Repair of Tunneled CVL

• Pediatric PN VAD Care and Maintenance
• Managing Central Line Tears
• Managing Central Line Occlusions

Pediatric PN VAD Care and Maintenance

• Clean outside of dressing/surrounding skin with alcohol before taking dressing off.
• Wear clean, non-sterile gloves when connecting or disconnecting PN and changing needle-less device(s).
• Cover VAD/PN connection site with alcohol foil wrap (remove alcohol pad), even when connection sites are not in use.
• Secure VAD away from anything that may contaminate, tear, or cause line to be pulled (for example, teeth, hands, tracheostomy, gastric tube, ostomies, etc.).
• Before changing the needleless device, the VAD connection site must be cleaned as follows:
  1. Clean with alcohol pad for 10 seconds x 3 using friction
  2. Then clean with Chloraprepfor 10 seconds  x 3
  3. Allow to dry for 10 seconds
• Prior to connecting PN to the needleless device, the top of the needleless device must be cleaned as follows:
  1. Clean with alcohol pad for10 seconds x 3 using friction
  2. Then clean with Chloraprep for 10 seconds x 3
  3. Allow to dry for 10 seconds
• Please Note:  If bodily fluids or fecal matter contaminate the connection site, clean VAD as follows:
  1. Clean well
  2. Clean with alcohol pad x 3
  3. Then clean with Chloraprep x 3
  4. Allow to air dry
  5. Notify physician to determine if prophylactic antibiotics are necessary
• Please contact the PN/VAD nurses with questions or concerns at extension 42379 or 42380.

To Avoid Central Venous Access Device (CVAD) Tears:

1. ALWAYS assess for kinks prior to accessing.
2. NEVER FORCE FLUSH!
   • If you are meeting resistance you may have either a partial occlusion (able to infuse  but unable to draw back blood) or a complete occlusion (inability to flush or draw back blood).
   • *If you experience either of these occlusions, notify Physician for alteplase Orders*.
3. PLACE CLEAR DRESSING  Or tape over "thin and thick" portion of CVAD.
   (To allow for visual assessment of kinks and secure line to prevent tears)

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Managing Central Line Tears

PN/ VAD nurses are able to externally repair Broviac and Hickman Catheters under sterile technique.  A physician’s order is required. Repair kits are available for the following catheter sizes: 4.2 Fr, 6.6 Fr, 7 Fr, 9.6 Fr, 10 Fr,

• Clamp - damaged portion of catheter proximal to the patient using cannula clamp or blue dialysis clamp. Do not use Kelly scissors as the teeth will further damage the catheter
• Clean – damaged portion of catheter with alcohol wipe x 30 seconds using friction
• Cover – damaged portion of catheter with gauze or alcohol prep wrapper & secure with tape
• Call – notify MD; notify VAT if damaged catheter is a PICC line; notify PN/ VAD nurses if damaged catheter is a tunneled line.

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Managing Central Line Occlusions

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