How to Care for your Child s Indwelling Subcutaneous Catheter

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1 The Emily Center How to Care for your Child s Indwelling Subcutaneous Catheter Procedure/Treatment/Home Care Si usted desea esta información en español, por favor pídasela a su enfermero o doctor. #1054 Name of Child: Date: How to Care for your Child s Indwelling Subcutaneous Catheter What is an indwelling subcutaneous catheter? Some children need medicine every day that needs to be given as a shot under their skin (called subcutaneous injection). An indwelling subcutaneous catheter means your child gets fewer painful pokes. Fewer pokes also mean fewer breaks in the skin for germs to enter. This lowers the chance of infection. An indwelling subcutaneous catheter is a small plastic tube that is put under the skin. It looks like an IV but goes under the skin instead of into the vein. After the catheter is put in, the needle inside it is taken out. The plastic tube (catheter) is taped down and can stay in place for 3 to 7 days. You will learn how to put medicine in this catheter, and how to change it. Make sure someone from your health care team watches you do this before you go home. This will help you be more comfortable and gives you a chance to ask questions. Ask all those what if? questions until you know the answers. 1 of 9

2 How to give medicine through an indwelling subcutaneous catheter What you need p antimicrobial soap p sink with water p paper towels or a towel p alcohol wipes p syringe of medicine with a 1 2 inch needle p milk jug, coffee can or plastic soap bottle with lid, so you can throw out the syringe and needle safely. What to do 1. Find a quiet place, where you will not be disturbed. 2. If the child is active, you will need another person to help keep the child still while you give the medicine. 3. Wash your hands with antimicrobial soap for seconds. Wash every surface of your hands. Wash under your fingernails, the backs of your hands, your wrists, and between your fingers. Rinse completely and dry your hands with a clean towel. Then hold the faucet with the towel and turn off the water. Wash your hands with antimicrobial soap for seconds. 4. Clean your work area. Get the right dose of the right medicine ready. Keep everything sterile. Don t let the needle touch anything. Sterile means there are no germs at all. Even though you washed your hands, they are not sterile. 5. Tell your child what you expect, such as, Your job is to hold still while I give you your medicine. This will help giving medicine easier for both of you. 6. Check the skin around the indwelling subcutaneous catheter. If you child shows signs of infection, don t give the medicine and call your child s doctor right away. Signs of infection are: 2 of 9

3 bruising swelling redness bleeding pain pus or if your child: has a fever over 101º F. has chills 4. Scrub the catheter hub (where you will put the needle) with an alcohol wipe for 15 seconds. Let the hub dry. Do not fan or blow on it. 5. While the hub is drying, carefully pull the needle cap off the syringe and throw out the cap. Keep the needle sterile. Do not touch the needle or put the syringe down. 6. Hold the syringe in the hand you write with, take the other hand and hold the hub of the catheter. Do not touch the part of the hub that the needle will go into. Place the needle into the hub until it stops. Do not push the needle tip farther than the hub. 7. Press down on the plunger with your finger. This will put the medicine through the tube, under the skin. 8. Hold the catheter hub, and pull the needle straight out of the hub. p yes p no The medicine given is Enoxaparin or Lovenox This medicine keeps the blood from clotting. When blood flows under the skin without clotting, it makes a bruise. You can help prevent a bruise from forming by pressing on the site with a piece of clean gauze for two full minutes after giving the medicine. Watch a clock. Two minutes can seem like a long time. If a bruise forms at the site, your child may tell you pressing on the bruise hurts. 9. Leave the needle on the syringe, and put it all in the needle container. Your nurse will tell you what to do with full needle containers. 10. Thank the child for helping. 3 of 9

4 When to take out the old catheter and put in a new one An indwelling subcutaneous catheter needs to be replaced every 7 days, or sooner, if: the foam pad is loose the catheter comes out, even a little the site leaks bleeds has pus is red is swollen hurts How to take out the old indwelling subcutaneous catheter and put in a new one What you need p antimicrobial soap p sink with water p paper towels or a towel p numbing medicine (such as EMLA cream), if you use it p alcohol wipes p new indwelling subcutaneous catheter p skin prep p sticky foam pad p milk jug, coffee can or plastic soap bottle with lid, so you can throw out the syringe and needle safely What to do 1. Find a quiet place, where you will not be disturbed. 2. Wash your hands with antimicrobial soap for seconds. Wash every surface of your hands. Wash under your fingernails, the backs of your hands, your wrists, and between your fingers. Rinse completely and dry your hands with a clean towel. Then hold the faucet Wash your hands with antimicrobial soap for seconds. 4 of 9

5 with the towel and turn off the water. 3. Pick the site where you will put the new catheter. Your nurse will show you the best sites to use. The new site should be away from folds of skin and edges of clothing. If the old catheter is on the left side of the body, put the new one on the right. If the old catheter is on the right side of the body, put the new one on the left. 4. If you are going to use numbing cream, read the package. The package will tell you when and how to put the numbing medicine on the site you choose. 5. If the child is active, you will need another person to help keep the child still. 6. Wash your hands again. Clean your work area. Get your supplies ready. Keep everything sterile. Don t let the needle touch anything. Sterile means there are no germs at all. Even though you washed your hands, they are not sterile. 7. Tell your child what you expect, such as, Your job is to hold still while I put in a new tube. This will help changing the catheter be easier for both of you. 8. Take out the old catheter. Peel off the foam pad and pull the catheter straight out. Do not touch the site where the tube went in. Keep it clean. 9. Put the old catheter in the needle container. 10. If you used the numbing cream, wipe it off with a paper towel. 11. Scrub the site with an alcohol wipe for 15 seconds and let it dry. Do not fan or blow on it. 12. Put skin prep on the site. This will protect the skin and make the foam stick better. 13. Open the catheter package without touching anything inside. Lay it flat on your work surface. 14. Pick up the catheter with the hand you write with. With your other hand, take off the cap, and cap wings back end indwelling subcutaneous catheter 5 of 9

6 put it on the back end of the catheter. 15. With the empty hand, pinch up the skin at the site. Hold the catheter like a dart. In one smooth, quick move, put the catheter in under the skin at a 20 to 45 degree angle. In one smooth, quick move, put the catheter in under the skin at a 20 to 45 degree angle. 16. Hold the wings of the catheter down on the skin. With the other hand, slowly pull the needle out of the tube. Put it in the needle container. 17. Keep holding the wings down, and with the other hand, put on the foam pad. window for injection site Put the clear window over the injection site, then press the edges down. 18. Thank the child for helping. Protect the foam pad for 3 hours, until it sticks well. foam pad Your child should not take a bath, a swim, or exercise until it is set. After three hours, you child can exercise, swim, or take a bath. The water should not be very warm or salty ocean water. Call your nurse or doctor right away if If your child shows signs of infection, don t give the medicine and call your child s doctor right away. Signs of infection are: bruising swelling redness bleeding pain pus 6 of 9

7 or if your child: has a fever over 101º F. has chills If you are not able to give medicine through the catheter. Now that you ve read this: p Show your nurse or doctor how you will put medicine into the catheter. (Check when done.) p Tell your nurse or doctor how you will choose the next site for a new catheter. (Check when done.) p Show your nurse or doctor how you put in a new catheter. (Check when done.) p Tell your nurse or doctor the signs of a problem or infection, and what you would do if you saw them. (Check when done.) If you have any questions or concerns, p call your child s doctor or p call If you want to know more about child health and illness, visit our library at The Emily Center at Phoenix Children s Hospital 1919 East Thomas Road Phoenix, AZ Disclaimer The information provided at this site is intended to be general information, and is provided for educational purposes only. It is not intended to take the place of examination, treatment, or consultation with a physician. Phoenix Children s Hospital urges you to contact your physician with any questions you may have about a medical condition. Monday, August 23, 2010 DRAFT to family review #1054 Written by Phillip Nevin, RN Illustrated by Rebekka Takamizu 7 of 9

8 Name of Health Care Provider: Number: 1054 For office use: Date returned: p db p nb Family Review of Handout The Emily Center How to Care for your Child s Indwelling Subcutaneous Catheter Procedure/Treatment/Home Care Si usted desea esta información en español, por favor pídasela a su enfermero o doctor. Health care providers: Please teach families with this handout. Families: Please let us know what you think of this handout. Would you say this handout is hard to read? p Yes p No easy to read? p Yes p No Please circle the parts of the handout that were hard to understand. Would you say this handout is interesting to read? p Yes p No Why or why not? Would you do anything differently after reading this handout? p Yes p No If yes, what? After reading this handout, do you have any questions about the subject? p Yes p No If yes, what? 8 of 9

9 Is there anything you don t like about the drawings? p Yes p No If yes, what? What changes would you make in this handout to make it better or easier to understand? Please return your review of this handout to your nurse or doctor or send it to the address below. Fran London, MS, RN Health Education Specialist The Emily Center Phoenix Children s Hospital 1919 East Thomas Road Phoenix, AZ Thank you for helping us! 9 of 9

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