• Patients may have indwelling venous access catheters (central lines) in several locations. Some of the devices are located under the skin and can be felt but not seen.
• Common emergencies involving these catheters include: blockage of the line, complete or partial accidental removal, complete or partial laceration of the line.

EMT/ AEMT Standing Order

• Always evaluate the patient for cardiovascular stability as some complications may be life-threatening.
• Patients may be experiencing complications for their underlying medical condition; ask caregivers about the patient’s condition. If the line is blocked, do not attempt to force the catheter open.
• For partial or complete removal, do not attempt to reinsert. Apply dressing to the site and maintain pressure until bleeding has stopped. If the catheter was completely removed, bring it with the patient to the hospital.
• For partial or complete laceration of the line, clamp proximally to the laceration with a padded clamp.
• For patients with a sudden deterioration begin basic resuscitation and transport (the patient may have a pneumothorax or internal bleeding).
• If there are fluids infusing through the central line, determine the nature of the fluid and the time that the fluid was started. EMTs are not to initiate, adjust, or discontinue the infusion. EMTs are allowed to transport a patient with a pre-existing medical device or drug administration (MDDA) not covered in the EMT’s scope of practice. Contact Medical Control for any concerns or questions.

• If the indwelling catheter is functional and not the cause of the emergency AND if unable to establish peripheral IV access for emergent medication / fluid administration, the paramedic who has been trained to use central lines and has the appropriate equipment may contact Medical Control and ask for permission to use the catheter.

INDWELLING VENOUS ACCESS CATHETERS (Central Line)

• ASSESS AND MANAGE AIRWAY
• MAINTAIN O2 SATS >95%
• EVALUATE PATIENT CONDITION
  • IDENTIFY ALL LOCATIONS OF CENTRAL LINES
  • CHECK LINES FOR BLOCKAGES, LACERATIONS, OR ACCIDENTAL REMOVAL.
    • IF LINE IS BLOCKED DO NOT ATTEMPT TO FORCE OPEN
    • IF LINE IS LACERATED CLAMP LINE CLOSE TO LACERATION
  • CHECK LINE AT INSERTION SITE
    • IF PARTIALLY REMOVED DO NOT ATTEMPT TO PUSH THE LINE BACK IN
    • IF COMPLETE REMOVED MAINTAIN PRESSURE TO STOP BLEEDING
• MONITOR VITAL SIGNS
• REASSURE PATIENT
• TRANSPORT

• MAY USE CENTRAL LINE FOR IV ACCESS WITH
  CLEARANCE FROM MEDICAL CONTROL IF PROPERLY
  TRAINED AND HAVE APPROPRIATE EQUIPMENT