Gastroenterology & Nutrition | Parenteral Nutrition

Intravenous Access

PN can be administered through a central venous catheter or a peripheral line.

Central venous catheters come in various forms

• 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®, HICKMAN®, subclavian, 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.

Peripheral intravenous lines

• 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 place longer.

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 set.

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