Central Venous Access Device (CVAD)

Guide to Central Venous Access Device (CVAD) Care

Post discharge guide for management of central venous access devices care

What is a central venous catheter (CVC)?
A CVC is small-calibre, soft, flexible tubing inserted through a vein either in the arm, chest or neck, tip positioned in the large vein above the heart (also known as central vein).
Examples include non-tunneled central venous catheter, Hickman’s (tunneled) catheter, peripheral inserted central catheter (PICC) and implanted central venous access port (Port-a-cath).

Why is a CVC needed?
Your doctor may have recommended the insertion of a CVC for one of the following reasons:

• Poor venous assess
• Infusion of total parenteral nutrition
• Chemotherapy
• Prolonged (>2 weeks) intravenous antibiotic therapy
  
  

What are the preparations needed for insertion of CVC?

• You will be admitted for the procedure.
• For moderate sedation, usual fasting time is at least 3 hours before the procedure. For deep sedation/ analgesia you will be asked to fast for at least 6 hours.
• In some cases, PICC line insertion might be done without sedation, thus, fasting is not required
• You will need some routine blood tests to ensure that your blood counts are normal.
• You will need to inform your doctor or nurse if you are taking blood thinning medication e.g. warfarin, clexane.
  
  

How is CVC inserted?

• CVC will be inserted by a trained interventional radiologist at X-ray department or by a surgeon at the operating theatre
• Local anesthesia will be administered during the procedure. Under extraneous situation you may be sedated.
  
  

What are the risks associated with having a central venous catheter?

• Bleeding from the insertion site.
• Puncture of lung during the procedure (for neck and chest access).
• Infection on the skin where the catheter is placed or from the catheter itself.
• Tip of catheter in less than ideal position/migration of catheter tip position.
• Blockage of the catheter.
•  Blockage of the vein due to clot formation around the catheter.
  
  

How to care for your central venous catheter?

Do’s
Keep dressing dry and intact. Regular weekly change of dressing around the catheter site, or earlier if it becomes soiled. Regular flushing of the catheter to maintain patency. Observe CVC site for bleeding, redness, swelling and discharge. Light exercises is allowed e.g. brisk walking Inform the nurse if you/your child develops any allergic reaction to the dressing used (e.g. itchy skin, redness). Ensure the catheter is taped down securely at all times to prevent dislodgement.

Dont’s
No strenuous exercises, e.g.: tennis, swimming, golf. (Swimming is only permitted if you have Port-a-cath after the surgical wound has healed completely.) Avoid carrying heavy load. Avoid tight fitting clothes. Avoid pulling on the catheter. Avoid scratching the catheter. Avoid changing the dressing or flushing the catheter unless you have been trained and certified by a nurse.

When do I need to come back to hospital?
If you have any of the following signs and symptoms:

• Redness, swelling, pain or tenderness around catheter site and along the course of the catheter.
• Persistent fever (T>38℃), chills and sweating (signs of infection).
• Rashes or blisters,
• Loose or broken stitches.
• Pus discharge from the site of catheter.
• Leakage or cracks on the catheter.
•  If catheter is blocked, unable to flush or aspirate.
• If the catheter is dislodged or has slipped out (do secure with tape/dressing material to prevent further slippage)
  

Footnote: Your nurse will be educating you on how to care for your catheter should you require to go home with the CVC.

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