Learning About Your Child's 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 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.

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

Your child will usually lie down when you flush the line. This helps prevent air from getting into the 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 your child has. You may have syringes that are already filled with the solution (preloaded).

Here are basic tips for how to flush your child's CVAD.

Preparing the syringe

Flushing the line

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 child's 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.
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 don't 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 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.