Tunneled Central Venous Catheter Flushing Guide

A tunneled central venous catheter should be flushed after medicines, intravenous fluids, or nutrition have been given. Flushing the catheter helps prevent blood and medicine residue from collecting in the catheter and clogging it. The following are instructions to flush your tunneled central venous catheter. Your caregiver may also give you additional flushing instructions.

GENERAL TUNNELED CENTRAL VENOUS CATHETER FLUSHING INFORMATION

  • If possible, another person should help you when flushing the catheter. Always wash your hands before touching or flushing the catheter.

  • Each access (lumen, port) of the catheter has a clamp. Open the clamp to flush the catheter or when infusions are being given. Keep the clamp closed when the catheter is not in use.

  • Do not use force to flush the catheter.

  • Do not use a small diameter syringe such as a 3 mL syringe to flush the catheter. Flushing the catheter with a small diameter syringe can burst the catheter. A 10 mL syringe should be used when flushing the catheter.

  • Do not use a sharp-edged clamp (hemostat) to clamp the catheter.

  • If the catheter has heparin instilled in the line, the heparin should be removed before using the catheter. The heparin helps the catheter from becoming clogged when it is not used on a regular basis.

WITHDRAWING HEPARIN FROM THE TUNNELED CENTRAL VENOUS CATHETER

  • When the tunneled central venous catheter is not used for long periods of time, heparin may be injected into the catheter lumen(s) and left to "dwell" until it is used again.

  • If heparin has been instilled in the catheter, the heparin must be removed before it can be used. The following are steps to remove heparin from the tunneled central venous catheter:

  • Gather the appropriate supplies as told by your caregiver.

  • Wash your hands thoroughly with soap and water.

  • Put on clean gloves.

  • Vigorously scrub the injection cap for 15 seconds with an alcohol prep pad.

  • Unclamp the catheter.

  • Attach an empty 10 mL syringe to the injection cap. Pull back on the syringe plunger and withdraw 10 milliliters of blood. This is considered a "waste" withdrawal. Dispose the "waste" syringe into an appropriate waste container.

  • Rescrub the injection cap for 15 seconds with an alcohol prep pad.

  • Attach a prefilled 10 mL normal saline syringe to the injection cap. Flush the catheter with normal saline to clear away the blood in the catheter. The catheter can now be used for medicines, intravenous fluids, and nutrition.

  • Follow your caregiver's advice regarding when the tunneled central venous catheter should be flushed with heparin.

FLUSHING THE TUNNELED CENTRAL VENOUS CATHETER WITH NORMAL SALINE

  • Normal saline is used to flush the catheter before and after medicines, intravenous fluids, and nutrition are given. It is important to check for a blood return before using the catheter. A blood return is checked to ensure the catheter is open (patent) and is not clogged. The following are instructions to check for a blood return and flush the catheter with normal saline.

  • Gather the appropriate supplies to flush the catheter as instructed by your caregiver.

  • Wash your hands thoroughly with soap and water.

  • Put on clean gloves.

  • Vigorously scrub the injection cap for 15 seconds with an alcohol prep pad.

  • Unclamp the catheter.

  • Attach a 10 mL prefilled normal saline syringe to the injection cap. Flush 5 milliliters of normal saline into the catheter. Pull back on the attached syringe until you see blood in the catheter. When blood is identified in the catheter, flush the catheter with the remaining normal saline.

  • The catheter can now be used for medicines, intravenous fluids, and nutrition.

  • After medicines, intravenous fluids, or nutrition have been given, be sure to flush the catheter with 10 milliliters of normal saline.

TROUBLESHOOTING THE TUNNELED CENTRAL VENOUS CATHETER

  • If you cannot flush the catheter, check to make sure the catheter is unclamped.

  • The injection cap may need to be changed if blood cannot be completely cleared from the cap or if there is a crack in the injection cap.

  • If the catheter is difficult to flush, flush the catheter with 10 milliliters of normal saline using a "pulsing" flush method.

  • If you do not see blood when you pull back the syringe plunger, change your body position. This can include raising your arms above your head or taking a deep breath and cough. Pull back on the plunger again. If there is still no blood return, flush with a small amount of saline and change positions, take a deep breath, or cough again. Pull back on the plunger again. If there is still no blood return, finish injecting the normal saline. Disconnect the syringe and clamp the catheter.

  • If you cannot get a blood return or the catheter continues to be difficult to flush, it is very important to contact your caregiver. The catheter may be clogged. Your caregiver can troubleshoot and fix problems with the catheter.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You notice redness, swelling, pain, or have any type of drainage at or around the catheter insertion site.

  • Your catheter is difficult to flush, or you cannot flush the catheter.

  • You cannot get a blood return from the catheter.

  • Your catheter leaks when flushed or when fluids are infused into it.

  • There are cracks or breaks in the catheter.

  • You have swelling on the arm nearest to the catheter.

  • You have an unexplained fever.