About Your Central Venous Catheter (CVC) for Pediatric Patients

This information explains the procedure to place your CVC, including how to get ready and what to expect. It also explains how to care for your CVC. In this resource, the words “you” and “your” refer to you or your child.

About CVCs

A CVC is a catheter (long, flexible tube) that’s put into a vein in your chest. There are many types of CVCs. Your doctor will decide which type is best for you.

All CVCs have 1 central catheter that’s put into a large vein near your heart. Outside your body, the central catheter divides into 1, 2, or 3 smaller tubes called lumens. Each lumen has a clamp, a needleless connector (sometimes called a clave), and a disinfection cap on the end (see Figure 1).

Having a CVC will help you need fewer needle sticks. Your care team can use your CVC to:

• Take blood samples from you
• Give you fluids
• Give you chemotherapy and other medications
• Give you blood transfusions
• Give you intravenous (IV) nutrition

Your CVC can stay in your body for as long as a few years. It will stay in place for your whole treatment. Your doctor will remove your CVC when you don’t need it anymore.

Having a CVC shouldn’t keep you from doing your normal activities, such as going to school or work, showering, and doing light exercise. Read the section “Caring for Your CVC” for more information.

You’ll have a procedure to place your CVC. Your nurse will tell you how to get ready for your procedure. They’ll also teach you how to care for your CVC after your procedure. You’ll learn to:

• Change your dressing (bandage)
• Change your needleless connectors
• Change your disinfection caps (such as SwabCaps®)
• Flush your CVC

You can have a caregiver, family member, or friend learn with you. After you go home, use this resource to help you remember the steps to care for your CVC.

Before Your Procedure

Ask about your medications

You might need to stop taking some of your medications before your procedure. Talk with your healthcare provider about which medications are safe for you to stop taking. We’ve included some common examples below.

Anticoagulants (blood thinners)

If you take a blood thinner (medication that affects the way your blood clots), ask the doctor who’s doing your procedure what to do.

Medications for diabetes

If you take insulin or other medications for diabetes, ask the healthcare provider who prescribes it what to do the morning of your procedure. You might need to change the dose before your procedure.

Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs)

If you take aspirin, a medication that contains aspirin, or an NSAID such as ibuprofen (Advil^® or Motrin^®), ask your healthcare provider if you need to stop taking it before your procedure. This will depend on the reason you’re taking it.

For more information, read the resource How To Check if a Medicine or Supplement Has Aspirin, Other NSAIDs, Vitamin E, or Fish Oil. You can find it online or ask your healthcare provider for a copy.

Vitamin E and other dietary supplements

If you take vitamin E, stop taking it 7 days before your procedure or as directed by your healthcare provider.

If you take a multivitamin, any herbal remedies, or any other dietary supplement, ask your healthcare provider if you should keep taking it.

Tell us if you’re sick

If you get sick (such as with a fever, cold, sore throat, or the flu) before your procedure, call your healthcare provider.

1 Day Before Your Procedure

Note the time of your procedure

A staff member will call you the day before your procedure. If your procedure is scheduled for a Monday, they’ll call you on the Friday before. If you don’t get a call by 4:00 p.m., call 212-639-5948.

The staff member will tell you what time to get to the hospital on the day of your procedure. They’ll also remind you where to go. It will be one of the following places:

• Pediatric Ambulatory Care Center (PACC)
  1275 York Avenue (between East 67th and East 68th Streets)
  New York, NY 10065
  Take the B elevator to the 9th floor.
• Presurgical Center (PSC) on the 6th floor
  1275 York Avenue (between East 67th and East 68th Streets)
  New York, NY 10065
  Take the B elevator to the 6th floor.

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Do not eat any solid foods after midnight the night before your procedure. This includes hard candy and gum.

The Day of Your Procedure

Instructions for drinking before your procedure

You can keep drinking formula, breast milk, and clear liquids after midnight. Follow the instructions in the table below. It’s OK to brush your teeth and take your medications with a small sip of water.

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Do not drink anything starting 2 hours before your scheduled arrival time. This includes formula, breast milk, water, and other clear liquids.

Take your medications as instructed

If your healthcare provider tells you to take certain medications the morning of your procedure, take only those medications with a sip of water. Depending on what medications you take, this may be all, some, or none of your usual morning medications.

Shower

Shower using your usual soap, shampoo, and conditioner. After your shower, dry yourself off with a clean towel and put on clean clothes. Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne.

Things to remember

• Wear clean, comfortable clothing.
• If you wear contact lenses, wear your glasses instead. Wearing contact lenses during a procedure can damage your eyes.
• Don’t wear any metal objects. Remove all jewelry, including body piercings. The tools used during your procedure can cause burns if they touch metal.
• Leave valuable items at home.
• If you’re menstruating (have your monthly period), use a sanitary pad, not a tampon. You’ll get disposable underwear, as well as a pad if needed.

What to bring

• A list of the medications you take at home, including over-the-counter and prescription medications, patches, and creams.
• Medications for breathing problems (such as inhalers), if you take any.
• Medications for chest pain, if you take any.
• A case for your glasses or contacts.
• Your Health Care Proxy form and other advance directives, if you’ve completed them.
• Your breathing device for sleep apnea (such as your CPAP or BiPAP), if you have one.
• This resource. You’ll use it to learn how to care for your CVC after your procedure.

Where to park

MSK’s parking garage is on East 66^th Street between York and 1^st avenues. If you have questions about prices, call 212-639-2338.

To get to the garage, turn onto East 66^th Street from York Avenue. The garage is about a quarter of a block in from York Avenue. It’s on the right (north) side of the street. There’s a tunnel you can walk through that connects the garage to the hospital.

There are other parking garages on:

• East 69th Street between 1st and 2nd avenues.
• East 67th Street between York and 1st avenues.
• East 65th Street between 1st and 2nd avenues.

Once you’re in the hospital

When you get to the hospital, take the B elevator to the 9^th floor (if you’re going to the PACC) or the 6^th floor (if you’re going to the PSC).

Many staff members will ask you to say and spell your name and date of birth. This is for your safety. People with the same or a similar name may be having a procedure on the same day.

When it’s time to change for your procedure, you’ll get a hospital gown, robe, and non-skid socks to wear.

Meet with a nurse

You’ll meet with a nurse before your procedure. Tell them the dose of any medications (including patches and creams) you took after midnight and the time you took them.

Your nurse will place an intravenous (IV) line into one of your veins. The IV line may be used to give you fluids, medication to help you relax during your procedure, or both.

Meet with an anesthesiologist

You’ll also meet with an anesthesiologist before your procedure. They will:

• Review your medical history with you.
• Ask you if you’ve had any problems with anesthesia in the past, including nausea (feeling like you’re going to throw up) or pain.
• Talk with you about your comfort and safety during your surgery.
• Talk with you about the kind of anesthesia you will have.
• Answer your questions about your anesthesia.

Get ready for your procedure

One or 2 visitors can keep you company as you wait for your procedure to start. When it’s time for your procedure, a staff member will bring your visitor(s) to the waiting area.

Before you go into the operating room, you may need to remove your hearing aids, prosthetic devices, wig, and religious items, if you have any.

You’ll either walk into the operating room or a staff member will bring you on a stretcher. A member of the operating room team will help you onto the operating bed. Once you’re comfortable, your anesthesiologist will give you anesthesia through your IV line and you’ll fall asleep.

During your procedure

First, your doctor will give you an injection (shot) of a local anesthetic near your collarbone. A local anesthetic is a medication that makes an area of your body numb. This will help keep you from having pain after your procedure.

Next, your doctor will make 2 small incisions (surgical cuts) called the insertion site and exit site.

• The insertion site is where your CVC will enter your vein. This incision will be just below your collarbone.
• The exit site is where your CVC will leave your body. This incision will be a few inches below the insertion site.

Then, your doctor will place one end of your CVC through the insertion site and into your vein. They’ll tunnel the other end under your skin and out of the exit site. Tunneling your CVC under your skin will help keep it from moving.

After your CVC is in place, your doctor will close the insertion site with Dermabond^® (surgical glue) or Steri-Strips^™ (surgical tape). They’ll close the exit site with sutures (stitches). They’ll also stitch your CVC to your skin at the exit site so it stays in place until it becomes anchored in the tunnel under your skin. Then, they’ll put on 2 dressings: 1 dressing over your insertion site and 1 dressing over your exit site and CVC.

After Your Procedure

When you wake up after your procedure, you’ll be in the Post-Anesthesia Care Unit (PACU). As soon as you’re settled, a nurse will bring your visitors in to be with you.

Your nurse will be keeping track of your body temperature, pulse, blood pressure, and oxygen levels. Once you’re fully awake, they’ll give you a drink and a light snack.

Your nurse will teach you and your caregiver how to care for your dressing before you’re discharged from the hospital. They’ll also give you an emergency kit. The emergency kit should have:

• 2 toothless clamps
• 1 dressing change kit
• Alcohol pads
• Medical (paper) tape
• Your doctor’s office and emergency telephone numbers

Keep your emergency kit with you at all times. You’ll need it if your catheter is leaking, your dressing gets dirty or comes off, or your needleless connector or disinfection cap falls off.

Caring for your incisions

You may have some discomfort around your incisions. Your care team will make a plan to manage your pain based on your needs. Tell them if your pain isn’t managed.

It’s important to keep your dressings dry for the first 24 hours (1 day) after your procedure. After 24 hours, your dressings will need to be changed. Read the section “Changing Your Dressing, Needleless Connectors, and Disinfection Caps” for more information.

You can take off the dressing over your insertion site 2 days after your procedure. You don’t need to put on a new one. If you have Steri-Strips, leave them in place until they start to peel off. This should happen about 3 to 5 days after your procedure. Don’t take off the dressing covering your CVC.

Your healthcare provider will give you instructions about what exercises and movements you can do while your incisions are healing. Check with them before starting heavy exercises (such as running, jogging, or lifting weights).

Caring for Your CVC

• Don’t put your CVC underwater (such as in a bathtub or swimming pool).
• Clamp the lumens when your CVC isn’t in use.
• Always keep your CVC secure to avoid pulling it. Ask your nurse about the best way to secure your CVC.
• Avoid contact sports and activities that might pull on your CVC (such as football, soccer, and roughhousing). Ask your healthcare provider about any activities before you start them. Be careful not to pull on your CVC when you’re changing your clothes.
• Check your exit site every day for:
  • Redness
  • Tenderness
  • Leakage
  • Swelling
  • Bleeding

If you have any of these, call your healthcare provider. You might have an infection.

What to do if your CVC is leaking

What to do if your CVC dressing is damaged, loose, dirty, or wet

Change your dressing right away. Follow the steps in the section “Changing Your Dressing, Needleless Connectors, and Disinfection Caps.”

What to do if your needleless connector gets dirty or falls off

• If your needleless connector gets dirty, change it. Follow the instructions in the section “How to change your needleless connectors and disinfection caps.”
• If your needleless connector falls off, throw it in the trash. Don’t put it back on the lumen. Put on a new needleless connector following the steps below.
  1. Gather your supplies. You’ll need:
     • 2 alcohol pads
     • A new needleless connector
     • A new disinfection cap
  2. Make sure the clamp on the lumen is closed.
  3. Using an alcohol pad, hold the lumen with your nondominant hand (the hand you don’t write with) close to, but not touching, the needleless connector.
  4. Pick up another alcohol pad in your dominant hand. Use the alcohol pad to scrub the end of the lumen for 15 seconds. Throw away the alcohol pad. Let the lumen dry for 15 seconds.
  5. Pick up the new needleless connector with your dominant hand. If it has a cover, remove the cover. Twist the new needleless connector onto the lumen.
  6. Put a disinfection cap on the end of the needleless connector.
• Call your healthcare provider after you put on the new needleless connector. You may need to have blood drawn to make sure you don’t have an infection.

What to do if your disinfection cap falls off

Throw away the disinfection cap that fell off. Don’t put it back on the lumen.

To put on a new disinfection cap:

Guidelines for Showering

Follow the instructions in this section when you shower. Don’t put your CVC underwater (such as in a bathtub or swimming pool).

For more information about showering with a CVC, watch the following video.

Use a waterproof cover

You can shower with your catheter in place using a single-use waterproof cover that goes over your dressing (such as AquaGuard^®). You can buy waterproof covers online.

Each time you shower, cover your dressing and CVC completely with a new waterproof cover to keep them from getting wet. To put on the waterproof cover:

Don’t shower for longer than 15 minutes. Use warm water, not hot water. This will help keep the waterproof cover from coming off.

After your shower, dry the waterproof covering before taking it off. If your dressing gets wet, change it. Follow the instructions in the section “Changing Your Dressing, Needleless Connectors, and Disinfection Caps.”

Use a 4% chlorhexidine gluconate (CHG) solution antiseptic skin cleanser such as Hibiclens®

While your CVC is in place, it’s very important to keep your skin clean to lower your risk of infection. Wash with 4% CHG solution every day while you have a CVC.

CHG is a strong antiseptic (liquid used to kill germs and bacteria) that kills germs for up to 24 hours after you use it. Showering with a 4% CHG solution antiseptic skin cleanser will help lower your risk of infection while you have a CVC.

You can buy a 4% CHG solution antiseptic skin cleanser without a prescription from any local pharmacy or online. You’ll also get a small bottle when you’re discharged from the hospital.

Instructions for using 4% CHG solution

Important points to remember when using 4% CHG solution

• Don’t use CHG on children younger than 2 months old.
• Don’t use regular soap, lotion, cream, powder, or deodorant after washing with 4% CHG solution without talking with your nurse first. If you’re in the hospital, your nurse might give you a lotion you can use after using 4% CHG solution.
• Don’t use 4% CHG solution on your head, face, ears, eyes, mouth, genital area, or on deep wounds. If you have a wound and aren’t sure if you should use 4% CHG solution on it, ask your healthcare provider.
• Don’t use 4% CHG solution if you’re allergic to chlorhexidine.
• If your skin gets irritated or you have an allergic reaction when using 4% CHG solution, stop using it and call your healthcare provider.

Changing Your Dressing, Needleless Connectors, and Disinfection Caps

Your dressing, needleless connectors, and disinfection caps will need to be changed and your CVC will need to be flushed at least once a week. Usually, a nurse will do these things for you during your appointments. It’s helpful to know how to do them yourself in case your dressing, needleless connector, or disinfection cap gets damaged, loose, wet, dirty, or falls off.

Always contact your healthcare provider if you have any questions.

• Don’t change your dressing in the bathroom after a shower. The steam from a shower can keep it from sticking to your skin.
• You’ll use a Tegaderm™ dressing to cover your exit site. Your dressing needs to be changed once a week. If it gets wet, damaged, or dirty, change it sooner. Change it on the same day you change your needleless connectors and disinfection caps and flush your CVC.
• If the gel pad on your Tegaderm dressing becomes swollen, change your dressing. You can test the gel pad by gently pushing down on it with your finger. If you see an indent, the gel pad is swollen and your dressing should be changed. This can happen if there’s a lot of sweat under your dressing.
• If you have problems with your skin, such as irritability or sensitivity, your nurse may suggest a different type of dressing. In that case, you may need to change it more often than once a week.
• No matter which dressing you’re using, always change it right away if it starts to come off or gets wet. Don’t just put another dressing or tape over it.

Supplies

• 1 dressing change kit
• Nonsterile gloves
• Medical (paper) tape
• 1 disinfection cap for each lumen
• A different dressing or needleless connector, if your nurse gave you one
• A mirror that can stand up on a table, such as a makeup mirror
• Adhesive remover spray or pads, as needed

Sterile procedure for changing your dressing

Remember not to change your dressing in the bathroom after a shower.

You’re now done with the sterile part of the dressing change. Keep your gloves and mask on to change the needleless connectors and disinfection caps.

Changing your needleless connectors and disinfection caps

After you put on a new dressing, you’ll change the needleless connector and disinfection cap on each lumen of your CVC. Make sure you have 3 alcohol pads for each lumen.

If you’re changing your dressing because it’s damaged, loose, wet, or dirty, you don’t need to change your needleless connectors and disinfection caps unless they’re also dirty.

How to Flush Your CVC

A member of your care team will tell you if you need to flush your CVC. If you do, follow the steps below.

Supplies

• 10 mL syringe(s) prefilled with normal saline solution. You’ll need 1 syringe for each lumen.
• Nonsterile gloves
• 2 alcohol pads for each lumen
• 1 disinfection cap for each lumen

Steps to flushing your CVC

Repeat steps 4 to 12 for each lumen. Once you’re done, throw away your mask and gloves. Wash your hands well with warm water and antibacterial soap or use hand sanitizer.

When to Call Your Healthcare Provider

Call your healthcare provider right away if:

• There’s redness, swelling, or drainage around your exit site
• You have a fever of 100.4 °F (38 °C) or higher
• Your catheter is broken or leaking
• Your needleless connector falls off
• There’s blood backing up into your catheter
• Your catheter becomes disconnected from your pump
• Your catheter is connected to a pump and the alarm on the pump is going off
• You have an unexplained problem with your catheter

Contact information

Monday through Friday from 9:00 a.m. to 5:00 p.m., contact your healthcare provider directly.

After 5:00 p.m., during the weekend, and on holidays, call 212-639-2000. Ask for the pediatric doctor on call.