# Central venous access devices

Source: [[../policies/POL-CW-02-central-line.md|POL-CW-02]] v2.0 (8 Jan 2026) · Owner: Vascular Access / CNC · Ages **under 16**

Teaching copy. Not KHCC policy. Not for real patients.

## The rules as written

- Neutropenia for line decisions = ANC **< 1000/µL**.
- Flush PICC/Broviac with 10 mL 0.9% saline. **No heparin** — except a monthly heparin lock on a port that will sit unused.
- On discharge, **every** central line goes home with a heparin lock.
- Dressing: every 7 days. Skin prep: **chlorhexidine 4% aqueous**, no alcohol.
- Fever with a line: notify attending **within 2 hours**. Do not start antibiotics through the line until the attending has reviewed. Peripheral cultures optional if stable.
- Culture order: **line first**, then peripheral.
- Suspected line infection: **vancomycin + cefepime**. Stop vancomycin at 48 h if cultures negative.

## Linked notes

- [[febrile-neutropenia]] — FN is 0–18, ANC < 500, peripheral-first, pip-tazo, start antibiotics after cultures without waiting for the attending.
- [[discharge-fever]] — agrees on heparin at discharge; disagrees with the “no heparin on PICC/Broviac” rule in the same file.
- [[visitor-isolation]] — shares a near-identical five-moments hand-hygiene paragraph.

## Open questions

- Age band under 16 leaves 16–18-year-olds on Cedar Ward with no line protocol in this folder.
- 4% aqueous chlorhexidine is not the usual alcoholic 2% CHG skin prep. Flag as a possible error.
- The file contradicts itself on heparin (no heparin on PICC/Broviac vs heparin lock for every discharge).