Gastroenterology & Nutrition | Parenteral Nutrition
PN can be administered through a central venous catheter or a
Surgically-inserted, permanent BROVIAC® or
HICKMAN® catheters, single or double lumen, are
placed in the OR under sterile conditions. These
catheters may remain in place for months to years.
Percutaneously-inserted, temporary subclavian or
jugular vein catheters can be placed in the OR,
intensive care units, or patient floors.
Multi-lumen catheters are often used. Usual
duration of catheter placement is one to three weeks.
Percutaneously-inserted central catheter (PICC
line) is a temporary, silastic catheter,
inserted initially into an antecubital vein and
advanced centrally for completed placement.
These are placed in the OR, in the APC, and on
the floors. PICC lines can be used for as long
as 6 to 8 weeks.
For any of these catheters, the tip should be located at
the SVC-RA junction or in the IVC to allow infusion of
hypertonic solutions without injury to adjacent vascular
endothelium. Proper placement should be confirmed by
x-ray. If the catheter tip is not ideally located,
adjustments to the PN solution are necessary. Blood
sampling can be done via BROVIAC®,
or jugular catheters. PICC lines often have resistance
due to length and small lumen diameter. Complete
guidelines for Central Venous Catheter Management are
available on each nursing unit or via the Office of
Pediatric Surgery. This manual reviews guidelines for
management of multiple clinical problems, including
fever, catheter occlusion, and catheter breakage.
PICC lines are inserted in peripheral veins and
then are advanced to a central location.
Peripheral IVs are started with aseptic
technique. The IV site should be examined
frequently for signs of infiltration or
infection. Changing the IV site should be
considered every 5 to 7 days to minimize local
and systemic infection. If a peripheral vein
cutdown is necessary, the IV line may remain in
Assembly and Change of PN Set-Up
PN solutions arrive from the Pharmacy ready-for-use. No additions
are made on the nursing unit. Regular infusion sets and pumps should
be used and assembly should be aseptic. If IL is used, the two
solutions (AAM and IL) are infused simultaneously through a
Y-connector close to the site of infusion. Additional solutions of
electrolytes or medications can also be infused via multi-channel
connectors. Once assembled, the PN line should not be disturbed
except in unusual circumstances or for routine changes of infusion
Central Venous Catheter
IV infusion set including tubing is changed every 48
hours down to the hub of the catheter. Blood drawing
should be co-ordinated on a daily basis with change in
set-up to avoid repeated entry into the system and
minimize chances of bacterial contamination.
Peripheral IV lines
IV infusion set, including tubing, is changed down to
the hub every 48 hours.
Catheter flushing and blood drawing
Heparin 10 units/cc
Infant BROVIAC® 2.7 Fr
Infant BROVIAC® 4.2 Fr
HICKMAN® All Sizes