8
Caution: Use aseptic techniques whenever the catheter lumen is opened or connected to other devices.
WARNING: Alcohol should not be used to lock, soak or declot polyurethane PICCs because alcohol is known to
degrade polyurethane catheters over time with repeated and prolonged exposure.
C.
Occluded or Partially Occluded Catheter
Catheters that present resistance to flushing and aspiration may be partially or completely occluded. Do not flush against
resistance. If the lumen will neither flush nor aspirate and it has been determined that the catheter is occluded with
blood, a declotting procedure per institution protocol may be appropriate.
17. Central Venous Pressure Monitoring (CVP)
Prior to conducting central venous pressure monitoring:
A.
Ensure proper positioning of the catheter tip.
• Flush catheter vigorously with sterile saline.
• Ensure the pressure transducer is at the level of the right atrium.
• It is recommended that a continuous infusion of sterile saline (3 mL/hr) is maintained through the catheter while
measuring CVP to improve accuracy of CVP results.
B.
Use your institution’s protocols for central venous pressure monitoring procedures.
WARNING: CVP Monitoring should always be used in conjunction with other patient assessment metrics when
evaluating cardiac function.
18. Catheter Removal
A.
Remove dressing and StatLock® stabilization device or tape securement strips.
Caution: Do not use scissors to remove dressing to minimize the risk of cutting catheter.
B.
Grasp catheter near insertion site.
C.
Remove slowly. Do not use excessive force.
D.
If resistance is felt, stop removal. Apply warm compress and wait 20-30 minutes.
E.
Resume removal procedure.
F.
Examine catheter tip to determine that the entire catheter has been removed.
19. Catheters with Sherlock™ Tip Location System Stylet
Indications for Use: Catheter stylets provide internal reinforcement to aid in catheter placement. The Sherlock™ TLS Stylet
contains passive magnets that generate a magnetic field. This field can be detected by the Sherlock™ TLS Detector to provide
the placer rapid feedback on catheter tip location.
Description: The Sherlock™ TLS stylet is made of specially-formulated materials designed to aid in the placement of central
venous catheters. The stylet material provides internal reinforcement to aid in catheter placement. In addition, the Sherlock™
TLS stylet may be used with the detector to provide catheter tip placement information during the insertion procedure.
Note: The Sherlock™ TLS stylet may be used with patients who have cardiac rhythm devices (e.g. pacemakers and defibrillators)
implanted. When a cardiac rhythm device is present, it is recommended that the Sherlock™ TLS stylet be placed on the
contralateral side.
Modification of Catheter Length when Using PICC with Sherlock™ TLS Stylet
Note: Catheters can be cut to length if a different length is desired due to patient size and desired point of insertion. Catheter
depth markings are in centimeters.
A.
Measure the distance from the insertion site (zero mark) to the desired tip location.
B.
Loosen the T-lock connector/stylet assembly from the luer hub.
C.
Withdraw the entire T-lock connector/stylet assembly as one unit.
D.
Retract the stylet well behind the catheter cut location.
E.
Using a sterile trimming device (e.g. scalpel, scissors, etc.) carefully cut the catheter.
Caution: The stylet or stiffening wire needs to be well behind the point the catheter is to be cut. NEVER cut the stylet or
stiffening wire.
F.
Inspect cut surface to assure there is no loose material.
G.
Re-advance the T-lock connector/stylet assembly locking the connector
to the luer hub. Assure stylet tip is intact.
H.
Gently retract the stylet through the locked T-lock connector until the
stylet tip is contained inside the catheter.
I.
Prior to insertion, ensure that the stylet tip is contained inside and
within the catheter but not more than 1 cm from the trimmed end of
the catheter. [See Figure 1]
WARNING: Ensure that the stylet tip does not extend beyond the
trimmed end of the catheter. Extension of the stylet tip beyond the
catheter end, combined with kinking and excessive forces may result in
vessel damage, stylet damage, difficult removal, stylet tip separation, potential embolism and risk of patient injury. [See
Figure 2]
Caution: The detector identifies the position of the stylet tip. Ensure that the stylet tip remains inside and within 1 cm
from the end of the catheter tip. Failure to do so could result in catheter malposition. [See Figure 3]
Figure 1
Correct
1 cm
Incorrect
Figure 2
1 cm
Incorrect
Figure 3
1 cm
