5

Incenter Hemodialysis Policies & Procedures
DaVita HealthCare Partners Inc.
Procedure: 1-04-02A
Printed copies are for reference only. Please refer to the electronic copy for the latest version.
TITLE:
CENTRAL VENOUS CATHETER (CVC) PROCEDURE
_____________________________________________________________________________________________
Materials required:
Standard Initiation and Dressing Change CVC Kit or the following supplies
o 2 non-occlusive sterile gauze pads
o 4 Large Alcohol Prep Pads
o Germicidal/antiseptic solution or swab
o Single use tape
o 2 - 10 ml syringes without needle
o 2 - 10 ml syringes with needle
o 2 - Face Masks
o 1- clean, moisture proof barrier
o Antibiotic ointment, if prescribed
TEGO Connector Initiation and Dressing Change kit, if applicable, materials include the
above standard initiation and dressing change CVC kit plus the following items
o 4 - Large Alcohol Prep Pads
o 2 - TEGO connectors
Termination Kit
o 1 - clean, moisture proof barrier
o 2 - Face Masks
o 2 - 10 ml syringes with needle
o 3 - Large Alcohol Prep Pads
o 1 - non-occlusive sterile gauze pad
2- Sterile CVC end caps, if applicable
PPE-personal protective equipment (face protection, including face mask, gloves, fluid
resistant/fluid impervious barrier garment)
NOTES:
DaVitas standard of care includes utilization of 2% Chlorhexidine/70%

Alcohol swab. If these agents are contraindicated for a patient, the physician
will prescribe an agent for the individual patient and individual supplies will
be used in place of the CVC kit, per manufacturers recommendations.
Property of DaVita HealthCare Partners Inc.

Confidential and Copyrighted 2007-2015
Origination Date: September 2007
Revision Date: June 2008, March 2011, September 2011, March 2013, March 2014, September 2014, March 2015
Page 1 of 9
Procedure: 1-04-02A

Device
Disinfectant
and Skin
Antiseptic
Effective for:
2%
Only CVC
Chlorhexidine access exit site
Gluconate/70%
Only skin
Isopropyl
Alcohol
70% Alcohol Only CVC caps
pad
Only CVC
lines
Procedure: 1-04-02A
Effective Volume
Effective
Contact
Time
Air
Drying
Time
1 prepackaged swab
30 seconds
60
seconds
1 LARGE pad per limb
60 second
scrub
None
NOTE: Throughout this procedure, minimize catheter manipulation to avoid trauma to exit site.
Procedure
Rationale
1.
Perform hand hygiene.

PPE.
2.
Use Dialysis Precautions and

aseptic technique throughout
procedure.
Set-up clean field with supplies.
Instruct patient to turn head to
opposite side of CVC exit site.
Patient and teammate will wear
face masks covering the nose and
mouth during catheter procedure.
3.
4.
5.
Put on 1.
2.
3.
4.
5.
6.
Place patient in comfortable 6.

supine position.
Then place
barrier under catheter to prevent
contamination.
7.
Remove old dressing and discard.
Hand hygiene protects patient and

teammate from cross contamination. PPE
is worn to protect teammate.
Reduces risk of infection to patient,
teammate and others.
Decreases the risk of aerosolized bacteria

contaminating site.
These measures are vital to preventing the
exposure of the catheter and exit site to
nasal droplets and infectious bacteria such
as methicillin resistant Staph aureus
(MRSA).
Supine position increases blood flow
through catheter and diminishes risk of air
embolism. Teammate is to be positioned
for comfortable access to the CVC without
leaning over the patient.
7.

Page 2 of 9
Procedure: 1-04-02A

8.
9.
10.
11.
12.
13.
14.
Observe site for signs and

symptoms of infection such as
redness, drainage, swelling or
pain. If present, report to RN/MD.
If drainage is present, obtain order
for exit site culture.
Observe CVC at exit site for
evidence of cuff migration, cracks,
or leaks in the catheter limbs. If
present, do not initiate dialysis.
Report to MD for further followup.
Clamp both arterial and venous
catheter limbs.
Remove gloves and discard.
Perform hand hygiene per
procedure and re-glove.
Procedure: 1-04-02A
8.
Culture may be collected prior to

obtaining physician order, however,
culture should be sent to laboratory only
with a physicians order.
9.
If there is evidence of cuff migration,

cracks, or leaks initiation of dialysis may
cause harm to the patient due to
misalignment of catheter, possible air
embolism and/or possible contamination.
10.
Prevents blood loss or air embolus.
11.
As outlined in policy: 1-05-01 Infection

Control for Dialysis Facilities 0907 rev0914,
alcohol based hand rubs may be used
unless hands are visibly contaminated.
Hand washing will be performed if hands
are visibly contaminated with blood or
bodily fluids.
Effective
contact
time
for
2%
Chlorhexidine Gluconate/70% Isopropyl
Alcohol is 30 seconds and dry time is 60
seconds.
Holding catheter with the non- 12.

dominant hand and using aseptic
technique, clean exit site with 2%
Chlorhexidine
Gluconate/70%
Isopropyl Alcohol swab for a
minimum of 30 seconds, apply to
the CVC exit site in a back and
forth pattern, using gentle friction
progressing from the insertion site
to the periphery using both sides
of the swab.
Then wait 60
seconds for air dry time.
If site is not free of exudates, 13.
repeat this step with new 2%
Chlorhexidine
Gluconate/70%
Isopropyl Alcohol swab.
Clean each CVC limb with a new 14.
alcohol prep pad. Starting close to
the exit site and down to the
TEGO connector or cap.

Page 3 of 9
Procedure: 1-04-02A

15.
Remove gloves and discard, 15.

perform hand hygiene per
16.
Apply antibiotic ointment to exit

site, if prescribed.
Place sterile 2x2 gauze over the
catheter
exit
site
leaving
connections accessible.
Seal
edges of gauze with tape; limiting
the amount of tape on the limbs as
it may leave adhesive residue
which attracts biologic materials
and microbes.
Apply label to the dressing
indicating:
Date dressing change was
performed
Initials of TM performing
procedure
Perform hand hygiene per
17.
18.
19.
Procedure: 1-04-02A

bodily fluids.
16.
17.
18.
19.

bodily fluids.
20.
Scrub CVC TEGO connectors or 20.

caps with LARGE alcohol prep
pad, one (1) per limb for 60
seconds.
21.
Place sterile 4x4 gauze pad under 21.
Verify cleaned CVC limbs and TEGO
catheter limbs while removing the
connectors or end caps are not in contact
alcohol prep pad
with or placed on a non-sterile surface(s).
For patients using TEGO:
If performing TEGO connector change, proceed with steps 22-24.
If not performing TEGO connector change, proceed to step 25.

IF no TEGO connector is prescribed, proceed with step 22 and 25 only (skip steps 23, 24)

Page 4 of 9
Procedure: 1-04-02A

22.
Remove each CVC lumen TEGO 22.

connector or end cap one at a time
and disinfect the hub with a new
alcohol prep pad for each hub.
Scrub the sides, threads and end of
hub thoroughly with friction
making sure to remove any
residue, for example blood. Allow
to air dry.
Procedure: 1-04-02A
Silicone connector cap device (TEGO)

may remain luer locked on CVC lumen
for seven (7) days unless signs of cap
fatigue or failures such as cracks, leaking,
etc. appear.
Verify open lumen is not placed on a nonsterile surface and minimize the time it is
open.
Allowing the hubs to air dry after
disinfection prevents the alcohol from
acting as an adhesive to the TEGO.
23.
24.
25.
26.
27.
28.
Remove protective cover from

male end of TEGO device and
secure onto arterial and venous
catheter limbs.
Swab each TEGO connector with
an alcohol prep pad.
Then attach a sterile 10 ml syringe
to the arterial and venous limb.
Aspirate an amount greater than
the catheter limb lumen, generally
about 5 ml from each limb.
Proceed to step 30 if both limbs
are patent. If they are not patent,
proceed with step 27.
If unable to aspirate from either
arterial or venous limb, attach a 10
ml saline filled syringe to affected
limb and gently infuse saline. Reattempt to aspirate.
If able to infuse saline into arterial
limb but unable to aspirate, check
venous limb for patency.
If
venous limb is patent, use venous
limb for arterial source for this one
(1) treatment only. Notify the
physician of access insufficiency.
23.
Immediately securing silicone connector

cap device (TEGO) to CVC lumen
decreases contamination risks.
24.
25.
26.
27.
Excessive pressure should be avoided

since such force could cause rupture of the
catheter or expulsion of a clot into the
circulation.
28.

Page 5 of 9
Procedure: 1-04-02A

29.
30.
Procedure: 1-04-02A
If unable to infuse or aspirate from 29.

arterial limb, check venous limb
for patency, DO NOT use catheter.
Notify physician.
Refer to
procedure: 1-06-11A Administration of
Cathflo Activase 0308 rev01013.
Draw lab specimens if applicable. 30.
Refer to procedure: 1-08-02B
Obtaining Blood Specimens from Central
Venous Catheters (CVC) 0907 rev0914.
31.
35.
Aseptically
discard
syringe
containing indwelling solution
from arterial limb and attach a
saline filled syringe. Repeat step
for venous limb.
Unclamp and flush each limb with
saline and re-clamp.
Attach heparin loading dose to
venous limb, as applicable.
Unclamp and gently flush back
and forth 3-5 times into catheter.
Re-clamp.
After 5 minutes, remove syringes
from access ports while attaching
blood lines carefully, as not to
contaminate blood line tips or
catheter limbs.
Secure connections.
35.
36.
Initiate dialysis per procedure.
36.
32.
33.
34.
31.
32.
33.
DO NOT initiate dialysis for 5 minutes

after heparin administration to allow
heparin to circulate systemically.
34.
UPON COMPLETION OF DIALYSIS

37.
Perform hand hygiene

per 37.

bodily fluids.
38.
Set-up clean field with supplies.
38.

Page 6 of 9
Procedure: 1-04-02A

39.
If using Streamline blood line

39.
saline infusion line LockSite to
draw up normal saline flushes and
the sterility cap is not in place on
the saline infusion line LockSite;
it must be disinfected prior to use
by:
a. Placing an alcohol prep pad
over the opening on the saline
infusion line LockSite;
b. Inserting the cap probe into
the saline infusion line LockSite,
pushing the alcohol prep pad down
firmly into the saline infusion line
LockSite socket;
c. Pressing firmly and rotating for
30 seconds;
d. Removing cap probe and
discarding alcohol prep pad.
OR
If using Y port on saline infusion
line and sterile cap has been
removed, clean Y port with an
alcohol prep pad for 30 seconds.
40.
Aseptically draw normal saline 40.

flushes from Y port or LockSite.
Recap syringes.
Instruct patient to turn head to 41.
opposite side of CVC exit site.
Patient and teammate will wear
face masks covering nose and
mouth.
41.
42.
Place patient in comfortable 42.

supine position. Discard initiation
barrier and place new barrier
under
catheter
to
prevent
contamination.
Procedure: 1-04-02A
Decreases the risk of aerosolized bacteria

contaminating site. These measures are
vital to preventing the exposure of the
catheter and exit site to nasal droplets and
infectious bacteria such as methicillinresistant staph aureus (MRSA).
Supine position increases blood flow
through catheter and diminishes risk of air
embolism. Teammate is to be positioned
for comfortable access to the CVC without
leaning over the patient.

Page 7 of 9
Procedure: 1-04-02A

43.
Perform hand hygiene

44.
Scrub CVC limbs at blood line 44.

connection with LARGE alcohol
prep pad, one (1) per limb for 60
seconds.
45.
Place sterile 4x4 gauze pad under 45.

scrubbed limbs with blood line
connections while removing the
alcohol prep pad.
Clamp arterial catheter limb and
46.
blood line. Disconnect arterial
blood line from arterial CVC limb.
Attach a 10 ml syringe filled with
normal saline. Push normal saline
into arterial port. If using TEGO
leave a small amount of fluid (0.10.5 ml) in the tip of the syringe.
Then quickly clamp arterial limb.
Attach arterial blood line to saline
infusion line and conclude dialysis
and rinse back per procedure:
Termination of Dialysis applicable
to your blood lines and dialysis
delivery system.
Clamp venous catheter limb and
47.
blood line. Aseptically disconnect
venous blood line and connect 10
ml syringe with normal saline to
the venous catheter limb.
46.
47.
per 43.
Procedure: 1-04-02A

bodily fluids.
CVC limbs may be a source of
contamination and must be disinfected
prior to opening the clamped CVC
lumens.
This is a CDC/HICPAC
recommendation.
Verify cleaned CVC limbs with attached
blood line connections are not in contact
with or placed on a non-sterile surface(s).
Creates positive pressure in the catheter
limbs and removes residual blood from
catheter wall.
For TEGO: Leaving a small amount of
fluid in the tip of the syringe prevents the
syringe from bottoming out and causing
any reflux or rebound effect.
Prevents blood loss or air embolus.

Page 8 of 9
Procedure: 1-04-02A

48.
49.
50.
51.
52.
53.
Push normal saline into venous

48.
port. If using TEGO leave a small
amount of fluid (0.1-0.5 ml) in the
tip of the syringe. Then quickly
clamp venous catheter limb.
Remove normal saline syringes
and proceed to step 51.
If using end caps, remove normal
saline syringes and connect
syringe appropriate for catheter
lumen volume with prescribed
locking solution to each catheter
limb one at a time and instill
solution.
Remove
prescribed
locking
solution syringes and disinfect the
hub with a new alcohol prep pad
for each hub. Scrub the sides,
threads and end of hub thoroughly
with friction making sure to
remove any residue, for example
blood. Apply sterile CVC cap to
each catheter limb one at a time.
Label catheter limbs by either
wrapping with gauze per patient
comfort
and
then
placing
medication label on the outside of
the gauze or by placing a label
with the following information on
the CVC dressing::
Name and dose of prescribed
locking solution per lumen
Date and initials of teammate
performing procedure
Remove gloves and wash hands.
Document findings and procedure
in patients treatment record.
49.
Procedure: 1-04-02A
Creates positive pressure in the catheter

limbs and removes residual blood from
catheter wall.
For TEGO: Leaving a small amount of
fluid in the tip of the syringe prevents the
syringe from bottoming out and causing
any reflux or rebound effect.
Syringes should be no smaller than a 5 ml
size due to the increased pressure exerted
by a smaller syringe, which may rupture
the catheter.
50.
Accidental piercing of the catheter could

lead to infection and/or air embolism. At
no time should prescribed locking solution
be injected via a needle inserted through
the CVC cap.
51.
Allows subsequent caregiver to identify

date and dose of locking solution
instillation.
Not placing a label on the CVC limbs
directly prevents adhesive residue which
attracts biologic materials and microbes.
52.
Hand washing protects patient and

teammate from cross contamination.
53.

Page 9 of 9
Procedure: 1-04-02A

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Incenter Hemodialysis Policies & Procedures

DaVita HealthCare Partners Inc.

CENTRAL VENOUS CATHETER (CVC) PROCEDURE

DaVitas standard of care includes utilization of 2% Chlorhexidine/70%

Property of DaVita HealthCare Partners Inc.

Incenter Hemodialysis Policies & Procedures

1 LARGE pad per limb

Perform hand hygiene.

Use Dialysis Precautions and

Place patient in comfortable 6.

Remove old dressing and discard.

Hand hygiene protects patient and

Decreases the risk of aerosolized bacteria

Property of DaVita HealthCare Partners Inc.

Incenter Hemodialysis Policies & Procedures

Observe site for signs and

Culture may be collected prior to

If there is evidence of cuff migration,

Prevents blood loss or air embolus.

As outlined in policy: 1-05-01 Infection

Holding catheter with the non- 12.

Property of DaVita HealthCare Partners Inc.

Incenter Hemodialysis Policies & Procedures

Remove gloves and discard, 15.

Apply antibiotic ointment to exit

As outlined in policy: 1-05-01 Infection

As outlined in policy: 1-05-01 Infection

Scrub CVC TEGO connectors or 20.

If performing TEGO connector change, proceed with steps 22-24.

If not performing TEGO connector change, proceed to step 25.

Property of DaVita HealthCare Partners Inc.

Incenter Hemodialysis Policies & Procedures

Remove each CVC lumen TEGO 22.

Silicone connector cap device (TEGO)

Remove protective cover from

Immediately securing silicone connector

Excessive pressure should be avoided

Property of DaVita HealthCare Partners Inc.

Incenter Hemodialysis Policies & Procedures

If unable to infuse or aspirate from 29.

Initiate dialysis per procedure.

DO NOT initiate dialysis for 5 minutes

UPON COMPLETION OF DIALYSIS

Perform hand hygiene

As outlined in policy: 1-05-01 Infection

Set-up clean field with supplies.

Property of DaVita HealthCare Partners Inc.

Incenter Hemodialysis Policies & Procedures

If using Streamline blood line

Aseptically draw normal saline 40.

Place patient in comfortable 42.

Decreases the risk of aerosolized bacteria

Property of DaVita HealthCare Partners Inc.

Incenter Hemodialysis Policies & Procedures

Perform hand hygiene

Scrub CVC limbs at blood line 44.

Place sterile 4x4 gauze pad under 45.

As outlined in policy: 1-05-01 Infection

Prevents blood loss or air embolus.

Property of DaVita HealthCare Partners Inc.

Incenter Hemodialysis Policies & Procedures

Push normal saline into venous