These instructions are for Children’s Hospital of Philadelphia (CHOP) patients going home with a tunneled central venous catheter, also called a central line.

Important information about the tunneled central line:

• Learn more about a tunneled central line.
• The central line will have a clear sterile dressing over the catheter exit site. It is changed once a week by a nurse. The nurse will wear a mask during the dressing change. You and your child will also need to wear a mask during the dressing change.  
• The needleless cap on the end of the catheter needs to be changed once a week. A nurse will change the needleless cap when the dressing is changed.  
• The central line catheter should be secured to avoid dangling, and always kept away from the diaper area. Tight fitting clothing is recommended to keep the central line secure and avoid any pulling on the catheter.
• It is important to watch your child carefully while playing and if they are teething to avoid pulling, breaks or leaks in the catheter.
• When your child is not getting IV antibiotics or fluids through the central line, blood can back up and cause the catheter to clot. To prevent clotting, the catheter is flushed with heparin.

Instructions for the central line dressing:

• Call your homecare nurse to have the dressing changed if it:
  • Looks wet underneath.
  • Becomes loose or begins to fall off.
  • Meets the maximum number of reinforcements allowed (1 per side).
  • Is soiled or bloody.
• Follow these instructions if any of the above situations happen:

1. Clean your hands with soap and water.   
2. Never use anything sharp around the catheter. No scissors!
3. Tape down any loose edges that are lifting or rolling up.   
4. If the entire dressing is damaged or comes off, place a sterile dressing such as Tegaderm™ over the site to avoid air exposure.   
5. Call your homecare company to have a nurse come and change the dressing.   

• If IV tubing is connected to the catheter, the IV tubing should be secured with a safety pin to your child’s clothing to prevent tugging on the catheter.

1. Fold a piece of tape around the end of the IV tubing connected to the catheter.
2. Leave one inch of tape hanging.
3. Put the safety pin through the hanging tape. Be careful not to pierce the catheter with the safety pin.
4. Pin to clothing.   

• Your child’s central line may be secured with a StatLock™ device. If the StatLock begins to peel up from the skin, contact your homecare or healthcare provider to have a new one put on.

Instructions for bathing with a central line:

The clear sterile dressing is water-resistant, but not waterproof. Your child may shower or bathe with the dressing in place, but you need to protect the dressing.   

• Place the central line site and caps in a plastic bag and tape this to your child’s chest or arm.  
• Cover the dressing and site with AquaGuard^® whenever there is a risk of the dressing coming in contact with water. You may need to use more than one AquaGuard. Follow these instructions: Aquaguard for Bathing and Showering with a Central Line.
• If taking a bath, keep the dressing above the bath water.   
• If showering, face away from the spray. The water should hit your child’s back, not the catheter site directly.   
• Inspect the dressing and catheter after the bath or shower is complete, including the StatLock and stitches.

Instructions for flushing a central line:

Heparin comes in different strengths. Your healthcare provider will prescribe the right strength for your child. You must flush the catheter with heparin once a day if it is not being used.

If your child is getting IV antibiotics or Parenteral Nutrition (PN) you will flush the catheter with normal saline (0.9% sodium chloride) before hooking up. This will show you if the catheter is working properly. After the antibiotic or PN is finished you will flush with saline again, then heparin.

1. Select a clean working surface in a well ventilated, draft free area. Avoid the bathroom or kitchen as these areas may have more germs in them. If you must use the kitchen, avoid areas where you prepare food. Clean the work surface with an antibacterial cleaning solution every time.  
2. Gather your supplies. Never use anything sharp around the catheter. No scissors!
   • Alcohol pad (or provided scrubbing device with alcohol product)
   • Heparin flush syringe
   • Normal saline flush
3. Clean hands with soap and water or use hand sanitizer.
4. Inspect the central line dressing catheter as you complete the steps for flushing, including the StatLock™ and stitches.
5. Remove the air from the flush syringe:
   • Gently tap the side of the syringe to make any air bubbles rise to the top.
   • Remove the cap from the syringe and hold it making sure that nothing touches the inside of the cap or the end of the syringe.
   • Place the syringe in your hand and gently push up on the plunger with your thumb. You may feel resistance.
   • Continue to push up until a small amount of solution comes out of the top of the syringe and there are no more air bubbles in the syringe.
   • Replace the cap on the syringe until you are ready to use it.
6. Scrub the cap with an alcohol wipe for 15 seconds. Allow the cap to dry for 15 seconds. Do not blow or fan over the cap.
7. Remove the needleless cap from the syringe and screw the end of the syringe onto the catheter cap.  Turn to the right until it is securely connected.  
8. Unclamp the catheter.
9. Use push-pause technique to push the heparin or saline from the syringe into the catheter.  Keep pressure on the syringe plunger while you clamp the catheter. Note: always clamp over the reinforced clamping sleeve.
10. If the catheter is hard to flush, stop pushing in the heparin. Check to make sure the catheter is not clamped and that there are no kinks in the catheter tubing.
11. If you are still having trouble flushing the catheter: clamp it, remove the flush syringe and call your homecare company. Never force when flushing.
12. Unscrew the syringe from the catheter cap and throw it away. Check to make sure that the catheter cap is on tightly.
13. If instructed to use an alcohol protective cap, follow these instructions.

Instructions for the catheter’s needleless cap:

For emergency use only -- when being instructed by a nurse

• Call your homecare nurse immediately if the needleless cap comes off. Make sure the catheter is clamped.
• Do not attempt to change or replace the needleless cap without direct instruction from your homecare team.

Instructions for troubleshooting central line problems:

We do not expect your child to have problems with their central line. If a problem occurs, we want you to know what to do. Call your CHOP healthcare team, homecare nurse, or emergency medical services for the following signs:

• Infection: pain, redness, puffiness, drainage at the catheter site; fever (your healthcare team will tell you what they consider to be a fever for your child); poor appetite, decreased activity, sleeping more, increased crankiness or crying.
  • Action: call your CHOP healthcare team immediately.
• Clogged catheter: increased pressure when flushing, unable to flush line or medicine will not infuse and/or pump will alarm.
  • Action: Do not forcefully flush! Catheter damage may result!
    Check that clamp is open and there are no kinks of the tubing or catheter.
    If still unable to flush, clamp the central line and call the healthcare team. They may be able to open the catheter with medicine.
• Leakage or breakage: leakage of liquid anywhere along the tubing or catheter, dressing is wet underneath after flushing or you see a bulging or bubbling of the catheter when flushed.
  • Action: clamp above the break or leak and cover area with sterile gauze and tape.  Call your healthcare team immediately. The catheter tubing will need to be repaired or replaced.  
• Infiltration: swelling of the neck or chest, chest pain or difficulty breathing.
  • Action: stop any fluids running through the central line. Call your CHOP healthcare team or 911 immediately.
• Central line has been partially or completely pulled out: the catheter is longer or is completely out, the cuff has moved or is able to be seen, neck or chest swelling, or your child complains of a gurgling sound in ears.
  • Action for partial removal: do not use the catheter. Apply sterile gauze and tape over the dressing. Call your CHOP healthcare team immediately.  
  • Action for complete removal: apply sterile gauze and pressure to the insertion and exit sites. Call your CHOP healthcare team immediately.  Save the catheter.
• Central vein thrombosis: a blood clot has formed in the vein that the catheter lies in which may cause swelling of the neck, arm or hand.
  • Action: Call your CHOP healthcare team immediately.  
• Air embolism: air enters the bloodstream which may cause pale, gray or bluish skin color, trouble breathing, coughing, chest pain, fainting.
  • Action: clamp catheter immediately. Place child on the left side with head down to trap air in the right side of the heart. Call 911 or emergency medical services.

If you have any questions about your child’s health, please contact your child’s healthcare provider. This document is intended only to provide general educational information and is not intended as medical advice or treatment. Please consult with your healthcare provider prior to use, as some of this information may need to be adapted for your child’s specific needs. It is the responsibility of your healthcare provider to advise you on the appropriate use of this information. If you/your child are not already a CHOP patient, this document does not create a doctor-patient relationship between you/your child and CHOP. CHOP is not responsible for any outcomes you/your child might experience from your use of this document. This document is provided "AS IS", WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, express or implied. If this document refers to any drugs or medical devices, it is the responsibility of your healthcare provider to check the FDA status prior to use. If this document includes references to drug dosing, please do not rely on this document. Your healthcare provider should check the package insert for each drug before use. Hyperlinks used within this document may not be translated into other languages.

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