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Your Child’s Health

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Home Care of Your Child’s Central Venous Catheter

Unit: __________________________________ Telephone: ________________________

Type of central venous catheter: __________________ Size: _________________________

These are instructions to help you with the care of your child’s central venous catheter. You may get additional help or supplies from your home care agency.

After reading this information, you will have a better understanding of how to:

• Changethedressingofyourchild’scentralvenouscatheter

• Heparinflushlockthecatheter

• Changethecathetercap

• Drawbloodsamplesfromthecatheter

• Knowwhattodoifthecatheterbreaks

• Knowwhomtocallincaseofproblems

I. Important Information

• Callyourproviderifyouseeswelling,drainageorrednessontheskinnearthesiteofthecatheter.

• Callyourproviderifthereispain,burningoranythingunusual while flushing your catheter.

• Alwayscarryablue plastic clamp with you in case yourcatheterleaksorbreaks.Ifyouseebloodorfluidleakingfromthecatheter,clampthecatheterright awaybetweenyourchildandtheleakingarea.(SeeFigure1.)CallyourUCSFproviderandgotothenearestemergencyroomwithyourcentrallinerepairkit.Somecatheters cannot be repaired.

Figure 2: Biopatch Figure 3: Stress loop

Tape

Figure 4: Statlock for PowerLine

Figure 6: Sample syringe to injection cap

 

Figure 1: Emergency clamp placement

Break  

Figure 5: Vacutainer blood collection device direct to injection cap

Figure 7: Transfer device

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II. General Guidelines

• Alwayscleanyourhandswithsoapandwateroralcoholhandsanitizerbeforeandafterhandlingyour catheter.

• Scrubtheinjectioncaporcatheterhubconnectionwithanalcoholpadforacountof10eachtimeyou enter the catheter to flush, draw blood, or give medications.

• Alwaysclampthecatheterwhennotinuse.

• Donotletcatheterordressinggetwet.

• Donotusescissors,safetypinsorothersharpobjectsnearthecatheter.

• PICClinedressingchangeisdoneinclinicorbyHomeHealthNurse.

III. Dressing Change

Transparent Dressing with or without Biopatch

Transparent Dressing with Gauze

Tape Dressing with Gauze

Schedule Changeevery7days. Changeevery48hours. Changeevery48hours.

Note: The dressing should always be changed if it becomes loose, dirty or wet. Chlorhexidine Allergy or Sensitivity:Pleasesee“DressingChangeUsingPovidone-Iodine”.

• Gathersuppliesorusedressingkit(ifprovided)

o Chlorhexidineskinpreparation

o Transparent dressing

o Biopatch®

o Tape

o Glovesandmask(ifprovided)

o StatLock(ifPowerLine)

1. Cleanworkareawithsurfacedisinfectant.

2. Putonmask,ifprovided.

3. Cleanhandswithsoapandwateroralcoholhandsanitizer.

4. Opensuppliesordressingchangekitoncleanworkarea.

5. Takeoffolddressing.Lookatskinforsignsofinfection, such as: swelling, drainage, or redness.

6. Cleanhandswithsoapandwateroralcoholhandsanitizer.

7. Putongloves,ifprovided.

Figure 2: Biopatch Figure 3: Stress loop

Tape

Figure 4: Statlock for PowerLine

Figure 6: Sample syringe to injection cap

 

Figure 1: Emergency clamp placement

Break  

Figure 5: Vacutainer blood collection device direct to injection cap

Figure 7: Transfer device

Figure 2: Biopatch Figure 3: Stress loop

Tape

Figure 4: Statlock for PowerLine

Figure 6: Sample syringe to injection cap

 

Figure 1: Emergency clamp placement

Break  

Figure 5: Vacutainer blood collection device direct to injection cap

Figure 7: Transfer device

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8. Scrubaroundthesitewithchlorhexidineinbackandforthdirectionsforatleast30secondstocompletelycleantheskin.

9. Lettheareaairdrycompletely.Do not blow or wipe chlorhexidine away.

10.PlaceBiopatchoncatheterexitsitewiththesmoothfoamsideonskin.PutslitofBiopatchindirectionofcatheter.PuttransparentdressingovertheBiopatch.(SeeFigure2.)

11.Makeanextraloopoutsideofthetransparentdressingandsecurewithapieceoftape.(Seefigure3.)

12. For PowerLine Only.PlaceBiopatchoncatheterexitsitewiththesmoothfoamsideonskin.PutslitofBiopatchindirectionofcatheter.AttachandcloseStatLockoncatheterandpeelawaypaperbackingandattachtoskin.PuttransparentdressingovertheBiopatchandStatlock. (SeeFigures2and4.)

Dressing Change Using Povidone-Iodine (Betadine®)

Theseinstructionsshouldbeusedifyourchildisallergicorsensitivetochlorhexidine.

• Gathersupplies

o Povidone-iodine(Betadine®)swabsticks

o Two sterile normal saline pads

o Transparent dressing

o Biopatch®

o Sterile2x2gauze

o Tape, if needed

o Glovesandmask(ifprovided)

o StatLock(ifPowerLine)

1. Cleanworkareawithsurfacedisinfectant.

2. Putonmask,ifprovided.

3. Cleanhandswithsoapandwateroralcoholhandsanitizer.

4. Opensupplies,leaveinpackagingandplaceoncleanworkarea.

5. Takeoffolddressing.Lookatskinforsignsofinfectionsuchas:swelling,drainage,orredness.

6. Cleanhandswithsoapandwateroralcoholhandsanitizer.

Figure 2: Biopatch Figure 3: Stress loop

Tape

Figure 4: Statlock for PowerLine

Figure 6: Sample syringe to injection cap

 

Figure 1: Emergency clamp placement

Break  

Figure 5: Vacutainer blood collection device direct to injection cap

Figure 7: Transfer device

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7. Putongloves,ifprovided.

8. Usepovidone-iodineswabstickstocleanfrominsertionsiteoutwardinacircularmotion.Completethreetimes,usinganewswabstickeachtime.

9. Allowpovidone-iodinetoairdryfortwominutes.

10.Removepovidone-iodinewithsterilesalinewipesusingthesamecircularmotion.Blotdrywithsterile2x2gauze.Makesureskiniscompletelydrybeforeapplyingdressing.

11.PlaceBiopatchoncatheterexitsitewiththesmoothfoamsideonskin.PutslitofBiopatchindirectionofcatheter.PuttransparentdressingovertheBiopatch.(SeeFigure2.)

12.Makeastressloopoutsideofthetransparentdressingandsecureitwithapieceoftape.(SeeFigure 3.)

13. For PowerLine Only.PlaceBiopatchoncatheterexitsitewiththesmoothfoamsideonskin.PutslitofBiopatchindirectionofcatheter.AttachandcloseStatLockoncatheterandpeelawaypaperbackingandattachtoskin.PuttransparentdressingovertheBiopatchandStatLock.(SeeFigures2and4.)

IV. Flushing Your Catheter

Flush/Lock Cap Change

Flush/Hep-Lock

• Everyday/2mL(20units)

• After med/fluid infusion or lab draw

• Every7daysOR

• IfyouseedirtorbloodundertheedgeofthecapOR

• Ifbloodcannotbeflushedfromcap

Groshong Catheter ONLY

Flush/Saline Lock

• 5mlevery7days

• After med/fluid infusion or lab draw

• Every7daysOR

• IfyouseedirtorbloodundertheedgeofthecapOR

• Ifbloodcannotbeflushedfromcap

A. Flushing your Catheter through the Injection Cap

NOTE: For Groshong Catheters:Onlyusenormalsalinetoflushcatheter.Heparinnotneeded.

• Gathersupplies

o Alcohol pads

o Heparinlockflush(10unitsheparinpermL),oneforeachlumen

o 10mLnormalsalinesyringe(s),oneforeachlumen

o Gloves(ifprovided)

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1. Cleanworkareawithsurfacedisinfectant.

2. Cleanhandswithsoapandwateroralcoholhandsanitizer.

3. Opensuppliesoncleanworkarea.

4. Putongloves,ifprovided.

5. Scrubinjectioncapwithalcoholforacountof10.

6. Attachnormalsalinesyringetocap.Unclampcatheterandflushwith10mLnormalsaline.Removesyringe. For Groshong Catheters Only:Stophere.

7. Scrubinjectioncapwithalcoholforacountof10.

8. AttachHeparinlockflushsyringetoinjectioncapandflushwith2mL(20units)Heparin.Clampcatheter.Removesyringe.

9. Repeattheaboveprocedureforsecondinjectioncapifyouhaveadoublelumencatheter.

B. Flushing Through the Injection Cap with Cap Change

NOTE: For Groshong Catheters:Onlyusenormalsalinetoprimecapandflush.Heparinnotneeded.

• Gathersupplies

o Alcohol pads

o Heparinlockflush(10unitsheparinpermL),oneforeachlumen

o 10mLnormalsalinesyringe(s),oneforeachlumen

o Sterileinjectioncap(s)

o Maskandgloves(ifprovided)

1. Cleanworkareawithsurfacedisinfectant.

2. Putonmask,ifprovided.

3. Cleanhandswithsoapandwateroralcoholhandsanitizer.

4. Opensuppliesoncleanworkarea.

5. Putongloves,ifprovided.

6. Primenewinjectioncap(s)withnormalsaline.Toprimecap:Attachnormalsalinesyringetonewinjectioncap(s)andslowlypushonendofsyringeuntilyoucanseeasmallamountoftheliquidinthe cap.

7. Holdcatheterbelowthecatheterhubandinjectioncapjunction.Wrapanalcoholpadaroundthejunctionandscrubwithalcoholforacountof10.

8. Make sure the catheter is clamped.

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9. Removetheoldinjectioncap.

10.Ifyoucanseedirtorbloodonthecatheterhub,useanewalcoholpadtocleanaroundthecatheterhub. Be careful to clean only the outside of the hub; do not touch the inside of the catheter lumen. Placenewprimedinjectioncaponendofcatheter.Unclampcatheterandflushwith10mLnormalsaline.Removesyringe.For Groshong Catheters Only:Stophere.

11.Scrubinjectioncapwithalcoholforacountof10.

12.AttachHeparinlockflushsyringetoinjectioncapandflushwith2mL(20units)Heparin.Clampcatheter.Removesyringe.

13.Repeattheabovestepsforsecondinjectioncapifyouhaveadoublelumencatheter.

V. Drawing Blood from Your Catheter

A. Vacutainer Blood Collection Method

• Gathersupplies

o Gloves(ifprovided)

o Alcohol pads

o 10mLnormalsalinesyringes,twoforeachlumen

o Heparinlockflush(10unitsheparinpermL),oneforeachlumen

o Labtubes

o Vacutainer blood collection device

1. Cleanworkareawithsurfacedisinfectant.

2. Cleanhandswithsoapandwateroralcoholhandsanitizer.

3. Opensuppliesoncleanworkarea.

4. Putongloves,ifprovided.

5. Scrubinjectioncapwithalcoholforacountof10.

6. Unclampcatheter.

7. Attachnormalsalineflushsyringetoinjectioncapandflushwith10mLnormalsaline.Usingthesamesyringe,pullback2mLbloodfordiscard.Removesyringe.

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8. Scrubinjectioncapwithalcoholforacountof10.Attachbloodcollectiondevicetoinjectioncapandplacelabtube(s)intothedevicetocollectbloodsample(s).(SeeFigure5.)Removedevice after filling lab tubes.

9. Scrubinjectioncapwithalcoholforacountof10.

10.Attachnormalsalineflushsyringetoinjectioncapandflushwith10mLnormalsaline. Removesyringe.

11.Scrubinjectioncapwithalcoholforacountof10.

12.AttachHeparinlockflushsyringetoinjectioncapandflushcatheterwith2mL(20units)Heparin.Clampthecatheter.Removesyringe.

13.Foradoublelumencatheter:Afterdrawingblood,flushthesecondlumenwith10mLnormalsalinefollowedby2mL(20units)Heparin.

B. Syringe Method

• Gathersupplies

o Gloves(ifprovided)

o Alcohol pads

o 10mLnormalsalinesyringes,twoforeachlumen

o Heparinlockflush(10unitsheparinpermL),oneforeachlumen

o Emptysyringe(s)forbloodsample

o Labtubes

o Blood transfer device

1. Cleanworkareawithsurfacedisinfectant.

2. Cleanhandswithsoapandwateroralcoholhandsanitizer.

3. Opensuppliesoncleanworkarea.

4. Putongloves,ifprovided.

5. Scrubinjectioncapwithalcoholforacountof10.

6. Unclampcatheter.

7. Attachnormalsalineflushsyringetoinjectioncapandflushwith10mLnormalsaline.Usingthesamesyringe,pullback2mLbloodfordiscard.Removesyringe.

Figure 2: Biopatch Figure 3: Stress loop

Tape

Figure 4: Statlock for PowerLine

Figure 6: Sample syringe to injection cap

 

Figure 1: Emergency clamp placement

Break  

Figure 5: Vacutainer blood collection device direct to injection cap

Figure 7: Transfer device

Your Child’s Health

Find a Doctor: (888) 689-8273 • Patient Education Library: www.ucsfbenioffchildrens.org/education

8. Scrubinjectioncapwithalcoholforacountof10.Attachbloodsamplesyringe(s)toinjection capandpullbackvolumeofbloodneededforbloodtest(s).(SeeFigure6.)Removeblood sample syringe.

9. Scrubinjectioncapwithalcoholforacountof10.

10.Attachnormalsalineflushsyringetoinjectioncapandflushwith10mLnormalsaline. Removesyringe.

11.Scrubinjectioncapwithalcoholforacountof10.AttachHeparinlockflushsyringetoinjectioncapandflushcatheterwith2mL(20units)Heparin.Clampthecatheter.Removesyringe.

12.Transferbloodfromsamplesyringetolabtubes.(Seeprocedurebelow.)

13.Foradoublelumencatheter:Afterdrawingblood,flushthesecondlumenwith10mLnormalsalinefollowedby2mL(20units)Heparin.

Transferring Blood from Sample Syringe to Lab tubes

• Attachbloodsamplesyringetobloodtransferdeviceandplacelabtubesintodevicetofill. Bloodwillflowquicklyfromthesamplesyringeintothelabtubes.(SeeFigure7.)

Figure 2: Biopatch Figure 3: Stress loop

Tape

Figure 4: Statlock for PowerLine

Figure 6: Sample syringe to injection cap

 

Figure 1: Emergency clamp placement

Break  

Figure 5: Vacutainer blood collection device direct to injection cap

Figure 7: Transfer device

SDPED05

40•R

evised

7/13

Figure 2: Biopatch Figure 3: Stress loop

Tape

Figure 4: Statlock for PowerLine

Figure 6: Sample syringe to injection cap

 

Figure 1: Emergency clamp placement

Break  

Figure 5: Vacutainer blood collection device direct to injection cap

Figure 7: Transfer device