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Problems you notice |
Possible cause |
What to do |
How to prevent this |
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· 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 |
1. Call your Community Health Nurse (CHN). 2. Call CHEO’s Vascular Access Team (VAT). 3. 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 |
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· problems flushing the catheter with normal pressure · infusion pump rings ‘occluded |
The catheter is blocked |
1. Check IV tubing for kinks. 2. Make sure all clamps on the tubing are open. 3. Check the CVL catheter for kinks. 4. Call your CHN. 5. If the nurse can’t come quickly, call the VAT at CHEO, and bring your child to CHEO’s Emergency Department. 6. 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’ |
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· blood or fluid leaking from the catheter hub · fluid leaking from the end of the IV tubing |
Cap or tubing has become disconnected |
1. If the cap has not fallen completely off: tighten all connections and clean with gauze. 2. If the cap has fallen off: clamp catheter right away and cover the end of the catheter with sterile gauze. 3. Call your CHN. 4. Tubing will need to be changed. |
· check cap and connections often to make sure they are tight |
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· blood or fluid leaking from under the dressing · blood backs up along the IV tubing |
Hole or cut in the catheter |
1. Clamp the catheter right away, between the ‘hole’ and the exit site (use a disposable clamp). 2. Call your CHN. 3. If the problem is with the IV tubing or extension set, it will need to be replaced. 4. 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 |
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· 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 |
1. Press down on the site with sterile gauze for at least 5 minutes. 2. Cover with a bandage or gauze and tape. 3. Call your CHN. |
· no rough play or sports · check the dressing often to make sure it is in place · keep the dressing dry |
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· 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 |
1. Call your CHN to come to change the dressing. 2. If your CHN cannot come reinforce the dressing with extra tape. 3. Call the VAT or come to CHEO’s Emergency. 4. 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 |
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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 |
1. Call your CHN. 2. Call the VAT and then come to CHEO’s Emergency Department to have the CVL checked |
Listen carefully to your child’s complaints. |
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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. |
1. Stop medication. 2. Call your CHN. 3. Call the VAT or CHEO Emergency Department. 4. 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 |
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This is an emergency! Your child has: · chest pain · trouble breathing |
Air has entered the catheter, |
1. Clamp the catheter near the exit site right away. 2. Have your child lie down on the left side and stay quiet. 3. 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 |
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Your child has: · pain or swelling in the arm · pain in the ear or shoulder
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· Blood clot in a vein near the exit site · internal leak |
1. Call your CHN. 2. Call the VAT Nurse or CHEO’s Emergency Department. 3. 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 |