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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).

    1. External Lines. 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.
    1. Subcutaneous Lines. 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 care.

    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 provider immediately. (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 Catheter

    • 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. Cover with 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 chest.

    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 it.

    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:

    • Redness, tenderness, 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

     


    Problem

    What to Do


    Ÿ Sudden chest, neck or shoulder pain, coughing or difficulty breathing


    Ÿ Make sure the CVC is clamped. Lie on your left side with your head down. Stay in this position while your caregiver calls 911.


    Ÿ Accidental removal of the CVC from chest


    Ÿ Apply 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.


    Ÿ Accidental removal of injection cap


    Ÿ Make 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.


    Ÿ Swelling of face, neck, chest or arm. New or prominent chest veins.


    Ÿ Call your doctor or home care nurse immediately.


    Ÿ Drainage, redness, swelling or bleeding at the exit site.


    Ÿ Call your doctor or home care nurse immediately.


    Ÿ Fever of 100.5F (38C) or greater and/or chills.


    Ÿ Call your doctor or home care nurse immediately.


    Ÿ Damage to the CVC, such as a hole or crack in the tubing.


    Ÿ 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.


    Ÿ Difficulty flushing the catheter


    Ÿ Make 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.


    Ÿ Loose suture at the exit site


    Ÿ Tape 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.


    Ÿ CVC is displaced, CVC is longer, a "cuff" is visible at the exit site, or CVC is not working.


    Ÿ Do not use the CVC. Tape the CVC to your skin if it seems loose. Call your doctor or home care nurse immediately.

 

 

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