Learning about your central vascular access device: Changing the dressing

What is a central vascular access device?

A CVAD is a thin, flexible tube. It's also called a central line. It is used when you need to receive medicine, fluids, nutrients, or blood products for several weeks or more. The fluids are put through the CVAD so that they move quickly into the bloodstream. The line can be used many times, so you are not poked with a needle every time.

A CVAD is put through the skin into a vein, often in the neck, chest, arm, or groin. The point where it leaves the skin is called the exit site. Usually about 12 inches of the line stays outside of the body. But sometimes the CVAD is completely under the skin. The line may have two or three ends so that you can get more than one medicine at a time. These ends are called lumens. The end of each lumen is covered with a cap.

General guidelines

• Try to keep the exit site dry. When you shower, cover the site with waterproof material, such as plastic wrap. Be sure you cover both the exit site and the cap(s).
• Never touch the open end of the line if the cap is off.
• Never use scissors, knives, pins, or other sharp objects near the line or other tubing.
• If it has a clamp, keep it clamped when you aren't using it.
• Fasten or tape it to your body to prevent pulling or dangling.
• Avoid clothing that rubs or pulls on it.
• Avoid bending or crimping it.
• Always wash your hands before you touch your line.
• Check it every day for signs of infection. These include pain, tenderness, swelling, drainage, pus, redness, or warmth at or near the exit site.

How to change the dressing

If you just got your CVAD, do not let the exit site get wet for 72 hours. Avoid exercise until your doctor says it is okay.

If you have a gauze dressing, change it every 48 hours. If you have a clear plastic dressing, change it every 5 days. Also change your dressing if it is damp, bloody, loose, or dirty. Your doctor may also give you directions for when to change the dressing.

Be sure you have all your supplies ready. These include medical tape, a surgical mask, sterile gloves, your dressing, an applicator, and skin-protecting swabs. The names and brands of the items will vary. Your doctor or nurse may give you specific instructions for changing the dressing. Here are basic tips for how to change the dressing. You may need help changing it.

1. Wash your hands with soap and water for 15 to 30 seconds. Dry them with paper towels.
2. Put on the surgical mask.
3. Loosen and remove your old dressing. Peel the dressing toward the CVAD, not away from it. You may need to use an adhesive remover if it doesn't come off easily.
4. Look at the area carefully for redness, swelling, drainage, tenderness, or warmth. If you notice any of these, call your doctor.
5. Wash your hands again, and put on the sterile gloves.
6. Clean the area with the applicator your doctor gave you or with alcohol and swabs. Clean in an up-down or side-to-side motion. When you have finished, let the area dry for about 30 seconds.
7. Swab the edges of the cleaned area with the skin protector.
8. Remove the backing from the clear plastic dressing. Place the dressing or the gauze your doctor gave you over the site.
9. Tape the CVAD to your skin so it will not dangle or pull.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

• You passed out (lost consciousness).
• You have severe trouble breathing.
• You have sudden chest pain and shortness of breath, or you cough up blood.
• You have a fast or uneven pulse.

Call your doctor now or seek immediate medical care if:

• You have signs of infection, such as:
  • Increased pain, swelling, warmth, or redness.
  • Red streaks leading from the exit site.
  • Pus or blood draining from the exit site.
  • A fever.
• You have a fever or you have chills.
• You have swelling in your face, chest, neck, or arm on the side where the central line is.
• You have signs of a blood clot, such as bulging veins near the line.
• Your central line is leaking.
• You feel resistance when you inject medicine or fluids into your line.
• Your central line is out of place. This may happen after severe coughing or vomiting, or if you pull on the central line.

Watch closely for changes in your health, and be sure to contact your doctor if:

• You have any concerns about your line.