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You are going home with a central venous access device (CVAD). It is often used when medicines or nutrition are needed for weeks or more. At home, you need to care for your CVAD to keep it working and help prevent the spread of germs. Follow the instructions below unless your provider or home health agency has told you differently.
Caring for Your CVAD
Hand washing: Wash your hands and put on clean gloves when caring for your CVAD and touching any supplies. Follow these steps to help prevent infection:
If hands do not look dirty, you can use an alcohol-based product such as Purell gel. Rub it well, all over your hands front and back, until dry.
If hands look dirty, use soap and water. Wash well, for at least 15 seconds. Use a new, clean towel or paper towel to dry hands well.
Nails: Fake nails can increase the risk of infection. Keep your nails short, trimmed, and clean.
Activity: Always protect your CVAD. Avoid rough activities.
Supplies: When you go home, supplies and equipment may be delivered by your home care agency. To order more supplies, contact your home care agency.
Flushing Your CVAD
If you get medicines using your CVAD at home, your home care agency will teach you how to care for the CVAD.
Flush your CVAD every day and after each use. Your nurse may tell you to flush more often if needed.
1-prefilled 10 mL normal saline syringe OR 1 prefilled 5 mL heparin syringe (10 units/mL) per lumen (if told not to use saline)
Steps for Flushing Your CVAD
Clean work area.
Put on gloves.
To prepare the flush, remove syringe from the plastic wrapper. Remove the plastic cover from the tip of the syringe.
Scrub the hub of the needleless connector with an alcohol wipe for 15 seconds. Allow hub to dry and do not let it touch anything. Attach and flush syringe.
Note: If anything touches the hub before you attach the flush syringe, stop and scrub the hub again with a new alcohol wipe for 15 seconds.
Remove the plastic cover from the syringe. There is a small amount of air in the syringe. Point the syringe up, and gently push the air out of the syringe.
Connect the syringe filled with saline or heparin to the hub of the needleless connector. Twist on completely.
Note: If the tip of the syringe touches anything other than the end of the CVAD, stop, and replace the syringe.
Unclamp the CVAD.
Begin flushing using a “push-pause method” on the syringe plunger. Push the contents of the syringe into the CVAD, leaving a small amount of fluid in the syringe.
Note: The CVAD should flush easily. If it is hard to push the fluid in, make sure the clamp is open and that the CVAD is not kinked. If it is still hard to push the fluid in, do not force the plunger. Call your home care agency.
Clamp the CVAD.
If you have more than one lumen, repeat steps 5-12 for each lumen.
Follow the instructions your clinic or home health nurse gave you to throw away the used supplies.
Changing the Needleless Connector
Change the needleless connectors at least every week. A good time to change it is when you change the dressing.
1-prefilled 10 mL normal saline syringe OR 1 prefilled 5 mL heparin syringe (10 units/ml) per lumen (if told not to use saline)
Steps for Changing a Needleless Connector
Use soap and water or cleaning wipes to clean a table or counter. Dry with a clean towel or paper towel.
Put on clean gloves.
Make sure the CVAD is clamped.
Remove plastic cover from the syringe. Do not touch end of the syringe.
Firmly insert and twist the syringe into the clean needleless connector. Be careful not to touch the end of the needleless connector to anything other than the syringe.
Push the syringe slowly until the saline or heparin comes out the end of the needleless connector. Keep syringe attached.
Remove the light blue tip from the end of the new needleless connector. Do not allow that end to touch anything.
Remove the old needleless connector from the CVAD. Do not touch the end of the lumen.
Place the new needleless connector on the end of the CVAD. Secure the needleless connector by twisting it on. Make sure it is secure and tight. Do not over-tighten.
Unclamp the CVAD.
Flush normal saline or heparin into the CVAD using a “push-pause method” 1 mL at a time.
Clamp the CVAD.
Remove the syringe from needleless connector.
Throw away the supplies.
Showering with a CVAD
Tap water has germs that can cause infection and should not touch your CVAD. The site must remain dry when you shower.
Always cover your CVAD, even if you plan to change the dressing after.
Use extra plastic to cover the CVAD. You can use Glad Press’n Seal® or a plastic bag.
Keep your back facing the water to keep soap and water away from the CVAD and lumens.
Clear plastic cover
Steps to Cover CVAD During Shower
Apply the plastic cover or bag over the entire dressing, lumens and any tubing.
Use the tape to help seal any edges. Make sure it is sticking well to your skin.
When you are done with the shower or bath, gently remove the tape and plastic cover.
Make sure dressing is dry and intact.
If dressing is wet or loose, contact your home care agency or call your doctor.
Problems With the CVAD
Break in the line: Clamp the line above the break and cover with a sterile dressing.
Never use scissors or sharp objects near the CVAD. Only use padded rubber-tipped hemostats, blue plastic hemostats, or the clamp that comes attached to the CVAD.
CVAD comes out: If the CVAD comes out, apply pressure right away with a sterile gauze pad at the exit site for about 5 minutes. Then place a transparent (clear) dressing over the gauze on the exit site. If the CVAD comes out a bit from the body, do not push it back in.
Leaks: If the CVAD is leaking, clamp the CVAD with a hemostat between you and the leak.
When to Call
Call your doctor right away if you have any of these problems:
Fever of 100.4° F (38.0° C) or higher.
Swelling of chest, neck, face or arm.
CVAD will not flush or draw blood.
Pain, redness, or swelling at the site.
CVAD breaks, comes out or is leaking.
Terms to Know
Peripherally Inserted Central Catheter (PICC): A PICC is a thin, flexible, hollow tube placed in a vein. A vein above the elbow is usually used. The PICC is 18-24 inches long. It ends in the large vein near your heart. There may be one, two, or three lumens (IV access lines) at the end of the PICC. This is where your medicine will be given and blood for lab tests may be drawn.
Tunneled: A tunneled catheter is for long term use. The catheter is a line that rests on the outside of the body at the chest area. The line enters through the neck veins and then sits near the heart. Examples of a tunneled catheter include a Hickman®, PowerLine® or Broviac®.
Needleless connector: The needleless connector (also called the hub) is the 1-inch clear plastic piece. You can see this part at the end of the CVAD. It keeps the CVAD closed and helps keep air and germs out of your body. Your CVAD should always have a needleless connector on each lumen.
Scrub the hub: This refers to cleaning the needleless connector. Use an alcohol swab and wipe the hub for 15 seconds. When finished, let it dry for 15 seconds before use.
Flushing: Flushing the CVAD refers to using saline to clear anything that still may be in the CVAD such as blood, medicine or nutrition.
Locking: Locking the CVAD refers to putting heparin or saline in the CVAD when it is not being used. The CVAD should also be clamped when it is not being used.
Push-pause method: This a method you can use to flush your CVAD to keep it clear of any blood, extra medicine or nutrition.
Instead of a steady push, you should start (push) and stop using the push-pause method.
SASH: SASH stands for saline-administer (medicine)-saline-heparin. This helps you remember the order of giving medicine as well as flushing guidelines for your CVAD.
SAS: SAS stands for saline-administer (medicine)-saline. Some patients may be told to not use heparin. This will help you remember the order of giving medicine as well as flushing guidelines for your CVAD.
Securement device: Your CVAD is held in place by a special device. This locks the CVAD in place to keep it from coming out. A common device is called a StatLock®.
If you are a patient receiving care at UnityPoint – Meriter, Swedish American or a health system outside of UW Health, please use the phone numbers provided in your discharge instructions for any questions or concerns.