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Cautions:
1.
Check ingredients of prep sprays and swabs before using.
Some disinfectants used at catheter insertion site contain
solvents which can attack the catheter material. Alcohol
and acetone can weaken the structure of polyurethane
materials. These agents may also weaken the adhesive
bond between catheter stabilization device and skin.
• Acetone: Do not use acetone on catheter surface.
• Alcohol: Do not use alcohol to soak catheter surface or
to restore catheter patency.
Take care when instilling drugs containing high
concentration of alcohol. Allow insertion site to dry
completely prior to applying dressing.
2.
Ensure catheter patency prior to injection. Do not use
syringes smaller than 10 mL (a fluid filled 1 mL syringe can
exceed 300 psi), to reduce risk of intraluminal leakage or
catheter rupture.
3.
Remove catheter clamp and fastener (where provided)
prior to attempting a catheter exchange procedure.
4.
Do not exert excessive force while removing the catheter,
to minimize the risk of catheter breakage.
5.
Continuously monitor indwelling catheter for:
• desired flow rate
• security of dressing
• adherence of stabilization device to skin and
connection to catheter
• correct catheter position; use centimeter markings to
identify if catheter position has changed
• secure Luer-Lock connection(s)
6.
Minimize catheter manipulation throughout procedure to
maintain proper catheter tip position.
7.
Inject a small amount of radiopaque dye to locate
catheter tip if difficulty is encountered in visualizing the
catheter tip.
Guidewire / SWG Warnings and Precautions
Warnings:
1.
Do not cut guidewire to alter length.
2.
Do not withdraw guidewire against needle bevel to reduce
risk of possible severing or damaging of guidewire.
3.
Do not use excessive force when introducing guidewire
or tissue dilator as this can lead to vessel perforation and
bleeding.
4.
Passage of guidewire into the right heart can cause
dysrhythmias, right bundle branch block, and a
perforation of vessel, atrial, or ventricular wall.
5.
Do not apply undue force on guidewire to reduce risk of
possible breakage.
6.
Do not apply excessive force in removing guidewire or
catheter. If withdrawal cannot be easily accomplished, a
visual image should be obtained and further consultation
requested.
7.
Do not cut guidewire with scalpel.
• Position cutting edge of scalpel away from guidewire.
• Engage safety and/or locking feature of scalpel (where
provided) once cutaneous puncture site is enlarged,
to reduce risk of cutting the guidewire (refer to
Figure 27).
8.
Do not aspirate with guidewire in place or air will enter
syringe.
Caution:
1.
Maintain a firm grip on guidewire at all times. Keep
sufficient guidewire length exposed at hub for handling
purposes. A non-controlled guidewire can lead to wire
embolism.
2.
If resistance is encountered when attempting to remove
guidewire after catheter placement, guidewire may
be kinked about tip of catheter within vessel (refer to
Figure 28).
Tissue Dilator Warnings
Warnings:
1.
Do not leave tissue dilator in place as an indwelling
catheter. Leaving tissue dilator in place puts patient at risk
for possible vessel wall perforation.
2.
Do not use excessive force when introducing guidewire
or tissue dilator as this can lead to vessel perforation and
bleeding.
Possible Complications
cardiac tamponade secondary to vessel wall, atrial or
♦
ventricular perforation
pleural injury
♦
air embolism
♦
catheter embolism
♦
bleeding / hemorrhage
♦
bacteremia
♦
thrombosis
♦
hematoma
♦
fibrin sheath formation
♦
vessel erosion
♦
CVC |
:
(but not limited to)
mediastinal injury
♦
nerve injury
♦
thoracic duct laceration
♦
occlusion
♦
septicemia
♦
inadvertent arterial puncture
♦
dysrhythmias
♦
exit site infection
♦
catheter tip malposition
♦
3
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