Centralised Central Line Management Training

The Clinical Excellence Commission along with NSW Agency for Clinical Innovation and Health Education Training Institute  have developed an excellent centralised training resource.

Many cases occur because of accidental line disconnections (this problem can be engineered out – see here). Many other cases occur when central lines are removed with patients sitting upright – staff should ensure patients are lying flat or slightly head down to central line removal.

Rarely a patient may not be able to lie flat for a sufficient period for line removal. In this case we recommend the following:

Patients who can’t lie flat or have other risk factors have an increased propensity for air embolism on central line removal. In these circumstances there needs to be an escalation of procedure:

Assess patient for increased risk of air embolism before removal of the CVC. Risks include:
– Respiratory compromise (can generate a large negative intrathoracic pressure increasing risk and rate of air entrainment)
– Intravascular depletion (which can lead to a greater negative intravascular pressure, increasing the risk and rate or air entrainment)
– Inability to lie flat for an extended period (if unable to lie flat may create a pressure gradient that favours movement of air into the circulation)
– Low body mass index (smaller tract between the atmosphere and the vessel)

If the patient is unable to tolerate lying in the supine position or are considered high risk, the following should occur:
– Do not remove the CVAD in the first instance
– Contact an experienced critical care medical officer to review and manage the patient
– Delay removal until the risks can be minimised (if possible)
– Vascular access nurse (or experienced nurse) remove central line when appropriate
– Critical care medical officer in attendance
– Ensure alternative venous access already obtained
– Remove line in an adequate environment – monitored, with arrest trolley at hand
– Patient to remain monitored until satisfied risks of air embolism have abated

Click here for details

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