Nurse is aware Starship staff usually provide:

  • Scrub Nurse
  • Central line pack
  • Catheter
  • Diathermy electrode (polyhesive II electrode)

6

 Notify X-ray prior to procedure and also when Surgeon arrives.
7 Check the emergency trolley prior to surgery and ensure resuscitation drugs are available in room:
  • 0.9% NaCl 500mls
  • Neostigmine 0.08mg/kg (antidote for pancuronium) may be necessary.
  • Atropine 0.01mg/kg.
  • Sodium bicarbonate may be required.
  • Fentanyl may be required (DD Cupboard)
8 Ensure facilities for two suction units are available.
9 Ensure 'surgery in progress' notice on door. Screens placed outside door and masks available for staff entering the room.

Removal of a Surgically Placed Central Venous Line (CVL)

Dressing of surgically placed central line (CVL)

Step

Action

1

 Dressing at site is changed every 3 days using a sterile technique. Document clearly on care map when dressing is done.

2

 Remove old dressing, supporting central line throughout. A wet swab is taken if site looks infected.

3

 Swab with a skin disinfectant appropriate for the infant's gestation and postnatal age. The suture line in the neck is also cleaned and inspected.

4

 Place sofwick gauze around site of line and a small piece of gauze over the sofwick and catheter.

5

 Apply tegaderm over gauze, ensuring it is well adhered to skin and catheter.

6

 Always secure the line to the abdominal or chest wall with a piece of sleek.

Central Venous Catheter Repair Kit

Step

Action

1

 Note: Repair of Davol Broviac Catheters

Each Davol repair kit is provided with sterile detailed instructions for use. The instructions vary with repair kit size, and must be carefully followed if successful catheter repair is to be achieved.

2

 Doctor/NS-ANP will aspirate catheter gently to check for and remove any air present.

Central Venous Line Pressure (CVP)

Central venous pressure measures the right ventricular preload. Central venous access is obtained via the umbilical or the internal jugular vein. The catheter tip is in the right vena cava and zero calibration is at the mid thorax corresponding approximately to the level of the tricuspid valve.

It is difficult to establish ‘normal’ values for central venous pressure as the optimal filling pressure for any individual is unique and varies with changes in ventricular performance, compliance and afterload. A ‘normal’ level lies somewhere between zero and + 6mm Hg. Discuss with medical team the required normal level for each individual baby and document.

The main use of CVP measurement is in trend analysis and in monitoring treatment, some interpretation of initial or isolated measurements can be made.

In the ventilated neonate with respiratory distress a CVP of zero, is likely to be associated with hypovalaemia and inadequate right ventricular preload. A high CVP may be due to fluid/volume overload or congestive heart failure. In term babies with heart failure and pulmonary hypertension, higher pressures are found, so a value of 3mm Hg may also indicate inadequate preload.

It needs to be remembered that CVP is related, not only to the volume of intravascular blood within the venous system and the function of the cardiac pump, but also in intra-thoracic pressure. High CVP measurement may be artificially high, due to raised intra-thoracic pressure secondary to pneumothorax or over ventilation of compliant lungs. Inferior vena cava pressure reliability, predicts right atrial pressure in paediatric cardiac surgical patients.

Potential Risks of CVP Line

Central Venous Line Pressure (CVP)

Step

Action

1

 Set up to measure Central Venous Pressure (CVP) as per Blood Pressure Monitoring). Relabel "ABP" to "CVP".

2

 Set appropriate alarm levels following discussion with medical staff regarding desired central venous pressure.

3

 Follow the Recommended Best Practice for monitoring and recording continuous Blood Pressure measurement.
 

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