| Problems you notice | Possible cause | What to do | How to prevent this |
|---|
- redness or swelling at the exit site
- pain or heat at the exit site
- fluid or pus oozing from the site
- fever, chills
- your child is very tired or unwell
- your child is less active than usual
|
The exit site or the
CVL is infected
|
- Call your Community Health Nurse (CHN).
- Call CHEO’s Vascular Access Team (VAT) .
- If you can’t reach the CHN call CHEO’s Emergency Department evenings, nights and weekends.
|
- check the site often
- use sterile technique for all dressing and cap changes
- clean all caps and ports for 30 seconds and air dry for 30 seconds before using
|
- problems flushing the catheter with normal pressure
- infusion pump rings ‘occluded’
|
The catheter is blocked
|
- Check IV tubing for kinks.
- Make sure all clamps on the tubing are open.
- Check the CVL catheter for kinks.
- Call your CHN.
- If the nurse can’t come quickly, call the VAT at CHEO, and bring your child to CHEO’s Emergency Department.
- The CVL will need to be unblocked.
|
- follow instructions for dressings to prevent the catheter from kinking
- check tubing often, especially if your child is active
- your CHN will flush the tubing daily, using a ‘turbulent flush’
|
- blood or fluid leaking from the catheter hub
- fluid leaking from the end of the IV tubing
|
Cap or tubing
has become
disconnected
|
- If the cap has not fallen completely off: tighten all connections and clean with gauze.
- If the cap has fallen off: clamp catheter right away and cover the end of the catheter with sterile gauze.
- Call your CHN.
- Tubing will need to be changed.
|
- check cap and connections often to make sure they are tight
|
- blood or fluid leaking from under the dressing
- blood backs up along the IV tubing
|
Hole or cut in the catheter
|
- Clamp the catheter right away, between the ‘hole’ and the exit site (use a disposable clamp).
- Call your CHN.
- If the problem is with the IV tubing or extension set, it will need to be replaced.
- If the problem is with the CVL catheter, call the VAT or CHEO’s Emergency Department. We will need to remove the catheter.
|
- if the CVL is used for short periods and then heparinized, change the spot where the catheter is clamped each time
- keep scissors away from children
- never push too hard to flush the catheter
|
- CVL is no longer in the skin
- the CVL catheter looks longer than it should be
- you can see the ‘cuff’ on the Hickman®/ Broviac®
|
The CVL has
been partly or
completely pulled out
|
- Press down on the site with sterile gauze for at least 5 minutes.
- Cover with a bandage or gauze and tape.
- Call your CHN.
|
- no rough play or sports
- check the dressing often to make sure it is in place
- keep the dressing dry
|
- red rash under the dressing
- itching or tender skin under the dressing
- dressing is not sticking
- dressing falls off or has been partly pulled of
|
- skin irritation or sensitivity
- dressing not secure
|
- Call your CHN to come to change the dressing.
- If your CHN cannot come, reinforce the dressing with extra tape.
- Call the VAT or come to CHEO’s Emergency.
- Department to have the dressing checked.
|
- make sure the skin is completely dry before putting on the non-occlusive dressing
- a skin prep may be needed to protect the skin
- the dressing may need to be changed more often if your child sweats a lot
|
|
PICC only
- pain in the arm along the catheter’s path or shoulder
- a red line on the skin along the catheter’s path
- your child isn’t using the arm as much
|
- phlebitis (inflammation of the vein)
- blood clot (or thrombus) along the catheter’s path
|
- Call your CHN.
- Call the VAT and then come to CHEO’s Emergency Department to have the CVL checked
|
- Listen carefully to your child’s complaints.
|
Your child has:
- a ‘whooshing’ sound in the ear
- pain in the jaw, ear, teeth or face on the PICC side of the body
|
The CVL tip has moved into a
jugular vein in the neck.
|
- Stop medication.
- Call your CHN.
- Call the VAT or CHEO Emergency Department.
- Come to CHEO’s Emergency Department
|
- your CHN will check regularly for blood return in the IV tubing
- the CVL tip can sometimes move if your child is throwing up a lot
|
|
This is an emergency!
Your child has:
- chest pain
- trouble breathing
|
Air has entered the catheter,
causing an air embolus.
|
- Clamp the catheter near the exit site right away.
- Have your child lie down on the left side and stay quiet.
- Call 911 for an ambulance.
|
- always clamp the catheter before removing the cap
- make sure all the air is removed from the IV tubing when you are priming the tubing
|
|
Your child has:
- pain or swelling in the arm
- pain in the ear or shoulder
|
- Blood clot in a vein near the exit site
- internal leak
|
- Call your CHN.
- Call the VAT Nurse or CHEO’s Emergency Department.
- Your child will need to come to CHEO for an ultrasound to check the problem.
|
- CHN will check for blood return every day
to prevent the catheter from moving by making sure the dressing is secure
|
