Patient Instructions: Central Line Care for Dialysis Patients
Patient Instructions: Central Line Care for Dialysis Patients
These instructions are for Children’s Hospital of Philadelphia (CHOP) dialysis patients going home with a tunneled central venous catheter, also called a central line.
Important information about the tunneled central line:
Two lumens of a central line
The central line has two outside tubes called lumens. These lumens are used by the dialysis team for dialysis treatment. This may include medicines, fluids, blood products, or drawing blood samples. You will need to provide special care for your child’s central line when they are not in the hospital.
A clinician will teach you how to change the central line dressing. You may not change a dressing alone until you are approved by the dialysis team.
The TEGO® cap on the end of each lumen of the catheter needs to be changed once a week. ClearGuard™ caps are changed with each treatment. All caps are changed by the nurse.
The central line catheter should be secured to avoid dangling, and always kept away from the diaper area. Lumens should be in the Roo Defender™ at all times.
It is important to watch your child carefully while playing and if your child is of teething age to avoid pulling, breaks or leaks in the catheter.
Important information about heparin for dialysis treatment:
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 may be put into the red and blue lumens of the catheter at the end of treatment. This heparin stays in the lumens until the next dialysis treatment.
Heparin doses are carefully calculated by your healthcare provider. Patients typically receive an initial dose of heparin in the beginning of their treatment. A smaller dose of heparin is infused and stopped at least 30 minutes before the end of the dialysis treatment to allow your child’s blood clotting time to return to normal.
It is important that heparin is removed from each lumen of the catheter before flushing with saline. If the heparin is not removed and it is flushed through, your child might bleed. For safety, we put a label over the catheter to notify staff that there is heparin in both lumens. This label will remind staff to remove the heparin before flushing the catheter.
Instructions for changing the central line dressing:
The first dressing change may be done one week after the central line is placed. After that the dressing needs to be changed once a week on the same day each week.
The dressing should also be changed if it:
Looks wet underneath.
Becomes loose or begins to fall off.
Meets the maximum number of reinforcements allowed (1 per side).
Is soiled or bloody.
You will need the following supplies:
Dressing change kit (which may include):
Sterile gloves
Chloraprep™ sponge applicator
Alcohol wipes
4 sterile gauze pads
No-Sting barrier film
Sterile towel/drape
Mask (for the caregiver performing the dressing change)
Other supplies needed:
Procedure gloves (“regular” gloves)
Sterile clear dressing
Extra masks
Trash bag or can
Tape
Additional masks for others
Grip-lok®
Select a clean surface to work on. Avoid the bathroom or kitchen as these areas may have more germs in them. If you must use the kitchen, avoid areas where you prepare food. Clean the work surface with an antibacterial cleaning solution every time.
Gather the items you need to do the dressing change and place on a clean paper towel. Never use anything sharp around the catheter. No scissors!
Clean your hands with soap and water.
Inspect the catheter before starting the dressing change.
Remove the plastic cover from the dressing change kit and the mask.
Put on the mask. Masks should be worn by all people completing or observing the dressing change. Your child must wear a mask or turn their head away from the insertion site during the dressing change.
Clean hands with soap and water or hand sanitizer.
Open the dressing kit, touching only the outside of the wrapper or the edges of the wrapper.
If you do not have a helper to assist you, open the dressing and then the Grip-Lok® and carefully drop each item onto the opened kit.
Clean hands with soap and water or hand sanitizer.
Put on clean procedure (non-wrapped) gloves.
Carefully remove your child's dressing and Grip-Lok®. Support the skin and the catheter with your fingers while removing the dressing. Do not put your hands near the exit site.
Helpful hints:
To aid in lifting a dressing edge, secure a piece of surgical tape to one corner and rub firmly. Use the tape as a tab to help you slowly peel back the dressing.
Grasp one edge of the dressing and gently pull it straight out to stretch and release the dressing. Repeat at all corners until the entire dressing has been removed from the skin.
When the dressing is off, look at the skin for signs of infection, such as redness, drainage, or swelling.
Take off procedure gloves and throw away along with the old dressing.
Clean hands with soap and water or hand sanitizer.
Open the sterile glove package and carefully put on the sterile gloves as you have been taught. After the sterile gloves are on, you can only touch the supplies in the kit.
Now that you are wearing sterile gloves, remove the contents from the kit and place them onto the inside of your sterile wrapper or unfold sterile drape and place contents on the drape. You may use your empty kit for trash.
Pick up the Chloraprep™ applicator. Hold applicator with sponge facing downward and gently squeeze the wings to release the solution.
Press sponge onto the exit site and over the catheter and scrub with the sponge using a back-and-forth motion for 30 seconds. You should scrub an area of about 2 inches surrounding the exit site. You can use the sterile gauze pads to secure or hold the catheter as you are cleaning.
Allow Chloraprep™ solution to dry completely.
Open the No Sting barrier film and apply to skin where the outer edges of the dressing will lay.
Open and place the Grip-Lok® onto the skin under the lower portion of the catheter. Open the Velcro® tab and secure the catheter in place, then close the tab to secure the catheter. Make sure it fits under the dressing.
Center the Chlorhexidine Gluconate (CHG) gel pad over the site where the catheter enters the skin, and then smooth down the dressing over the site and slowly remove the paper frame while continuing to smooth down the outer edges of the dressing.
Remove notched tape strip from paper frame. Orient the notch towards the dressing and apply the tape strips under the extension tubing and over the dressing border. Remove adhesive-free tabs.
Document the date on the label strip. Apply label strip on top of dressing, over catheter lumens. Remove adhesive-free tabs.
Remove gloves.
Clean hands with soap and water or hand sanitizer.
Instructions for bathing with a central line:
The clear sterile 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.
Cover the dressing and site with AquaGuard® whenever there is a risk of the dressing coming in contact with water. You may need to use more than one AquaGuard®.
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.
Inspect the dressing and catheter after the bath or shower is complete, including the Roo Defender™ and stitches. Make sure the catheter is clamped at the reinforced section.
Instructions for troubleshooting central line problems:
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 CHOP healthcare team, homecare nurse, or emergency medical services for the following signs:
Bleeding under dressing:
Action: call 215-590-1000 and ask to speak to the Nephrology doctor on call.
Infection: pain, redness, puffiness, drainage at the entry site; fever (your healthcare team will tell you what they consider to be a fever for your child); poor appetite, decreased activity, sleeping more, increased crankiness or crying.
Action: call your CHOP healthcare team immediately.
Leakage or breakage: leakage of liquid anywhere along the tubing or catheter, dressing is wet underneath after flushing or you see 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 healthcare team immediately. The catheter tubing will need to be repaired or replaced.
Central line has been partially or completely pulled out: the catheter is longer or is completely out, the cuff has moved or is able to be seen, neck or chest swelling, or your child complains of a gurgling sound in ears.
Action for partial removal: do not use the catheter. Apply sterile gauze and tape over the dressing. Call your CHOP healthcare team immediately.
Action for complete removal: apply sterile gauze and pressure to the insertion and exit sites. Call your CHOP healthcare team immediately. Save the catheter.
Other complications: swelling of the neck, arm, or chest; chest pain or difficulty breathing, pale, gray or bluish skin color, coughing, fainting
Action: call your CHOP healthcare team immediately.
If you have any questions about your child’s health, please contact your child’s
healthcare provider. This document is intended only to provide general educational information
and is not intended as medical advice or treatment. Please consult with your healthcare provider
prior to use, as some of this information may need to be adapted for your child’s specific needs.
It is the responsibility of your healthcare provider to advise you on the appropriate use of this
information. If you/your child are not already a CHOP patient, this document does not create
a doctor-patient relationship between you/your child and CHOP. CHOP is not responsible for any
outcomes you/your child might experience from your use of this document.
This document is provided "AS IS", WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, express or implied.
If this document refers to any drugs or medical devices, it is the responsibility of your healthcare
provider to check the FDA status prior to use. If this document includes references to drug dosing,
please do not rely on this document. Your healthcare provider should check the package insert for
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