Complications of Central LinesDysrhythmiaoA dysrhythmia is an abnormal heart pattern indicated on the electrocardiogram. oIt may occur with catheter malposition or dislodgement. This could occur during the insertion procedure or later during the dwell time. oThe patient may not experience any clinical manifestations. oThis is why a chest x-ray is performed upon initial insertion to confirm the catheter tip is located in the correct area.oNursing interventions:Prior to initial use, the nurse should confirm that radiologic results reveal accurate catheter tip location. In addition to assessing heart rate and rhythm, the patient should be assessed for ear, neck, or back pain, which could also indicate catheter malposition and subsequently dysrhythmia. As the nurse completes routine assessments and dressing changes, the health care provider should be informed if the external catheter length has changed. InfectionoInfection can develop at the insertion site or along the catheter’s path. Common pathogens associated with central line infections are bacteria (such as Staphylococcus aureus), yeast, and fungi. Signs of infection include fever, chills, swelling tenderness, redness or drainage at the insertion/exit site.oNursing interventions:The mainstay of infection control is the same for central lines as for any other invasive device or procedure. One intervention requires maximal barrier precautions during the insertion procedure. This requires proper sterile draping of the patient, the use of sterile gloves, gown and mask for the person inserting the central venous access device and donning a face mask for everyone entering the area where the sterile procedure is being performed. Another intervention is proper hand hygiene, both during the insertion procedure of the central line as well as before any manipulation of a central venous access device. Since the needleless connector is recognized as potential site of contamination, injection ports should be thoroughly cleaned with chlorhexidine (or another facility-approved antiseptic) and allowed to dry prior to accessing the device. Some facilities may use a single-use access valve disinfection cap (SwabCap) instead of chlorhexidine or alcohol. The disinfection cap contains isopropyl alcohol and is twisted onto the needleless connector. Each time the line is accessed, a new disinfection cap is applied.Strict aseptic technique should be used when hanging solutions and with dressing changes. Additionally, the site should be assessed daily for redness, drainage, swelling, or discomfort at the insertion site. Page 1of 6
Complications of Central LinesSince Chlorhexidine has been found to reduce the number of CR-BSI, it isthe recommended skin disinfectant.