Learning About Your Child's 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 your child needs 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 your child's blood. A CVAD is more comfortable than being poked with a needle every time your child gets medicine or fluids.

A CVAD (also called a central line) is put through your child's 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 your child can get more than one medicine or fluid at a time. 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 with soap and water before you touch your child's CVAD.
• Check it every day for symptoms of infection. These include pain, tenderness, swelling, drainage, pus, redness, and warmth on the skin near the device.
• Make sure that your child doesn't get the device wet. When your child showers, cover the device with something waterproof, such as plastic wrap. Your child may not be able to go swimming depending on the type of CVAD they have.
• If your child's device has a clamp, keep it clamped when your child isn't using it.
• Fasten or tape the device to your child's body to prevent it from dangling and being pulled on. Remind your child not to play with the device or touch the open end of the line when the cap is off. You may need to repeat the reminder a few times.
• Avoid clothing that rubs or pulls on the device. Have your child be careful wearing jewelry, such as necklaces, that can catch on the device.
• Avoid bending or crimping it.
• Never use scissors, knives, pins, or other sharp objects near the device or other tubing.
• Clamp off the device if it breaks. Then take your child to the doctor as soon as possible.
• Consider having your child wear a medical alert bracelet and carry a medical alert card. These will tell health care providers about the port in case your child needs emergency care.

Keep your child's CVAD dry. Cover it with plastic wrap when your child showers.

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

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

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 the dressing 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 the 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. Use the applicator the care team gave you, or use alcohol pads. Clean in an up-and-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 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 child's body so it won't 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 your child may need emergency care. For example, call if:

• Your child passes out (loses consciousness).
• Your child has trouble breathing.
• Your child has chest pain, is short of breath, or coughs up blood.

Contact your doctor now or seek immediate medical care if:

• Your child has swelling in their face, chest, neck, or arm on the side where the line is.
• Your child has signs of a blood clot, such as bulging veins in the neck.
• Your child has fluid leaking from around the line.
• You feel resistance when you inject medicine or fluids into your child's line.
• Your child's line is out of place. This may happen after severe coughing or vomiting, or if something pulls on the line.
• Your child has 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 child's doctor if your child has any problems.

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