RCH@Home Manual: Care of a Central
Venous Line
Table of Contents
RCH@Home Manual: Care of a Central Venous Line .............................................. 1
1.
What is a central venous catheter? ........................................................ 2
2.
What is parenteral nutrition? ................................................................. 2
3.
Possible problems.................................................................................. 2
3.1
Line Infection ......................................................................................2
3.2
Signs of a line infection .........................................................................2
3.3
Preventing an infection .........................................................................3
3.4
Accidental disconnection or breakage of the CVC ......................................3
3.5
Preventing a breakage ..........................................................................3
4.
Troubleshooting Problems with a CVC ................................................... 3
4.1
The Smart site comes off the end of line .................................................3
4.2
Catheter has been cut or broken ............................................................4
4.3
The clamp comes opened ......................................................................4
4.4
Dressing comes off ...............................................................................4
4.5
Central line Dracon cuff that normally sits under the skin is showing on the
skin 4
4.6
The line comes out ...............................................................................4
5.
Connecting and disconnecting TPN from a central line .......................... 4
6.
Changing a sterile dressing and SmartSite ............................................ 4
6.1
What is a sterile area ............................................................................4
6.2
The sterile are can become contaminated (dirty) by: ................................5
6.3
Equipment for a sterile dressing and smartsite change for a single lumen
CVC 6
6.4
Procedure for assistant - the parent/guardian may assist with set up ..........6
Version
3
Date revised
January 2013
Next revision
January 2015
Nutrition Support Service, Home Parenteral Nutrition: instructions for the administration of
parenteral nutrition at home. Royal Children’s Hospital, Melbourne, 2007.
 RCH @ Home, Royal Children's Hospital.
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http://www.rch.org.au/uploadedFiles/Main/Content/hacc/home_care_manuals/RCH@Home%20Disclai
mer.pdf
Page 1 of 6
1.
What is a central venous catheter?
A Central Venous Catheter (CVC) is a thin rubber tube which has its tip in a vein near the
heart. The CVC is used to give medication and nutrition directly into the bloodstream. The
CVC has a part outside the body (external line) which is capped when not in use and
connected to intravenous tubing when in use. The external line may have one lumen
(tube) or two. The area where the tube comes out of the body (insertion site) must always
be covered with a waterproof sterile dressing.
2.
What is parenteral nutrition?
Parenteral Nutrition, also known as Total Parenteral Nutrition (TPN) is a form of liquid
nutrition used when the body cannot absorb enough nutrition from the food eaten. TPN is
a sterile liquid that is given straight into the blood stream through the CVC.
3.
3.1
Possible problems
Line Infection
Strict hand hygiene before starting any procedure involving central line care is the most
important factor in preventing the risk of infection (see the infection control manual
section).
3.2
Signs of a line infection

Central line site looks red and/or has ooze

Temperature more than 38 degrees (tell parents immediately)
 RCH @ Home, Royal Children's Hospital.
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3.3

Child is breathing faster

Lethargic, tired, sleepy, grumpy

Change in alertness (call an ambulance 000)
Preventing an infection

Follow the five moments of hand hygiene

Follow the correct technique when helping the child’s parents with all line
tasks

Parents will always check the expiry dates of all fluids and solution quality
before hooking the child onto the TPN

Do not use any solution if you are unsure of its quality
The child can become very unwell very quickly with a central line infection. It is important
for the support worker to notify the parents straight away if you are worried that the child
has a temperature or is becoming unwell. If the child’s temperature is 38 degrees Celsius
(or more) they will need to go to the emergency department at their hospital immediately.
An ambulance may need to be called.
3.4
Accidental disconnection or breakage of the CVC
The line may have moved, broken or be leaking if:
3.5
4.
4.1

The Dracon cuff that normally sits under the skin is visible

Leakage of fluid around the insertion site

“Lumpy” areas around catheter exit site or along catheter tract under the
skin

Blood in the line, or leaking from the line. This could be a break in the line
or a disconnection (e.g. cap removed from the end of the line, line
removed from patient, line unclamped, line severed somewhere)

If large amount of blood, call an ambulance (000) for transport to hospital

Inform the parents immediately if you suspect any disconnection or
breakage in the line
Preventing a breakage

Check that all connections are locked onto the line each shift

Protect lines from all sharp surfaces or objects

Make sure the line is strapped firmly to the child’s body

Make sure no part of the CVC is hanging free and able to get caught and
pulled on

Make sure exit site dressing is secure
Troubleshooting Problems with a CVC
The Smart site comes off the end of line
Clamp the line above the leak/end. Clean the end of catheter with an alcohol swab and
screw a new cap on. Call the parent/guardian immediately.
 RCH @ Home, Royal Children's Hospital.
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4.2
Catheter has been cut or broken
If possible move the clamp above the break and clamp the line. If this is not possible,
pinch the line to clamp it. Clean the broken end with a sterile swab and seal with a
waterproof dressing, to stop air going up the tube with each breath. Call ambulance 000
as the child will need to go to hospital for the line to be fixed. Inform parent/guardian as
soon as possible.
4.3
The clamp comes opened
Let parent/guardian know immediately as they will need to flush the line to stop blood
clotting (sterile procedure).
4.4
Dressing comes off
If only partially, the edges of the old dressing can be reinforced with another waterproof
dressing. If the dressing comes completely off, place a waterproof sterile dressing over
the site. Call the parent/guardian who will need to replace the dressing (sterile
procedure).
4.5
Central line Dracon cuff that normally sits under the skin is showing on
the skin
Do not try to push or pull the cuff. Tape the CVC as it is. Place a waterproof sterile
dressing over the site. Put pressure on the entry and exit sites. Call the parent/guardian
who will need to bring the child to the nearest hospital.
4.6
The line comes out
If there is bleeding put pressure over the site, using sterile gauze or clean towel. Call an
ambulance. If there is no bleeding put a waterproof sterile dressing over the site, then call
a parent, who will need to bring the child into the hospital. Place the central line in a
plastic bag to take to the hospital (for sizing).
5.
Connecting and disconnecting TPN from a central
line
Support workers will help the child’s parent/guardian either; connect the child to TPN in
the evening (known as “hook on”), or disconnect the child from the TPN in the mornings
(known as “hook off”). The support worker may need to assist with holding the child and
distracting them to make sure they don’t get any of the equipment dirty during these
procedures.
6.
Changing a sterile dressing and SmartSite
The parent or guardian will be taught by the RCH Nutrition nurses how to change a
smartsite (cap on the end of the catheter) and the dressing using a sterile technique. The
smartsite and dressing are usually changed every six – seven days or if the dressing is
loose or dirty. The support worker will assist the parent or guardian in preparing the
equipment for the procedure and also in distracting the child during the procedure to make
sure that the sterile area does not become dirty.
6.1
What is a sterile area
The sterile area is an area free of germs or dirt. For a dressing and smartsite change we
create this area by using a sterile dressing pack and sterile gloves and not touching
anything that we put within the area with our bare hands or skin.
 RCH @ Home, Royal Children's Hospital.
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Page 4 of 6
6.2
The sterile are can become contaminated (dirty) by:

Accidently touching it or something on it with bare skin or any part of us
that is not sterile

Putting equipment/rubbish on it that has been touched by bare skin (not
sterile)

Sneezing or coughing over it

Touching something on it with contaminated gloves

The child or any other person touching it
 RCH @ Home, Royal Children's Hospital.
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6.3
Equipment for a sterile dressing and smartsite change for a single lumen
CVC

Alcohol based hand gel

Alcohol Chlorhexidine

Dressing pack

Sterile gloves

2 x 10ml luer lock syringe

2 x 10ml normal saline ampoule

1 x heparin ampoule (only required if not hooking onto lines)

2 x Drawing up needle

SmartSite

IV 3000 or approved dressing
More equipment will be needed if there is more than one lumen on the central line.
6.4
Procedure for assistant - the parent/guardian may assist with set up
Procedure
1. Wash your hands (can use ABHR)
2. Clear a clean surface to open equipment onto and if required clean surface with
70% alcohol
3. Open sterile dressing pack onto clean surface being careful not to touch the
contents inside the pack (aseptic technique). The open dressing pack creates a
sterile surface which all the sterile equipment can be opened onto. Saline
ampoules and heparin ampoules are not sterile and should not be put on a sterile
field.
4. Open the sterile gloves onto a clean surface for the parent/guardian to use
5. Open the sterile syringes onto the sterile surface
6. Open the sterile IV 3000 dressing onto the sterile field
7. Open the smartsites onto the sterile field
8. Parent /guardian will put on sterile gloves and set up sterile field
9. Support worker to open ampoules of saline for parent to draw up
10. If required the support worker to open ampoule of heparin for parent to draw up
11. Pour alcoholic chlorhexidine into the sterile dish making sure not to touch anything
on the sterile field with the container
12. The Parent (sterile person) will now be ready to access the lines
13. The support worker will assist the sterile person with clamping and unclamping the
line as directed by the sterile person
14. The support worker will assist the sterile person by ensuring that the child is
prevented from touching the sterile field and the central line during the procedure.
15. Wash your hands (can use ABHR)
 RCH @ Home, Royal Children's Hospital.
This document is subject to a disclaimer, see
http://www.rch.org.au/uploadedFiles/Main/Content/hacc/home_care_manuals/RCH@Home%20Disclai
mer.pdf
Page 6 of 6