Types of Central Lines and their Care

Transcription

1 Patient and Family Education Types of Central Lines and their Care Here is a look at the common types of central lines your child may have and how to care for them. What is a central line? A central line is a small tube that is surgically placed in a main blood vessel and that can stay in place throughout your child s treatment. They are called central lines because no matter where in the body they are placed, they have tubing that reaches into a central big vessel near the heart. Your child s doctor will decide which type of line is needed for their treatment. If your child has had treatment at a different hospital, they may already have a central line or IV catheter in place when they arrive at Seattle Children s Hospital. When your child is being treated at Children s, the healthcare team will care for your child s line according to our policies to prevent infection and keep the line working as well as possible. This handout gives you a brief look at the types of central lines you may get and the basics of how to care for them. Your child may get more than one type of central line during their treatment. Details on the cleaning and care of the lines will be given to you by your home care company. The three main types of lines that we use at Children s are Hickman, Port-a-Cath and PICC (peripherally inserted central catheter) lines. Other lines are sometimes used, but they are like these three types. This includes apheresis lines which are placed for special apheresis procedures (see below). What are the benefits of having a central line? Fewer pokes. Most of the time, having a central line means fewer needle pokes for medicines, blood draws and lab tests. But don t promise your child that they will never have arm or finger pokes. Sometimes, special lab tests cannot be done on blood from the line, the blood cannot be drawn through a line for some reason, or another line needs to be placed for emergency treatments. A way to give medicines more safely. Using a central line is a safer way to give some medicines. What are the risks? Central lines can become infected. Let your child s nurse or doctor know if you notice redness, pus or drainage, swelling, increase in tenderness, fever of 38.3 degrees Celsius (101 degrees Fahrenheit)or higher or a temperature of 38 degrees Celsius for 8 or more hours. 1 of 6

2 The 4 types of central lines Hickman Line A Hickman catheter (tube) is surgically placed into one of the large blood vessels near the heart. The tubing then comes out through the skin. About 6 to 12 inches of tubing stays outside of the body, with a clamp on the tubing and a cap on the end. A double-lumen Hickman line is 2 tubes with 2 separate openings that are joined together to look like one tube. This allows 2 different medicines or intravenous fluids to be given at the same time. petergardiner@med-illustrator.demon.co.uk Care of a Hickman line Clean or flush Hickman line with 3mL normal saline and 1.5mL of 10unit/mL Heparin every 24 hours or after each blood draw. Talk with your healthcare provider about using Heparin or before giving any type of medicine to your child. If you have been taught and have supplies from Home Care, you will change the dressing, flush and change the caps on your child s Hickman line while you are at home. If you have not been taught, trained nurses will care for the line. Change the dressing every 7 days when a see-through dressing is used, and every 48 hours when the dressing is not see-through or gauze and tape are used to dress the line. Changing the dressing allows the caregivers to see the insertion site and see if it is clean, dry and does not appear infected. Change the dressing more often if it becomes wet or soiled. 2 of 6

3 Change the Hickman line caps every Wednesday and Sunday if the line is clamped and not being used to give medicine or blood products. Change caps once every 24 hours with blood draws or when blood products are given. Because blood is rich in nutrients, caps are changed after blood draws to prevent bacterial growth and invasion into the bloodstream. Port-a-Cath A Port-a-Cath, or port, is a type of line that is often used for some children with cancer. The Port-a-Cath is surgically placed into a large vessel near the heart. The Port-a-Cath has a small reservoir (or port) at the end of the line. The reservoir is surgically placed in the tissue just under the skin on the upper chest. When the port is not in use, there is no tubing hanging out of the body. When the port needs to be used, a special needle with tubing attached is placed through the skin into the reservoir. Care of a Port-a-Cath petergardiner@med-illustrator.demon.co.uk Flush the port with 6mL normal saline and 3mL of 10unit/mL Heparin every 24 hours or after each blood draw. The port needle can stay in place up to 1 week. When we put a needle into the port it s called accessing the port. After a week, the port is de-accessed (needle removed) and re-accessed (new needle inserted), if needed. A dressing is put in place to keep it stable and clean. If the dressing is not see-through, or a gauze and tape dressing is used, it must be changed every 48 hours in order for staff to see the needle insertion site and ensure it is clean, dry and does not appear infected. If the port is accessed (being used and has a needle in place), it will be flushed once every 24 hours. 3 of 6

4 Trained nurses will change the dressing and caps on the Port-a-Cath when needed. Port-a-Cath caps are changed every Wednesday and Sunday if the line is clamped and not being used to give medicine or blood products. Caps are changed once every 24 hours with blood draws or when blood products are given. Because blood is rich in nutrients, caps are changed after blood draws to prevent bacterial growth and invasion into the blood stream. When the port is not accessed, it will be flushed once a month. Special creams, such as EMLA or LMX4, can be used to numb the skin over the Port-a-Cath before the port is accessed (needle is put in). The cream needs to be placed over the port site 1 to 2 hours before it is accessed. PICC line A PICC line is a long catheter that is put into one of the large veins in the arm. and then threaded up the vein until it is close to the heart. Many times, this line can be used for blood draws, but not always it depends on the size of the tube. They are most often used for medicines and fluids. These lines are more temporary than Hickman lines and Port-a-Caths, but can still be used for many weeks. petergardiner@med-illustrator.demon.co.uk Care of the PICC line PICC lines come in sizes called French. PICC lines less than 3 French in size will not be used for blood draws. PICC lines 3 French or greater in size are used for blood draws and are flushed with 1mL normal saline and 0.5mL of 10unit/mL Heparin every 24 hours. 4 of 6

5 If you have been taught and have supplies from Home Care, you will change the dressing, flush and change the caps on your child s PICC line. If you have not been taught and do not have supplies, the Home Care nurses, Vascular Access Team nurses or other trained nurses will change the dressing. Change the dressing over the insertion site (the place where the PICC needle goes into the skin) every 7 days when a see-through dressing is used, and every 48 hours when the dressing is not see-through or gauze and tape are used to dress the line. Changing the dressing allows the healthcare team or caregivers to see the insertion site and see if it is clean, dry and does not appear infected. The dressing may need to be changed more often if it becomes wet or soiled. Change the PICC caps every Wednesday and Sunday if the line is clamped and not being used to give medicine or blood products. Caps are changed once every 24 hours with blood draws or when giving blood product. Because blood is rich in nutrients, caps are changed after blood draws to prevent bacterial growth and invasion into the blood stream. Apheresis Line If your child is having a special procedure, an apheresis line may be used. Apheresis is when certain cells are separated from whole blood through a machine, then returned to your child, all in the same procedure. This line is surgically placed in a vessel near the heart. The apheresis line has a larger diameter and is made of less flexible material than a Hickman line. The size of the apheresis line allows blood to be taken out and returned quickly by the apheresis machine. 5 of 6

6 To Learn More Ask your child s healthcare provider Care of the apheresis line Apheresis lines are flushed with 2mL normal saline and 1,000unit/mL Heparin. Because apheresis lines can be different diameters and lengths; the company prints the volume of Heparin needed on the outside of the line. Staff will refer to this when flushing the line. The apheresis line is flushed when it is first placed and after every use or every 7 days if not in use. Heparin is a medicine that is used to prevent clotting in the line. Apheresis lines require 1,000unit/mL Heparin. This Heparin sits in the line. Because a higher strength of Heparin is used, it should not be flushed into the body, rather removed before blood draws. This is called wasting the blood. The dressing over the apheresis insertion site needs to be changed every 7 days when a see-through dressing is used, and every 48 hours when the dressing is not see-through or gauze and tape are used to dress the line. Dressing changes allow the healthcare team or caregivers to see the insertion site and ensure it is clean, dry and does not appear infected. The dressing may need to be changed more often if it becomes wet or soiled. A special cap called a Tego cap is used on apheresis lines. Caps are changed weekly by a trained nurse. Free Interpreter Services In the hospital, ask your child s nurse. From outside the hospital, call the toll-free Family Interpreting Line Tell the interpreter the name or extension you need. Seattle Children s offers interpreter services for Deaf, hard of hearing or non-english speaking patients, family members and legal representatives free of charge. Seattle Children s will make this information available in alternate formats upon request. Call the Family Resource Center at This handout has been reviewed by clinical staff at Seattle Children s. However, your child s needs are unique. Before you act or rely upon this information, please talk with your child s healthcare provider Seattle Children s, Seattle, Washington. All rights reserved. Cancer and Blood Disorders Center 11/15 PE of 6