Venous Access:

Existing Catheter

 

Clinical Indication:

 

  • Inability to obtain adequate peripheral access.
  • Access of an existing venous catheter for medication or fluid administration
  • Central venous access in a patient in cardiac arrest.

 

Procedure:

 

  • Clean the port of the catheter with alcohol wipe.
  • Using sterile technique, withdraw 5-10 ml of blood and discard syringe in sharps container.
  • Using 5cc of normal saline, access the port with sterile technique and gently attempt to flush the saline.
  • If there is no resistance, no evidence of infiltration (e.g., no subcutaneous collection of fluid), and no pain experienced by the patient, then proceed to step 5. If there is resistance, evidence of infiltration, pain experienced by the patient, or any concern that the catheter may be clotted or dislodged, do not use the catheter.
  • Begin administration of medications or IV fluids slowly and observe for any signs of infiltration. If difficulties are encountered, stop the infusion and reassess.
  • Record procedure, any complications, and fluids/medications administered in the Patient Care Report (PCR).
  • The Broviac® catheter and the Hickman® catheter are temporary IV lines placed into a vein in the chest. The Broviac® is smaller than the Hickman® and therefore used for pediatric patients. These catheters are soft, come in double, and triple lumens.

 

  • The Groshong® catheter is similar to the Hickman but includes a valve at the tip of the catheter, which reduces the amount of Heparin needed in the line. Used mainly for pediatric patients.

 

  • Peripherally inserted central catheter (PICC) is a 20-24 inch soft IV line, which is inserted in the patient’s arm and threaded into the heart. These catheters come in single or double lumens.

 

Certification Requirements:

 

  • Maintain knowledge of the indications, contraindications, technique, and possible complications of the procedure. Assessment of this knowledge may be accomplished via quality assurance mechanisms, classroom demonstrations, skills stations, or other mechanisms as deemed appropriate by the local EMS System.