Nursing care
Venous Access Device Care: the nurse's role, start to finish
Written and reviewed by Dana Whitfield, RN, MSN · 5 min read · Updated September 2026
Short answer
Venous access device care covers the nurse's role before, during, and after PICC or central line placement, with air embolism as the complication that shapes practice most. Patients are positioned supine or Trendelenburg and told to bear down or hold their breath during insertion and removal specifically to prevent air entering the vein.
What the procedure achieves
A venous access device gives reliable access to the central venous circulation for therapies that peripheral IVs cannot safely deliver: vesicant chemotherapy, total parenteral nutrition, long-term antibiotics, vasopressors, and frequent blood draws. Peripheral veins tolerate these poorly over time, with a high risk of phlebitis or extravasation injury.
PICC lines, tunnelled catheters, and implanted ports each suit a different duration and pattern of use. A PICC is typical for therapy measured in weeks to a few months, while a tunnelled catheter or port suits patients needing access for many months to years, such as those on long-term chemotherapy or haemodialysis. Knowing which device the patient has tells you what care and what complications to anticipate.
Pre-procedure nursing responsibilities
Confirm informed consent has been obtained and that the patient understands the procedure in terms they can repeat back. Review coagulation studies and platelet count where ordered, since bleeding risk at the insertion site matters, and confirm there is no active infection at the planned site or systemically.
Gather and verify the ordered device type and size, confirm the planned insertion site, and ensure ultrasound guidance equipment is available if used for the approach. Establish baseline vital signs, and verify IV access is otherwise patent in case medications are needed during the procedure. Have the patient empty their bladder if the procedure will take any length of time.
Equipment and positioning
For central line insertion, the patient is typically positioned supine, often in slight Trendelenburg for internal jugular or subclavian approaches, because this increases central venous pressure and distends the vein, which both eases cannulation and reduces the risk of air being drawn into the vessel during needle entry.
Maintain strict sterile technique throughout: full barrier precautions for the inserter, including sterile gown, gloves, mask, and a large sterile drape, plus chlorhexidine skin antisepsis. The nurse's role during insertion is to monitor the patient continuously, watching for changes in colour, breathing, or level of consciousness, and to assist with positioning and equipment without breaking the sterile field.
Complications and early signs
Air embolism is the complication that drives positioning and technique at both insertion and removal, because an open central line creates a direct path from atmosphere to the venous circulation, and even a small volume of air reaching the right heart or pulmonary circulation can cause sudden hypotension, dyspnoea, chest pain, and a churning murmur audible over the precordium.
Pneumothorax is a risk specific to subclavian and, to a lesser extent, internal jugular approaches, presenting as sudden shortness of breath, chest pain, or decreased breath sounds on the affected side, usually confirmed with a post-procedure chest X-ray before the line is used. Catheter-related bloodstream infection and central line-associated thrombosis are the complications that develop later, over days to weeks, presenting as fever, site redness or drainage, or arm swelling on the catheter side.
Post-procedure care
Confirm catheter tip placement, typically with a chest X-ray, before the line is used for infusion, since a mispositioned tip changes both what the line can safely deliver and the risk profile. Document the length of catheter inserted and the external length remaining, which becomes the baseline for checking migration at every subsequent dressing change.
Maintain the sterile dressing per protocol, typically changed every seven days for a transparent dressing or sooner if it becomes soiled, loose, or damp. Flush the line per facility protocol to maintain patency, and assess the site at every shift for redness, swelling, drainage, or tenderness that might signal infection or thrombosis before it becomes clinically obvious.
What to teach before discharge
Teach the patient to keep the dressing dry and intact, and to cover the site during bathing rather than submerging it, since a wet dressing loses its barrier function. Show them how to recognise early signs of infection: redness spreading from the site, warmth, swelling, or drainage, and give clear instructions to call promptly rather than wait for a scheduled visit.
Explain the same air embolism principle that shaped their procedure: if the line ever becomes disconnected or the cap comes off, they should clamp the line immediately if they know how, lie down, and seek help rather than leaving it open to air. Reinforce that the line must never be used for anything the care team has not explicitly approved, and that any resistance, pain, or swelling during a flush should stop the flush and prompt a call to the line's care team.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our reduction of risk potential practice questions are the closest set to what this page covers.
One question from the reduction of risk potential set
Four hours after a cardiac catheterization via the right femoral artery, the nurse notes the client's right dorsalis pedis pulse is now faint and the foot is cool and pale. What is the nurse's priority action?
Rationale
A pulse that was present and is now faint, with a cool, pale extremity distal to the puncture site, is arterial occlusion until proven otherwise — a limb-threatening complication that needs the provider now. Documenting and rechecking wastes the window, warming treats the symptom and masks the change, and asking the client to move the ankle neither restores flow nor gives you new information.
Answer: C
Common questions
Why is a patient told to bear down during central line insertion or removal?
Bearing down, similar to a Valsalva manoeuvre, raises intrathoracic pressure and reduces the pressure gradient that could otherwise draw air into an open central vein. It is used at both insertion and removal, the two moments when the vein is briefly open to atmosphere.
What position is used for central line insertion and why?
Supine, often with slight Trendelenburg for jugular or subclavian sites. This distends the target vein by increasing central venous pressure, which both makes cannulation easier and lowers the risk of air entering the vessel during needle placement.
How often should a PICC line dressing be changed?
A transparent, semipermeable dressing is typically changed every seven days, or sooner if it becomes loose, soiled, or damp. A gauze dressing, if used, is generally changed more frequently, per facility protocol.
What are the signs of air embolism from a central line?
Sudden hypotension, shortness of breath, chest pain, and a churning or 'mill wheel' murmur heard over the precordium. It is a medical emergency: position the patient in left lateral Trendelenburg, apply oxygen, and call for immediate help.
What is the difference between a PICC line and a central line?
A PICC is inserted peripherally, usually through a vein in the upper arm, and threaded to end in the central circulation, making it a type of central venous access device suited to weeks-to-months of therapy. Central lines placed directly into the subclavian, internal jugular, or femoral vein are typically used for shorter-term, higher-acuity access.
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