Learning About Your Central Vascular Access Device: Flushing the Line and Changing the Cap

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 flush the line

A CVAD should be flushed as often as your care team tells you, to keep it clear of blood and prevent clotting. If the CVAD has more than one line (lumen), flush them in the same order each time. Depending on the type you have, you will flush it with either heparin or saline solution. Your care team will probably give you supplies and instructions on how to flush it. A nurse may come to your home to help you at first.

You will usually lie down when you flush the line. This helps prevent air from getting into your vein.

Be sure you have all your supplies ready. These may include the heparin or saline solution, syringes, needleless injection cannulas, alcohol pads, clean disposable gloves, and a disposal box. What you need will vary with the type of CVAD you have. You may have syringes that are already filled with the solution (preloaded).

Here are basic tips for how to flush your CVAD.

Preparing the syringe

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 clean disposable gloves.
4. Clean the rubber lid of the heparin or saline solution bottle with an alcohol pad for 15 to 30 seconds.
5. Remove the cover from the syringe, and twist the needle or needleless cannula onto it. (It may already be attached.)
6. Remove the cover from the needle or cannula. Note: If you have a preloaded syringe, skip to the next section, "Flushing the line."
7. Pull back the plunger of the syringe. Draw air into the syringe equal to the amount of heparin or saline solution you are using.
8. Push the needle or cannula through the rubber lid of the solution bottle.
9. Push the plunger of the syringe to force air into the bottle.
10. Turn the bottle and syringe upside down. Position the tip of the needle or cannula so that it is below the surface of fluid in the bottle. Pull back the plunger to fill the syringe with the amount of solution you need.
11. Before you take the needle or cannula out of the bottle, check for air bubbles in the fluid in the syringe. If there are bubbles, gently push the plunger back in to push the air bubbles into the bottle. Then make sure the needle or cannula is below the surface of the fluid in the bottle and then pull back on the plunger again.
12. Remove the needle or cannula from the bottle.
13. Fill other syringes in the same way if you need to flush more than one line. You will use one syringe per line.

Flushing the line

1. Use an alcohol pad to clean the cap of the line you want to flush. Clean for 15 to 30 seconds, and then let the cap dry.
2. Hold the end of the line so it does not touch anything.
3. If you have a clamp on the line, open it.
4. Insert the needle or cannula into the cap.
5. Slowly inject heparin or saline solution. If there is resistance, stop. Do not force it. Contact your care team.
6. If you have a clamp on the line, clamp it as you are finishing the injection and then remove the syringe. If the line has a positive pressure cap, remove the syringe and then clamp the line.
7. Repeat the above steps for each line you are flushing.
8. Put the syringe, needle, or cannula in the disposal box. Dispose of any used materials as instructed.
9. Wash your hands again with soap and water.

How to change the cap

You need to change the cap on each line (lumen) of the CVAD every 7 days, or anytime it leaks. Or follow the instructions your care team gave you.

Here are basic tips for how to change a cap.

1. Prepare a clean work area, such as a clean counter in your bathroom. Put your supplies on the clean area. These usually include clean disposable gloves, a surgical mask, alcohol pads, and new caps. You may need help changing caps.
2. If there's a clamp on each line, be sure it's closed.
3. 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.
4. Put on the surgical mask.
5. Put on the clean disposable gloves.
6. Open the package with the new cap. Loosen, but do not remove, the cover on the end of the new cap. Be sure you don't touch the sterile end of the new cap.
7. Hold the line with one hand. With your other hand:
   • Clean the old cap as instructed.
   • Remove the old cap, and set it aside.
   • Clean the end of the line as instructed.
   • Remove the cover from the new cap, being careful not to touch the sterile end of the cap.
   • Screw the new cap into the line.
8. Repeat steps 6 and 7 for each line.
9. Dispose of the old caps and any used materials as instructed.
10. 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 any 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.