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right atrium and parallel to the vessel wall. X-ray examination
should be used to ensure that the catheter is not in the right
atrium or ventricle.
2.
Caution. If blood is observed within the saline circuit, stop the
procedure and perform the check for a catheter leak.
3.
Possible complications with central venous catheters include: atrial
or ventricular perforation, cardiac tamponade, air embolism,
catheter embolism, thoracic duct laceration, bacteremia,
septicemia, thrombosis, inadvertent arterial puncture, hematoma
formation, hemorrhage, nerve damage and dysrhythmias.
4.
All Luer-Lock connections and covers must be securely tightened
to prevent air embolism or fluid or blood loss.
5.
Never use excessive force in moving the catheter or guidewire. If
resistance is encountered, an x-ray should be performed to
identify the reason for the resistance.
6.
Passage of the guidewire into the right heart can cause
dysrhythmias, right bundle branch block, vessel wall, atrial or
ventricular perforation.
7.
Use only sterile normal saline for catheter priming. It is the
circulating fluid in the catheter.
8.
The catheter should be routinely inspected for flow rate, security
of dressing, correct catheter position, and for secure Luer-Lock
connections. Use the centimeter markings to identify if the
catheter position has changed. A potential risk associated with
multi-lumen balloon catheters is a lack of therapy, including
failure to infuse drug therapy through the infusion lumens.
9.
Only x-ray examination can ensure that the catheter tip has not
entered the heart or no longer lies parallel to the vessel wall. If the
catheter position has changed, perform an x-ray examination to
confirm the catheter tip position.
10. For blood sampling, temporarily shut off the remaining infusion
ports through which solutions are being infused.
11. Use only a 30 cc or smaller syringe for blood sampling.
12. Alcohol and acetone can weaken the structure of the shaft
material. Care should therefore be taken when infusing drugs
containing alcohol or when using alcohol or acetone when
performing routine catheter care and maintenance. Alcohol
should not be used to declot the catheter.
13. Use only the ZOLL suture tab and clip provided in the kit to
prevent catheter damage.
14. Use of a syringe smaller than 10 ml to irrigate or declot an
occluded catheter may cause intraluminal leakage or catheter
rupture.
15. Do not infuse into the orange IN and OUT Luer-Lock connections,
as this will result in lack of therapy.
16. Fever may have infectious and/or non-infectious causes in
patients. Mitigation of fever as a sign of possible infection
necessitates daily, meticulous assessment for other signs of
infection.
17. Use care when infusing drugs that may be affected by cool
temperatures (as low as 4°C). Solutions containing mannitol are
temperature-sensitive and must not be delivered through the
catheter except for a rapid push of a solution of up to 20%
mannitol, followed by a saline flush. Higher than a 20%
concentration of mannitol drip or infusion pump delivery of
mannitol must be done via a separate line.
18. Cardiac Tamponade: Placement of indwelling catheters in the
right atrium is a practice that may lead to cardiac perforation and
tamponade. Practitioners placing central venous catheters must be
aware of this potentially fatal complication before advancing the
catheter too far relative to patient size. The actual position of the
tip of the indwelling catheter should be confirmed by x-ray after
insertion. Central venous catheters should not be placed in the
right atrium unless specifically required for special relatively short
term procedures, such as aspiration of air emboli during
neurosurgery. Such procedures are nevertheless risk-prone and
should be closely monitored and controlled.
19. The catheter is coated with heparin. This may induce or aggravate
pre-existing heparin-induced thrombocytopenia (HIT).
4/143
20. WARNING.When connecting infusion sets/injection systems to the
catheter, do not exceed 100 psi/689 kPa.
21. For patients being made hypothermic, the hypothermia itself may
exacerbate some disease states. Care should be taken to properly
monitor patient homeostasis during hypothermia.
•
Cardiac rhythm disturbances–both bradycardia and ventricu-
lar tachyarrhythmia.
•
Clotting and coagulations function. Patients at risk for distur-
bances of their clotting or coagulation function should be
closely monitored during hypothermia.
•
Blood gas and pH analysis. Hypothermia modifies resting pH
and PaCO
. Physicians should be aware of the effect of tem-
2
perature upon the result.
•
Prolonged hypothermia depresses the immune response and
lung function.
t^okfkdK=fåíê~äìãáå~ä=çê=Ä~ääççå=äÉ~â~ÖÉK Intraluminal leakage
(between the saline lumen and infusion lumens) or balloon leakage is a
potential catheter failure mode. In the event of such a failure, sterile
saline from the cooling circuit is introduced into the patient. Intralumi-
nal leakage or balloon leakage is typically associated with a fluid loss
alarm once the saline bag has been depleted and stops the system.
^äï~óë=áåîÉëíáÖ~íÉ=ÑäìáÇ=äÉîÉä=~ä~êãëK The cooling circuit is a closed
loop system – usually fluid loss alarms indicate a breach somewhere in
this closed loop. With any fluid loss alarm, check both the integrity of
the catheter and the Start-Up Kit (see below).
t^okfkdK=If you notice a depleted saline bag or an air trap alarm, do
not replace the saline bag prior to identifying the location of the leak
and taking the appropriate mitigation. Check for system leaks accord-
ing to the instructions in the Check for a Start-Up Kit leak and Check
for a catheter leak sections below. (Note that a leak could be external or
internal.)
Replacing the saline bag repeatedly without investigating the leak or
loss of saline may result in unintended infusion of saline into the
patient. Saline infusion may lead to the following adverse effects: local
swelling that can cause subsequent local tissue damage; systemic fluid
overload that can lead to dependent edema and subsequent skin
breakdown; internal organ fluid overload, with subsequent overloading
of the brain, lungs or heart. In some cases, this fluid overload may lead
to life threatening events.
`~ìíáçåK=The console emits an alarm when the saline bag is empty. The
bag must be completely empty and additional saline must have drained
between the saline spike and the air trap for the saline level in the air
trap to drop sufficiently to trigger the alarm.
`ÜÉÅâ=Ñçê=~=pí~êíJré=háí=äÉ~â
1.
Check the air trap for condensation. If the air trap shows signs of
condensation, wipe the air trap and reinstall it in the console. In
the case of an air trap alarm, verify that the air trap alarm is
cleared after this step.
2.
Carefully check the saline path from the saline bag to the console
for any leaks. Check if there is saline on the floor, console, or the
patient's bed.
3.
If there is any saline on the floor, console, or the patient's bed,
check that the Luers on the catheter and Start-Up Kit are not
cracked or damaged and that the connections are tight enough to
prevent leaks.
4.
If you find a leak in the Start-Up Kit, replace the Start-Up Kit and
see if there is also a leak in the catheter.
5.
If you do not find a leak in the Start-Up Kit, there is likely a leak in
the catheter. Investigate further.
`ÜÉÅâ=Ñçê=~=Å~íÜÉíÉê=äÉ~â
1.
Disconnect the Start-Up Kit from the catheter. Properly cap both
the catheter and Start-Up Kit using an aseptic technique.
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