Central venous line (CVL) insertion into the internal jugular vein: Caring for your child at home after the procedure

Your child has had a CVL insertion. The information on this page explains how to care for your child at home after the procedure, and when to call for help. When your child goes home, a home-care nurse will take care of your child’s CVL and can teach you how to provide some of this care yourself.

Discharge from the hospital

How much time your child stays in the hospital depends on the reason for the CVL insertion and on how your child is feeling after the procedure. Some children who have a CVL go home two hours after the procedure. Others remain in the hospital to receive additional treatment.

Dressings after the procedure

After having a CVL inserted into the internal jugular vein, your child will have two bandages: one on the neck and one over the chest area. These bandages are applied in a special way to keep each site as clean as possible. The bandage over the CVL exit site on the chest is clear. It is normal to see some blood under this bandage. You will also see a small stitch in both the neck and chest area. These stitches will dissolve and fall out on their own, usually within a few weeks.

The CVL can be used right away for your child's medication or fluids. Your child should not feel any pain when the CVL is being used.

Pain relief after the procedure

After the procedure, some children may feel mild pain or discomfort in the neck or chest area for the first day or two. If this happens, ask the nurse or doctor if your child can have something to relieve the pain.

For CVLs inserted into the internal jugular vein, children often feel like they have a stiff neck. It is good and safe for your child to move their neck as usual.

Once your child has fully healed, they should not have any pain or discomfort from the CVL.

Complications may occur with your child’s CVL. The line may break or leak, the cap may fall off, the dressing can come loose or the CVL can fall out. Broken CVLs will need to be removed and replaced. It is important that you are prepared to handle these situations.

Other possible complications include clotting of the CVL, blood in the catheter or cap, and infection.

Remember to wash your hands before handling any central line.

Catheter damage

Catheter damage can happen from rough handling, pulling, cutting with scissors, general wear and tear, or puncturing with a sharp object. If this happens, fluid may leak out of the catheter at the damaged point, germs can get inside, and blood may back up into the catheter. You may notice that the catheter is wet if there is a small tear in the line.

What to do if the CVL breaks or leaks

Before you leave the hospital, you will be given a CVL Emergency Kit. The kit contains the supplies you will need if your child’s CVL breaks or leaks. A nurse will give you the kit and review it with you before you leave. You should always make sure the kit is with your child.

If the CVL breaks or leaks:

1. Stay calm.
2. Clamp the CVL between the break and your child using the padded clamp that has been provided. If you do not have a clamp, bend the line over and tape it together.
3. Stop the infusion if your child has one running.
4. Clean the broken area with an alcohol swab.
5. Place clean gauze under the broken area and tape the CVL to the gauze.
6. Wrap the gauze around the catheter, then tape the gauze to your child’s arm or chest.
7. If the hole is small, and you have been taught how, you should try to heparinize the CVL to help prevent it from becoming blocked.
8. Call the Vascular Access Service as soon as you have done this for further instructions. You will be asked to come to the hospital for further assessment.
9. Bring the broken line with you. This is the fastest way of knowing the correct size.

Some CVLs can be repaired without having to be replaced. Some broken CVLs will need to be removed and replaced.

What to do if the cap falls off

If the cap falls off:

1. Wipe the end of the CVL with an alcohol swab.
2. Take a new cap and place it on the end of the line by screwing it onto the hub.
3. Wrap clean gauze around the cap and then tape the gauze to your child’s arm or chest.
4. Have the cap changed as soon as possible. You can perform the cap change using aseptic non-touch technique (ANTT), if you have been taught, or the home-care nurse can do it.

What to do if the dressing comes loose

1. If the dressing comes loose, reinforce it with tape.
2. If the dressing comes off, secure the line with a new clean dressing.
3. As soon as possible, a new dressing needs to be applied. You can perform the dressing change using ANTT, if you have been taught, or the home-care nurse can do it.

What to do if the CVL falls out

If the catheter falls out or gets pulled out:

1. To stop the bleeding, apply pressure for 10 minutes to the site where the catheter enters the vein. For a chest CVL, this will be at the neck entry site.
2. Clean the exit site on the chest with the usual cleaning solution, and apply a bandage over the area.
3. Observe the entry site on the neck for any swelling or bruising.
4. Contact a member of your health-care team for further instructions. The procedure to re-insert the CVL may not be possible right away.

What to do if there is blood visible in the catheter or cap

There may be blood visible in the catheter or cap if there is an increase in pressure in the chest veins from crying, laughing, exercising or leaving the clamp open while the pump is turned off. It will also happen if there is an opening anywhere along the system, such as a loose connection or defective cap.

If blood appears in the catheter, you should flush it and then heparinize it, if you have been taught how to do so. If you see blood, always check the system for leaks, cracks and loose connections. Replace any parts that are replaceable, and re-check for blood back-up. Let the health-care team know if you cannot fix the problem.

What to do if you cannot flush the CVL

Most CVLs have clots or sludge build-up. If you notice gradually increasing pressure when flushing the CVL, there may be particles sticking to the inside walls of the CVL, making the pathway for fluids narrower. If you suddenly are not able to flush the CVL, check that the clamp is open and that the CVL is not bent or twisted. If it is not one of these things, the CVL may have a clot stopping the flow of fluids. You must call a member of your health-care team if this happens.

Never try to flush a clot out of the CVL. You may burst the CVL or push a clot into your child’s heart and lungs.

If you find a complete blockage while trying to flush the CVL, report this to your health-care team. You will need to come to the hospital or clinic for help.

Infection

Having a CVL gives bacteria an easy route into the blood system. Therefore, there is a risk of infection every time you handle the line. The aseptic non-touch technique (ANTT) during CVL care is the most important way to prevent an infection. The catheter exit site must be cleaned and dressed properly to prevent the growth of germs. Getting the supplies dirty or wet, or not following the methods of ANTT could allow germs to enter and grow in the body, which could cause a serious infection.

If your child develops a fever of one degree above their normal temperature or has chills or sweats, call a member of your health-care team right away. Not all fevers mean that there is an infection in the CVL; but infection is always suspected, and the CVL needs to be looked at.

Before you call:

• Check to see if your child has any other signs of infection, such as a sore throat, cough, runny nose, sleepiness or any change in behaviour.
• Look at the CVL exit site to see if there is any redness, swelling or discharge.

For secondary caregivers

The video below will show family members, teachers, daycare providers and other caregivers how to manage the emergency procedures for a CVL. Review this video with anyone who is caring for your child in case they will need to perform any of these procedures.

Caring for your child at home with a CVL

There must always be a bandage over the CVL exit site on the chest. This bandage keeps the CVL clean and secure. The end of the catheter tube, called the hub, will be closed with a cap.

When you go home, a home-care nurse will care for your child’s CVL. As you become more comfortable caring for the CVL, the home-care nurse can teach you how to provide some of this care yourself.

To prevent the CVL from becoming blocked, it will always have one of the following:

• An infusion, where fluids are being pushed into the CVL through a pump.
• A heparin lock. Heparin is a medication that helps prevent the CVL from becoming blocked when there is no fluid infusing into it. New heparin will be flushed into the CVL after each use. If the CVL is not being used each day, the heparin flush will be done every 24 hours.

Protecting the internal jugular vein CVL

Although the CVL is quite secure, it is not attached to anything inside your child's body; so if it is pulled, it can come out. It is very important to make sure the CVL is always taped in place. It is also recommended to tape the tube(s) of the CVL to your child’s chest or tummy. Keeping the CVL taped to the body will also prevent it from twisting or kinking. This is important to prevent it from becoming damaged or broken.

Dressing Care

Your child will have two dressings: one bandage or surgical glue on the neck and one clear bandage over the chest area. There must always be a bandage over the CVL exit site on the chest. This bandage keeps the CVL exit site clean and secure.

• It is normal to see some dry blood on the dressings in the first 24 hours after insertion. There should be no bright red bleeding at the site of the CVL insertion. If there is, contact the Vascular Access Resource Service.
• Leave the dressings in place.
• Do not wet the dressing. If the CVL gets wet, it can become infected.
• A home-care nurse will change the dressings weekly, or as often as needed. This should be arranged by your referring doctor before you leave the hospital.
• Do not remove the little stitch at the site of the CVL insertion. It will fall out on its own after a few weeks.
• Make sure the CVL is always taped in place. The tube(s) of the CVL should also be taped to your child’s chest or tummy to prevent twisting or kinking.

Bathing

Your child may shower or take a bath 24 hours after the CVL is inserted. However, it is important to keep the CVL and neck site dry. Your child’s nurse will teach you how to cover the CVL to keep it dry when your child bathes. If the bandage gets wet, it should be changed right away.

Meals

If your child is feeling well enough after the anaesthetic, they can return to eating what they normally eat. It is also important to encourage your child to drink plenty of fluids for 48 hours after the procedure.

Pain relief

If needed, give your child acetaminophen for pain. Do not give your child any medicines that will thin the blood, such as acetylsalicylic acid (ASA) or ibuprofen, without checking with a nurse or your child's doctor first.

Activity

After the CVL insertion, your child will need to stay home from school or day care, and avoid physical activity for the first 24-48 hours. Your child may return to school 24-48 hours after the CVL insertion with restricted activity, as long as they are not experiencing any pain. Tell your child’s caregivers or teachers about the CVL.

Your child should avoid all major activities and physical exertion for two full weeks. These include:

• contact sports
• gymnastics
• bicycle riding
• rollerblading
• hockey
• soccer
• skiing
• horseback riding

In addition, the CVL should not be put under water. Your child should not play water sports or swim at any time. Never allow the use of scissors anywhere near the CVL, and do not let other children touch or play with the CVL.

When to see a doctor

Call your child's doctor, or go to the nearest Emergency Department right away if your child has any of the following:

• A fever greater than 38°C (100.4°F), or over the normal range provided by your doctors or nurses
• Pain requiring acetaminophen after 48 hours
• Bleeding that does not stop with pressure
• Leakage or drainage at the CVL site
• Difficulty breathing
• A funny feeling in their heart
• Noticeable swelling at the incision site on the neck, or on the upper chest at the CVL exit site
• The CVL catheter gets pulled out a little or all the way

What to do if you have concerns

If your child is a SickKids patient, you can contact the Vascular Access Resource Nurse Monday to Friday during business hours with questions or concerns via phone (416-813-6986) or email (vascularaccess.resourcenurse@sickkids.ca).

On weekends/after hours, you may need to go to the nearest Emergency Department for alternate methods for fluid/medication delivery if the line is blocked or broken.