Caring for Your Child's Central Line

A Central Line is a soft catheter that lies in a large vein in the center of the chest. Blood from the upper part of the body flows through this vein to the right side of the heart.

A small incision is made where the catheter is placed into the vein. This is called the “insertion site.” The Central Line is then tunneled under the skin and brought out at an “exit site.” Small bandage tapes, called Steri-Strips are placed over the insertion site. The Steri-Strips will fall off and do not need to be replaced. The catheter may also have a few stitches at the exit site to hold it in place. The exit site is covered by a sterile (germ-free) dressing.

The Central Line also contains a “cuff” which is buried under the skin. Your child’s tissue grows into this cuff to anchor it and decrease the chance that it will be pulled out. The cuff also acts as a barrier to keep germs out of the body.

An X-ray will be taken to be certain that the Central Line is in the correct place before it is used.

The Central Line may have 1, 2, or 3 outside openings called lumens. These lumens are used to give medications, fluids, blood products, or may be used to draw blood samples. You will need to provide special care for your child’s Central Line when he is not in the hospital.

The Dressing

The first dressing change is done within 48 hours after the Central Line is placed. After that the dressing is changed by a nurse once a week. 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 dressing also needs to be changed if:

  • If it looks wet underneath
  • If it becomes loose or begins to fall off
  • If it is soiled or bloody

If any of these happen:

  • Wash your hands with soap and water then use an alcohol based hand rub.
  • Tape down any loose edges that are lifting or rolling up.
  • If the entire dressing is damaged or comes off, place a sterile dressing such as Tegaderm over the site to avoid air exposure.
  • Call your homecare company to arrange for a nurse to come and change the dressing.
  • If IV tubing is connected to the catheter, the IV tubing should be secured with a safety pin to prevent tugging on the catheter. Fold a piece of tape around the end of the IV tubing connected to the catheter. Leave one inch of tape hanging. Put the safety pin through the hanging tape. Be careful not to pierce catheter with the safety pin. Pin to clothing.
  • Your child’s Central Line may be secured with a Stat-Lock device. If the Stat-Lock begins to peel up from the skin, contact your homecare or healthcare provider to have a new one put on.

Bathing

The clear 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.
  • 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.

Flushing

  • 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.
  • Heparin comes in different strengths. Your doctor 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.

You Will Need

  • Alcohol pad
  • Heparin Lock flush syringe
  • Normal saline flush
  1. Select a clean working surface and gather supplies.
  2. Perform hand hygiene.
  3. Remove the air from the flush syringe:
    1. Gently tap the side of the syringe to make any air bubbles rise to the top.
    2. 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.
    3. Place the syringe in your hand and gently push up on the plunger with your thumb. You may feel resistance.
    4. 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.
    5. Replace the cap on the syringe until you are ready to use it.
  4. Scrub the cap with an alcohol pad for 15 seconds. Allow the cap to dry for 15 seconds. Do not blow on the cap.
  5. Remove the cap from the syringe and screw the end of the syringe onto the catheter cap. Turn to the right until it is securely connected.
  6. Unclamp the catheter.
  7. 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.
    1. 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.
    2. If you are still having trouble flushing the catheter: clamp it, remove the flush syringe and call your homecare company.
  8. Unscrew the syringe from the catheter cap and throw it away. Check to make sure that the cap is on tightly.

For Emergency Use Only — When Being Instructed by a Nurse

Changing the Cap

  • The cap on the end of the catheter needs to be changed once a week.
  • Your homecare nurse will change the cap when she changes the dressing.
  • Call your homecare nurse immediately if the cap comes off. Make sure the catheter is clamped.
  • Do not attempt to change or replace the cap without direct instruction from your homecare team.

Troubleshooting

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 doctor, nurse practitioner, homecare nurse, or emergency medical services for the following signs:

Problem: Infection

Signs

  • Fever of 101°F or higher, poor appetite, decreased activity, sleeping more, increased crankiness or crying.
  • Fever of 100.4°F or higher if your child is on Parenteral Nutrition (PN)
  • Oncology patients: Fever of 101.3°F or higher OR 3 low grade temperatures between 100.4-101.2°F in 24 hours (at least 2 hours apart).
  • Pain, redness, puffiness, drainage at the entry site

Action

  • Call the doctor or nurse immediately

Prevention

  • Do procedures in a well ventilated, draft free area and wear a mask.
  • Perform hand hygiene before touching the catheter.
  • Use only sterile (germ-free) supplies.
  • Call to have dressing changed immediately if wet, damp, soiled, or loose.
  • Secure catheter to avoid dangling.
  • Keep it away from diaper area. 

Problem: Clogged Catheter

Signs

  •  Increased pressure when flushing or unable to flush line.
  • Medication will not infuse and/or pump will alarm. 

Action

  • Do not force-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 Central Line and call the doctor or nurse. They may be able to open the catheter with medication.

Prevention

  • Always flush the Central Line as shown and at the scheduled times.
  • Remember the correct way to flush.
    • Push - Pause.
    • Keep pressure on the syringe plunger while you clamp the catheter.
    • Remove syringe.

Problem: Leakage or Breakage

Signs

  • Leakage of liquid anywhere along the tubing or catheter. Dressing is wet underneath after flushing.
  • 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 doctor or nurse immediately.
  • The catheter/tubing will need to be repaired or replaced. 

Prevention

  • Never use anything sharp around the catheter. No scissors!
  • Never force when flushing.
  • Check that the cap is on tightly after using.
  • Watch child carefully while playing and/or if teething age.
  • Clamp at the reinforced section where it reads “clamp here.”

Problem: Infiltration

Signs

  • Swelling of the neck or chest.
  • Chest pain or difficulty breathing.

Action

  • Stop any fluids running through the Central Line.
  • Call the doctor or 911 immediately. 

Prevention

  • Inspect catheter during flushes and dressing changes.

Problem: Central Line has been partially or completely pulled out

Signs

  • The catheter is longer or is completely out.
  • The cuff has moved or is able to be seen.
  • Neck or chest swelling.
  • Your child complains of a gurgling sound in ears. 

Action

  • Partial removal – Do not use the catheter. Apply sterile gauze and tape over the dressing. Call the doctor or nurse immediately.
  • Complete removal – Save the catheter. Apply sterile gauze and pressure to the insertion and exit sites. Call the doctor or nurse immediately. 

Prevention

  • Check that the Stat-Lock or stitches are secure.
  • Keep catheter “tail(s)” out of reach of child and do not let them dangle. (Use tape or elastic dressing to secure.)
  • Wear tight fitting clothing.
  • Do not let any “pull” to be placed on the catheter. 

Problem: Central Vein Thrombosis

A blood clot has formed in the vein that the catheter lies in. 

Signs

  • Swelling of the neck, arm, or hand.

Action

  • Call your doctor or nurse immediately.

Prevention

  • Flush the catheter at the scheduled times with Heparin. 

Problem: Air Embolism

Air enters the bloodstream.

Signs

  • 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. 

Prevention

  • Never remove the cap.
  • Check that the cap is on tightly after each use.
  • Remove air from syringes and tubing. 

 

19:B:01
Written 10/08
Revised 8/09, 3/10, 12/22/10, 1/12, 9/12, 8/16, 2/17, 5/17, 10/17
(19:B:01SPA, ARA)

©Children’s Hospital of Philadelphia 2017. Not to be copied or distributed without permission. All rights reserved.

Patient family education materials provide educational information to help individuals and families. You should not rely on this information as professional medical advice or to replace any relationship with your physician or healthcare provider.


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