Learning About a Central Vascular Access Device

What is a central vascular access device?

A central vascular access device (CVAD) is a thin, flexible tube used to give medicines, fluids, nutrients, or blood products for several weeks or longer. It makes giving these things more comfortable for you because they are put directly into the device. You are not poked with a needle every time. The CVAD may also be used to draw blood for tests.

The CVAD (also called a central line) 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 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. The care team gives medicines or fluids or removes blood through the caps.

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

• A peripherally inserted central catheter, or PICC line (say "pick"), which usually goes into a vein in your arm, and the lumens and caps are taped to the skin on the arm.
• A tunneled catheter which often goes into a vein in the neck or chest, and the lumens and caps are taped to the skin.
• An implanted port. This is similar to a tunneled catheter but all of it is entirely under the skin. Medicines are injected through a "port" placed under the skin.

What problems can occur?

Possible problems with a CVAD include:

• Bleeding. This may happen when the device is inserted into a vein. It's usually mild and will stop by itself.
• Pain. You may feel pain where it is inserted or where it lies under your skin.
• Infection. If infection occurs, you will need antibiotics or the CVAD will be removed.
• Blockage. Regular flushing of the CVAD helps reduce blockage.
• Kinking. A twisted or kinked CVAD must be repositioned or replaced.
• Blood clots, which can form in veins, especially in the arms.
• Shifting. If the CVAD has moved out of place, it can sometimes be repositioned. If this doesn't work, it must be replaced.
• Rarely, a collapsed lung (pneumothorax). This would occur during placement of the CVAD.

What happens when you get a central vascular access device?

When you are in the hospital, a 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 and after 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 caps.
• 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.

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.