Learning About Your Central Vascular Access Device: Changing the Dressing

What is a central vascular access device?

A central vascular access device (CVAD) is a thin, flexible tube. It is used when you need to receive medicine, fluids, nutrients, or blood products for several weeks or longer. The medicine and fluids are put through the CVAD so that they move quickly into the blood. A CVAD is more comfortable than being poked with a needle every time.

A CVAD (also called a central line) is put through the skin into a vein, often in the neck, chest, arm, or groin. 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, called lumens, so that you can get more than one medicine or fluid at a time. The end of each lumen is covered with a cap.

General guidelines

• Always wash your hands with soap and water before you touch your device.
• To help prevent infection, take a shower instead of a bath. When you shower, cover the device with waterproof material, such as plastic wrap. Do not go swimming with a CVAD.
• Never touch the open end of the device if the cap is off.
• Never use scissors, knives, pins, or other sharp objects near the device 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 it from dangling and being pulled on.
• Do not wear clothing that rubs or pulls on it.
• Don't wear jewelry, such as necklaces, that can catch on the device.
• Avoid bending or crimping it.
• Clamp off the device if it breaks. Then go see a doctor as soon as possible.
• Check it every day for symptoms of infection. These include pain, tenderness, swelling, drainage, pus, redness, or warmth on the skin near the device.
• Carry a medical alert card with you, and consider wearing a medical alert bracelet. These will tell health care providers you have a CVAD in case you need emergency care.

How to change the dressing

Keep your CVAD dry. Cover it with plastic wrap when you shower.

If you have a gauze dressing, change it every 2 days. If you have a clear plastic dressing, change it every 7 days. Also change your dressing if it is wet, bloody, loose, or dirty. Your care team may also give you specific instructions on how and when to change the dressing.

Be sure you have all your supplies ready. These usually include medical tape, a surgical mask, clean disposable gloves, sterile gloves, your dressing, an applicator, alcohol pads, and skin-protecting swabs. The names and brands of the items will vary. You may need help changing the dressing.

Here are basic tips for how to change the dressing.

1. Prepare a clean work area, such as a clean counter in your bathroom. Put your supplies on the clean area.
2. Wash your hands with soap and water for at least 20 seconds. Be sure to wash between your fingers and under your fingernails. Dry your hands with paper towels.
3. Put on the surgical mask.
4. Put on the clean disposable gloves. Loosen and slowly peel away the old dressing while holding the CVAD securely in place. You may need to use an adhesive remover if it doesn't come off easily.
5. Look at the area carefully for redness, swelling, drainage, pus, tenderness, or warmth. If you notice any of these, contact your doctor.
6. Remove your disposable gloves.
7. Wash your hands again (as instructed in step 2), and put on the sterile gloves.
8. Clean the area with the applicator your care team gave you or with alcohol pads. Clean in an up-down or side-to-side motion. When you have finished, let the area dry for about 30 seconds.
9. Clean the outside of the CVAD.
   • Use an alcohol pad to hold the CVAD in place. Use another alcohol pad to gently clean the outside of it.
   • Start from where the CVAD is at the skin and gently clean toward the cap.
   • If the CVAD has 2 or 3 lines, use a fresh pad to clean each line.
10. Swab the edges of the cleaned skin area with the skin protector.
11. Remove the backing from the clear plastic dressing. Place the dressing over the device and the skin around it. If you are using a gauze dressing, be sure it covers the skin around the device and secure it with tape.
12. Tape or fasten the CVAD to your body so it will not dangle or get pulled on.
13. Dispose of the old dressing and any used materials as instructed.
14. Wash your hands again with soap and water.

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.

Contact your doctor now or seek immediate medical care if:

• You have swelling in your face, chest, neck, or arm on the side where the line is.
• You have signs of a blood clot, such as bulging veins in your neck.
• You have fluid leaking from around the line.
• 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 something pulls on the line.
• You have symptoms of infection, such as:
  • Increased pain, swelling, warmth, or redness.
  • Red streaks leading from the line.
  • Pus or blood draining from the line.
  • A fever.

Watch closely for changes in your health, and be sure to contact your doctor if you have any problems.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.