Page 215 - 2026 SMOG

VASCULAR ACCESS VIA CENTRAL CATHETERS
Clinical Indications
• In the presence of a life-threatening condition, with clear indications for immediate use of
medication or fluid bolus. (Not for prophylactic IV access)
Contraindications
• Suspected infection at the skin site
Procedure
• Determine the type of catheter present: PICC, Broviac, Hickman, Groshong, Mediport, etc.
Procedure for peripherally inserted central catheter (Cook, NeoPICC, etc.) and tunneled
catheter (Broviac, Hickman, Groshong, etc.):
• Prepare equipment:
˚ 2–3 10mL prefilled syringes of 0.9% NaCl
Sterile gloves (if available)
˚
• If more than one lumen is available (PICCs, Hickmans, and Broviacs can have one, two, or
three lumens), select the largest lumen available
• Vigorously cleanse the cap of the lumen with chlorhexidine or a 70% alcohol prep pad, and
allow to dry
• Unclamp the selected catheter lumen and, using a prefilled 10mL syringe:
˚ Vigorously flush the catheter using a pulsating technique and maintaining pressure at the end
of the flush to prevent reflux of fluid or blood
˚ If the catheter does not flush easily (note that a PICC line will generally flush more slowly
and with greater resistance than a typical intravenous catheter), reclamp the selected lumen
and attempt to use another lumen (if present)
˚ If unable to flush any of the lumens, the catheter cannot be used
• Attach the primed IV administration set and observe for the free flow of IV fluid
**Document procedure, results, and vital signs.**
Procedure for Implanted Catheter (PortaCath, P.A.S. Port, or Medi-Port)
• Prepare all necessary equipment:
˚ Non-coring, right-angle needle specific for implanted vascular access ports
˚ 2–3 prefilled 10mL syringes of 0.9% NaCl
˚ Sterile infusion port cap
˚ Sterile gloves (if available)
Sterile occlusive dressing large enough to completely cover the insertion site
˚
• Identify the access site, usually located in the chest
• Vigorously cleanse the cap of the lumen with chlorhexidine or a 70% alcohol prep pad, and
allow to dry
• Attach the infusion port cap to the end of the non-coring, right-angle needle tubing
• Prime the non-coring needle with attached tubing with saline using one of the prefilled 10mL
syringes. Leave the syringe attached to the tubing
• Palpate the port to determine the size and center of the device
• Secure the access point port firmly between two fingers and firmly insert the non-coring needle
into the port, entering at a direct 90° angle
(continues)

2026 Standard Medical Operating Guidelines (SMOG) • 207