Patient education: How to care for a central line catheter (The Basics)

What is a central line catheter? — 

A central line catheter, or "central line," is a special kind of IV. It goes into 1 of the large veins, most often in the neck or chest (figure 1). Sample brand names for central lines include Broviac, Hickman, Groshong, and Hohn. A central line is also called a "central venous catheter," or "CVC."

A central line can have 1, 2, or 3 ends called "lumens." These stay outside the body and are covered with caps. Most central lines have a clamp that closes off the tube. Others have a valve inside that acts as a clamp. Your doctor or nurse will tell you when and if you need to use a clamp.

Central lines are often used in the hospital to give medicines and fluids. The medical staff can also use it to draw blood if needed. But in some cases, people go home with a central line. A central line can stay in place for weeks or months.

How do I care for a central line? — 

Ask the doctor or nurse what you should do when you go home. Make sure you understand exactly what you need to do to care for yourself. Ask questions if there is anything you do not understand.

You should also:

●Know what kind of central line you have. Before you go home, your doctor or nurse will talk to you about your line. They will teach you how to change the dressing, flush the line, and change the cap. They will also make sure you have the supplies you need. Having a central line increases your risk of infection. This is why it's so important to take care of it.

●Ask a family member or friend to help you care for the line, if needed. Some people have a home health nurse come to their home to help with this.

How do I change the dressing on the central line? — 

To help prevent infection, keep your skin clean and change the dressing regularly. Replace clear dressings every 7 days. Always change the dressing right away if it gets wet, loose, or dirty. It is easier if another person helps you change the dressing.

●Gather the supplies, and place them on a clean workspace. You need sterile gloves, chlorhexidine swab sticks, and sterile dressings.

●Everyone should wash their hands well with soap and water before touching the line. This helps avoid spreading germs.

●Wear a mask when you change the dressing. If another person is helping, they should wear a mask as well.

●Wear clean gloves, and take off the old dressing. Do not use scissors or sharp tools. They could cut the line. Do not pull on the line when taking off the dressing.

●Check your skin where the line enters for swelling, drainage, or redness.

●Wash your hands again. Put on sterile gloves.

●Clean your skin with a chlorhexidine swab, using a back-and-forth motion for 30 seconds. Starting where the line enters your skin, clean the line and your skin, moving outward. Clean the entire area that will be under the dressing, about a 4-inch (10-cm) square. Let air dry for at least 30 seconds.

●In some cases, the doctor will give you:

•A small sponge disc to help prevent infection – If you have this, put it around the line where it comes out of your skin. The colored side should be facing away from your skin.

•A device to help hold the line in place – If you have this, remove the adhesive cover and place it under the hub of the line. Place the hub on top of it, and close the clasp or patch.

●Lay the line on your skin in a loose circle if it is long, or in a straight line if it is short. It should not cover the spot where it goes into your skin, and it shouldn't be coiled on itself. Put the dressing snugly on all sides of the line. Most dressings are clear and stick to your skin. If any dressing is not sticking, talk to your doctor or nurse about other dressing materials.

●The clear dressing goes over the small sponge disc, any devices used to hold the line in place, and the catheter.

●Throw away the old dressing and used swabs and wipes.

●Remove your gloves.

●Wash your hands with soap and water.

How do I flush the central line? — 

Flush all of the lumens of the line every day with a sterile fluid. You should also flush a lumen after it is used to give medicine. This helps keep the line from getting blocked. Your doctor will order heparin, normal saline, or another solution for you to use.

●Gather the supplies, and place them on a clean workspace. You need alcohol wipes and a syringe filled with the fluid to flush the line. Your doctor or nurse will tell you how much fluid to use. You need these supplies for each lumen you need to flush.

●Wash your hands with soap and water.

●Scrub the top and sides of the cap for at least 15 seconds with an alcohol wipe. Let dry.

●Remove the end cap from the syringe, and check for air bubbles. Slowly push the syringe plunger forward until all the air is out of the syringe.

●Screw the syringe onto the end of the cap on the line.

●Unclamp the line (if you have a clamp), and push the fluid into the line. The doctor or nurse will tell you which method of flushing is best for your line. You might be told to:

•Flush slowly and steadily until the syringe is empty, then clamp (if the line has a clamp).

•Flush slowly until the syringe is at the 7 mL mark, then pause for a second. Next, flush slowly until the syringe is at the 4 mL mark, then pause for a second. Finally, flush slowly to the 1 mL mark. As you reach the 1 mL mark, hold pressure on the syringe and clamp the line before you get to the very bottom of the syringe. This example is using 10 mL of flush. Your amount might be different.

●Remove the syringe from the line.

●If the line does not have a clamp, or you were told not to clamp the line, remove the syringe just before the black stopper reaches the bottom of the syringe.

●Repeat these steps for each lumen of the line. Use new supplies for each lumen. Do not reuse the same syringe.

●Throw away any used swabs, wipes, or other supplies. Throw away syringes into hard plastic container (picture 1).

●Wash your hands with soap and water.

How do I change the cap? — 

The cap is used to connect syringes or tubing to the central line. The cap might also be called a "needleless connector" or an "injection cap." Change the cap on each lumen every 7 days, or anytime there is a leak. A good way to remember this is to change the caps each time you change the dressing.

●Gather the supplies, and place them on a clean workspace. You need alcohol wipes, a sterile cap, and a syringe of fluid for each lumen of the line.

●Wash your hands with soap and water.

●Remove the new cap from the package without touching the ends.

●Connect the syringe of fluid to the end of the cap. Hold the syringe so the cap points up, and "prime" the cap with the fluid. To do this, tap the cap gently to get rid of any air bubbles and leave the syringe joined to the cap. Set the cap down on a clean alcohol wipe.

●Clamp the line (if it has a clamp), and remove the old cap.

●Scrub the lumen of the line for at least 15 seconds with alcohol, and let air dry.

●Remove the sterile tip protector from the new cap.

●Screw the new cap onto the line. Unclamp the line, and flush it as instructed. Clamp the line. Then, remove the syringe from the cap.

●Throw away any used swabs, wipes, or materials.

●Wash your hands with soap and water.

What else should I know? — 

While the central line is in, you should:

●Avoid contact sports or rough play.

●Keep sharp objects away from the line.

●Avoid swimming or soaking in water.

●Keep the dressing covered when showering. Change the dressing if it gets wet, dirty, or loose.

●Make sure the line is secured with special central line holders or tape.

●If your line has a clamp, keep the line clamped when the lumen is exposed to air. For example, it should be clamped when connecting to fluids or when changing the cap. The doctor or nurse will teach you when and how to clamp the line correctly.

●Check every day for signs of infection.

When should I call the doctor? — 

Call for advice if:

●You have symptoms of an infection. These include a fever of 100.4°F (38°C) or higher, chills, or redness, drainage, warmth, stinging, or pain where the central line goes into your skin.

●There are problems with the line, like:

•The line falls out all or part of the way.

•The tubing breaks, cracks, or leaks.

•You cannot get the medicine or flush solution through the line.

•You cannot get a blood return from the line.

•You have any concerns about the line.

●You have sudden shortness of breath or chest pain.

●You have swelling of your face, neck, or chest on the side of the line, or swelling or bulging veins around where it enters your skin.

More on this topic

Patient education: Lowering the risk of a central line infection (The Basics)
Patient education: Central line infection (The Basics)
Patient education: Central line catheter insertion (The Basics)
Patient education: Parenteral nutrition (The Basics)