Care of Your Central Venous Catheter
To eliminate the need for
repeated needle sticks in a vein, your doctor may recommend a
central venous catheter (CVC). A central venous catheter is a
surgically placed tube through which doctors can give
intravenous (IV) medications and other fluids, as well as draw
blood. A catheter can help take away some of the stress
associated with treatment and spare veins the damage that can
come from frequent sticks. It also can remain in the body for as
long as medically necessary.
Types of Catheters
There are a few different
types of central venous catheters, but all fall under two main
categories: external or subcutaneous (under the skin).
With an external line, one end of a thin, flexible plastic
tube is implanted into a large vein near the heart called
the superior vena cava. The other end exits the skin in the
breastbone area. The tube that sits outside of the body may
have one or two smaller tubes (called lumens) connected to
it, each with caps on the end. Medications that are injected
into the cap travel directly into the vein. Types of
external lines are: Broviac, Hickman, Hohn and Groshong, all
of them named for the companies that manufacture them.
These catheters may have the following features:
Hollow, soft tubes that may
be separated into 2 or 3 individual channels called lumens
Screw-like adapters on the
ends of the lumens that allow caps, syringes, and intra-venous
tubing to be securely connected
Hickman and Hohn CVC’s have
plastic clamps on the lumens to close the catheter when not in
use or when disconnecting the cap, infusion tubing, or syringe.
A line that is implanted entirely under the skin is usually
referred to as a port-a-cath or a medi-port. These lines are
usually placed in the chest, but may sometimes be placed in
the arm. One end of the thin tube is fed into a large vein
while the other leads to a small rubber dome, or portal,
just under the skin. When medications or other treatments
are given, a special needle with attached tubing (called a
Huber needle) is inserted through the skin into the port.
Although this method of accessing the port does still
require a needle, it is generally easier and less painful
than a typical needle stick. A numbing cream may be used on
the skin to lessen any discomfort.
Caring for Catheters
Both types of lines are
implanted in an operating room while the patient is under
general anesthesia, and afterward they both require some at-home
External catheters require
more attention than port-a-caths because the tubing remains
outside of the body. To prevent infection, the dressing around
the tube entry needs to be changed every 7 days if you are using
a transparent dressing and every 48 hours if you are using gauze
or Telfa island dressing and tape. If the dressing becomes wet
or loose, change it even if it is not the normal time to change
it. If you develop a
fever (a sure sign of infection) notify your health care
(See Signs of Catheter Problems below)
A nurse will make sure you
know exactly how to care for the line and what products to use
before you are sent home, so be sure to ask questions if there's
anything you do not understand.
Caring for an External Line
Always keep the site where the tube exits the
body covered with sterile gauze or a bandage.
Make sure the site stays
dry at all times, even while showering. Swimming is also
off-limits while the line is in place.
LiquaShield when showering so the dressing does not get wet.
Flush the line daily to prevent clotting. This
is usually done by injecting a solution of heparin (an
anti-clotting agent) into the line.
Change the caps on the ends of the line as
often as is recommended. Also, make sure the caps are always
screwed on tightly. A loose or missing cap can lead to
infection as well as complications with the line.
Keep special clamps handy in case the catheter
breaks. The nurse will give these to you prior to discharge
from the hospital.
Discuss with the doctor what types of physical
activity are OK for you to resume. Contact sports are
usually prohibited because of the potential of a blow to the
Caring for a Port-a-Cath
Make sure a health care provider flushes the
port with an anti-clotting solution about once a month.
Bathing and swimming are fine once the
incision has healed.
Although most physical activities are OK for
individuals with an internal port, check with the doctor
about contact sports, as a blow to the chest could dislodge
Signs of Catheter Problems
The signs of catheter infection and problems are similar for all
types of central venous catheters.
If you have any sign of
infection or catheter problem, call your doctor immediately.
Signs of infection, clotting, or other problems include:
drainage, warmth, or odor around the catheter site
Fever of 100.5F (38C) or
greater, or chills
Swelling of the face, neck,
chest, or arm on the side where your catheter is inserted
Leakage of blood or fluid
at the catheter site or the cap
Inability to flush the
catheter, or resistance to flushing the catheter
Displacement or lengthening
of the catheter
What to Do
chest, neck or shoulder pain, coughing or difficulty
sure the CVC is clamped. Lie on your left side with your
head down. Stay in this position while your caregiver
removal of the CVC from chest
pressure to the exit site and chest area above it with a
gauze dressing or clean washcloth. Call your doctor or
home care nurse immediately.
removal of injection cap
sure that the CVC is clamped. Clean the outside threaded
area of the lumen with an alcohol wipe for at least 30
seconds. Place a new cap securely into the open end. If
you do not have a new cap, wrap the end of the lumen
with sterile gauze until you can get a cap. Flush
catheter following the usual steps.
of face, neck, chest or arm. New or prominent chest
your doctor or home care nurse immediately.
redness, swelling or bleeding at the exit site.
Call your doctor or home care nurse immediately.
of 100.5F (38C) or greater and/or chills.
Call your doctor or home care nurse immediately.
to the CVC, such as a hole or crack in the tubing.
Immediately clamp the CVC
between the hole and your chest.
If necessary, pinch or fold it over to clamp it. Cover
the hole or crack with sterile gauze. Call your doctor
or home care nurse immediately.
flushing the catheter
sure the CVC is unclamped. Change your position by
raising your arms, lying down, sitting up more straight,
coughing, or taking a deep breath. If you still cannot
flush it, stop using the catheter and call your doctor
or home care nurse.
suture at the exit site
the CVC to your skin. If you do not need to flush or use
the CVC, notify your doctor or home care nurse during
routine business hours. If you need to flush or use the
CVC, do not use
it until you speak with your doctor or nurse.
is displaced, CVC is longer, a “cuff” is visible at the
exit site, or CVC is not working.
Do not use the CVC.
Tape the CVC to your skin if it seems loose. Call your
doctor or home care nurse immediately.