PURPOSE: To correctly and safely maintain the patency of the catheter and prevent sepsis.
RATIONALE: Ash II Split catheters are to be used for HPC apheresis after high dose chemotherapy. As the peak time in which to obtain HPC is short, it is imperative to maintain patency of these lines, especially one to draw from during the apheresis procedure. As a general rule, these catheters will be cared for by the apheresis nurses.
EQUIPMENT NEEDED:
Heparin 1:1000 units
Normal Saline flush
Subclavian care kit (Central Supply)
Infusion plug (Central Supply)
Syringes as needed (5ml x 1, 10 ml x 2, 30 ml x 1)
As necessary, Alteplase (1mg/ml) – 2 mg units per line
Infusion Plugs x 2
18 gauge or 20 gauge needle
NURSING ACTION:
PROCEDURE STEPS:
A. Blood Samples/Administering Medications and/or Blood
- Before use of the line, aspirate 3-5ml and discard. This ensures that any heparin in the line is withdrawn and not flushed into the patient’s system.
- Obtain amount of blood needed for specimens.
- Flush with 10ml of normal saline and begin ordered infusion or hep-lock.
- To heparin lock:
- Flush each lumen with 10ml of normal saline using positive pressure and clamp immediately.
- Replace the normal saline syringe with 2ml of 1:1000 units of heparin. Using positive pressure, flush each lumen with 2ml of heparin. The volume of the venous lumen (blue) is 1.8 ml; the arterial lumen (red) is 1.7 ml – this allows for complete filling of the lumen and prevents “dead space”.
- Remove syringe and apply infusion cap to each lumen maintaining sterility of both lumen and cap.
KEYPOINT: If the catheter is not in daily use, it is sufficient to do maintenance heparinization at least every third (3rd) day.
B. Dressing Care
- Change dressing the second day after catheter insertion or PRN. Dressing must be changed if it becomes soiled, wet, or is not occlusive.
- See Procedure for “Care of Central Venous Catheters.”
- DO NOT use alcohol based prep solutions on the first generation of Ash Split Catheters, as they can be damaged by alcohol.
- Cover the exit site with a vascular access dressing (VAD) OR place a 2 x 2 sterile gauze over the exit site.
- Change infusion plugs every treatment or PRN.
C. Use of Alteplase for Catheter Clearance
- Inform M.D. of occlusion and/or inability to obtain blood and obtain order for Alteplase.
- Follow Procedure for Use and Administration of Alteplase.
- If unsuccessful with first attempt, evaluate for mechanical obstruction.
- If there is no mechanical obstruction, you should attempt a second dose and allow it to dwell for at least 1 hour.
- If still unsuccessful, notify M.D.
- When successful, withdraw 5ml of blood and flush with 10ml of Normal Saline and resume infusion or heparinize.