What is the proper technique and rate for administering medication through a central line (central venous catheter)?

Proper Technique and Rate for Medication Administration Through a Central Line

When administering medication through a central line, always use aseptic technique including hand washing, wearing sterile gloves, and wiping the access port with an appropriate antiseptic such as alcohol before each access to minimize infection risk. 1

Preparation for Central Line Access

• Use aseptic techniques (hand washing) and appropriate barrier precautions (sterile gloves) when accessing a central venous catheter 1
• Clean catheter access ports with an appropriate antiseptic (e.g., alcohol) before each access 1
• Cap central venous catheter stopcocks or access ports when not in use to maintain sterility 1
• Consider using needleless catheter access ports which have been shown to lower rates of microbial contamination of stopcock entry ports 1

Proper Administration Technique

• Wipe the port with an appropriate antiseptic (alcohol) and allow it to dry completely before accessing the line 1
• Use a new sterile syringe and needle/needleless connector for each medication administration 1
• After medication administration, flush the line with normal saline to ensure complete drug delivery and prevent mixing of incompatible medications 1
• For viscous drugs or rapid fluid boluses, use manual pressure or an infusion pump to ensure proper administration 1

Administration Rate Considerations

• The administration rate should be determined based on:
  • The specific medication being administered (follow medication-specific guidelines) 1
  • The clinical situation (emergency vs. routine administration) 1
  • The patient's clinical status and tolerance 2
• For emergency medications during resuscitation, rapid IV/IO bolus with flush is appropriate 1
• For medications that may affect blood pressure or heart rate, slower administration with monitoring is recommended 1
• For irritating medications (calcium, amiodarone, procainamide, sympathomimetics), administration through a central line rather than peripheral access is preferred to minimize vein irritation 1

Special Considerations

• For high-risk medications (vasopressors, concentrated electrolytes), use of an infusion pump with appropriate safety limits is strongly recommended 2
• Monitor the patient for adverse reactions during medication administration, especially with high-alert medications 2
• For parenteral nutrition or solutions with high osmolarity, central administration is preferred over peripheral to reduce the risk of thrombophlebitis 1
• The osmolarity rate (number of milliosmols infused per hour) correlates with phlebitis risk (r = 0.95), so control the rate accordingly 1

Infection Prevention During Administration

• Implement a bundle approach to reduce central line-associated bloodstream infections (CLABSI) 1
• Maintain strict aseptic non-touch technique (ANTT) during all central line manipulations 3
• Pay particular attention to hand hygiene, port disinfection, and proper material collection 3
• Consider using alcohol caps for needleless connectors and chlorhexidine-impregnated dressings around catheter insertion sites for additional protection 1

Common Pitfalls to Avoid

• Failing to properly disinfect access ports before use 3, 4
• Using improper technique when collecting materials for administration 3
• Administering incompatible medications simultaneously or without proper line flushing 1
• Incorrect interpretation of central venous pressure readings during fluid administration 2
• Inconsistent adherence to aseptic technique protocols, which can lead to variable contamination rates 4, 5

By following these guidelines for central line medication administration, you can minimize complications and ensure safe, effective delivery of medications to your patients.