Learning about a central vascular access device

What is a central vascular access device?

A CVAD, also called a central line, is a long, thin, flexible tube used to give medicines, fluids, nutrients, or blood products over a long period of time, usually several weeks or more. It makes giving these things more comfortable for you because they are put directly into the line. You are not poked with a needle every time. It may be used to draw blood for tests only if another vein, such as in the hand or arm, can't be used.

The CVAD is inserted through the skin into a vein in your arm, chest, neck, or groin. One end is moved into a large vein near the heart. In most cases the other end sticks out where it entered the skin. The end of the line that sticks out of the skin has caps on it. The health care team gives medicine or removes blood through the caps.

Some of the common CVADs that are used outside the hospital or for longer periods of time include:

• A peripherally inserted central catheter, or PICC line (say "pick"). It usually goes into a vein in your arm, and one end of the line sticks out of the skin.
• A tunneled catheter, which is surgically inserted into a vein in the neck or chest, and one end of the line sticks out of the skin.
• An implanted port. This is similar to a tunneled catheter but is left entirely under the skin. Medicines are injected through a "port" placed under the skin.

After your CVAD is in place, you may stay in the hospital to receive your medicines. Or you may get your medicines at home.

What problems can occur?

Possible problems with a CVAD include:

• Bleeding. This may happen when the doctor inserts the catheter. It's usually mild and will stop by itself.
• Infection. If infection occurs, you will need antibiotics or the CVAD will be removed.
• Blockage or kinking. Regular flushing of the CVAD helps reduce blockage. If it's kinked, it must be repositioned or replaced.
• Pain. You may feel pain where it is inserted or where it lies under your skin.
• Blood clots, which can form in blood vessels, especially in the arms.
• Collapsed lung (pneumothorax). This is rare. It's most likely to happen during placement in the chest.
• Shifting. If the CVAD has moved out of place, it can sometimes be repositioned. If this doesn't work, it must be replaced.

What happens when you get a central vascular access device?

When you are in the hospital, a health care team will take care of you and your CVAD.

Insertion and care of the CVAD

Your team will:

• Check the site and dressing regularly. How often this is done depends on the situation.
• Wash their hands before and after handling the CVAD.
• Clean or replace parts when needed.

Changing the dressing

The team will:

• Use clean and proper materials for the dressing, which covers the site.
• Clean the site and area whenever they change the dressing.
• Replace the dressing when it is damp, loose, or dirty. It will be changed regularly.

Home care

If you go home with a CVAD, the team will give you detailed instructions on how to care for it and what to do if any problems occur. In general:

• Always wash your hands before you touch it. Make sure anyone who touches it also washes their hands.
• Try to keep the skin at the exit site dry. This can help prevent infection. When you shower or bathe, cover the site with waterproof material, such as plastic wrap. Be sure you cover both the CVAD site and the cap(s).
• Fasten or tape the CVAD to your body to prevent it from pulling or dangling. Avoid bending or crimping it. And wear clothing that doesn't rub or pull on it.