Learning About Your Child's 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 your child needs to receive medicine, fluids, nutrients, or blood products for up to several weeks or more. The fluids are put through the CVAD so that they move quickly into your child's bloodstream. The same line can be used for a while, so your child isn't poked with a needle every time.

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 line is completely under the skin. The line may have two or three ends so your child can get more than one medicine at a time. These ends are called lumens. The end of each lumen is covered with a cap.

What are some tips for being safe with a central vascular access device?

• Always wash your hands before you touch your child's central line.
• Check the skin near the central line every day for signs of infection.

  These signs include pain, tenderness, swelling, drainage, pus, redness, and warmth at or near the exit site.

• Make sure that your child doesn't get the exit site wet.

  When your child showers, cover the site with something waterproof, such as plastic wrap. Be sure to cover both the exit site and the central line cap(s).

• If your child's central line has a clamp, keep it clamped when your child isn't using it.
• Fasten or tape the central line to your child's body to prevent pulling or dangling.

  Remind your child not to play with the line or touch the open end of the line when the cap is off. You may need to repeat the reminder a few times.

• Never use scissors, knives, pins, or other sharp objects near the central line or other tubing.
• Avoid clothing that rubs or pulls on the central line.
• Avoid bending or crimping the central line.

How do you change the dressing?

It's important to keep your child's central line dry for the first 72 hours after it's placed. Don't let your child exercise until your doctor says it's okay.

If your child has a gauze dressing, change it every 48 hours. If it's a clear plastic dressing, change it every 5 days. Also change the dressing if it is damp, bloody, loose, or dirty. The doctor may give you more directions for when to change the dressing.

Be sure you have all the supplies ready. These include medical tape, a surgical mask, medical gloves, the dressing, an applicator, and skin-protecting swabs. The names and brands of the items will vary. The doctor or nurse may give you specific instructions for changing the dressing.

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 the old dressing.

   Peel the dressing toward the central line, not away from it. You may need to use an adhesive remover if the dressing doesn't come off easily.

4. Check the area carefully.

   Look for redness, swelling, drainage, tenderness, or warmth. If you notice any of these, call the doctor.

5. Wash your hands again, and put on the medical gloves.
6. Clean the area.

   Use the applicator the doctor gave you, or use alcohol and swabs. Clean in an up-and-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. Cover the site.

   Take the gauze or remove the backing from the dressing the doctor gave you. Place it over the site.

9. Tape the central line to your child's skin so it won't dangle or pull.