Choosing and Living with a CVAD

AVA has prepared this guide primarily for the information of patients and as a reference for practitioners and other interested parties. AVA has designed and limited the Guide to provide accurate and authoritative information about Central Vascular Access Devices (CVADs). AVA distributes this Guide with the understanding that AVA is not engaged in rendering medical or professional service through the distribution of the Guide. The reader should consult with a medical professional if medical service is required.

What You Need To Know

Choosing and Living with a CVAD

AVA (Association for Vascular Access) is a professional organization of vascular access professionals (nurses, doctors, pharmacists, physicians), suppliers (engineers, manufacturers), and consumers dedicated to improving vascular access practice and patient outcomes through education and information sharing. This guide has been designed to provide you with information about choosing and living with a vascular access device.

Living with a Central Vascular Access Device (CVAD)

You have an illness that requires use of a central vascular access device (CVAD). CVADs are available in many types. No matter what type you have, there is important information you need to know. CVAD is a term that describes many types of catheters, which are placed in a vein or artery in your body. These catheters are thin, hollow, flexible tubes that can stay in place for weeks, months or even years. Your CVAD can be used by your nurses and doctors to give your medications and draw blood. Sometimes having a CVAD means fewer needle sticks or being able to receive your therapy at home instead of in the hospital. Even though a CVAD can make your therapy easier, you still may have questions about the device and how it may change your life. This guide will help you ask your physician and nurse questions to help you understand your CVAD choices, possible problems and when to seek medical help.

Whats Inside This Guide?

Frequently Asked Questions About CVADs Common types of CVADs A PICC or PICC Line A Non-Tunneled Central Catheter A Tunneled Catheter A Port Some Common Problems with CVADs Blockages in a CVAD Infection Phlebitis CVAD Tip Movement External Catheter Breakage Internal Catheter Breakage Glossary of Terms

11441 South State Street I Suite A, #113 I Draper, UT 84020 I 888-576-2826, 801-576-1824, Fax 801-553-9137 I www.avainfo.org I e-mail: info@avainfo.org

Frequently Asked Questions About CVADs

Page 2

Like you, most people have many questions about how CVADs work, what it is like to live with one, and how to care for it. Here are questions you might want to ask your doctor or nurse: 1. What kinds of CVADs are available to me? 2. What kind of CVAD is best for me? Why? 3. How does the CVAD get put into my body? 4. When do I need to have the CVAD changed or replaced? Can I pull the CVAD out accidentally? 5. Where on my body is the CVAD placed? 6. Will people be able to see the CVAD? 7. Will it hurt to use a CVAD? 8. How long will the CVAD last? 9. Under what circumstances do I need to have the CVAD changed or replaced? 10. How do I take care of the CVAD? 11. How often do people have problems with CVADs? 12. How will I know if something is wrong with the CVAD? 13. What are the most common problems with CVADs? 14. What should I do if I have a problem with my CVAD? 15. Can I get the CVAD wet (showering, bathing, swimming)? 16. Can I work or play sports with my CVAD? 17. Is it safe to have sexual relations while I have a CVAD? 18. How much will the CVAD cost?

Choosing and Living with a CVAD

Common Types of CVADs

Page 3

A PICC or PICC Line

PICC stands for Peripherally Inserted Central Catheter. A PICC is a catheter that is placed in a peripheral (located near the surface of the skin) vein usually a vein in the arm and threaded up into a large vein in the chest.The end or tip stops just outside the heart in the large vein called the superior vena cava. PICCs can be used for just about any therapy. This type of catheter comes in single, double or triple lumen (channel) designs. Like all catheters, no matter how many lumens, there is still only one entrance site (the place where the CVAD is actually inserted into your vein) and exit site (the place where it comes out of your skin). You will see the PICC exit the skin near the vein in which it is placed. There will be a small segment of the PICC with a cap on the outside of your skin. This is how your infusions will be connected. Compared with other CVADs, PICCs can be easy and quick to place, as there is no tunnel or surgical pocket to create. No incision is required for a PICC, only a puncture into the vein. In addition, PICCs may have fewer complications than other CVADs. Although most people need PICCs for only a few weeks or months, PICCs can last for years if taken care of properly. They are relatively small and flexible, so most people find them comfortable. However, because there is an external segment, all PICCs require regular flushing and dressing changes. Your doctor or healthcare provider should give you specific instructions about care, maintenance and any activity limitations. PICCs usually do not require any special procedure for removal. They slide out like a regular Intravenous (IV) catheter. A nurse can remove them in your doctors office or at home.

PICCs can be used for just about any therapy.

Choosing and Living with a CVAD

Common Types of CVADs

Page 4

A Non-Tunneled Central Catheter

A Non-Tunneled Central Catheter is most often used for short-term therapies that might last only a few weeks. The catheter can be inserted near the base of the neck or under your collarbone.The tip or end of the catheter stops just above the heart in the large vein called the superior vena cava. A portion of the catheter remains outside the body, and this is how your medications can be connected. In a Non-Tunneled Central Catheter, the catheter comes out of the skin close to where it enters the vein. There is no tunnel. These catheters are usually stitched for added security so they are not accidentally pulled out. Nurses usually change the dressing on a Non-Tunneled Catheter, but your doctor or nurse may teach you this procedure. Removal of a Non-Tunneled Central Catheter is done by a doctor or nurse specially trained in the procedure. The stitch is snipped and the catheter is easily pulled out. Afterwards an air occluding dressing is applied to the site to help it heal without infection. It is important that this dressing remains undisturbed until your doctor tells you that it is safe to remove the dressing.

A Non-Tunneled Central Catheter is most often used for short-term therapies that might last only a few weeks.

Choosing and Living with a CVAD

Common Types of CVADs

Page 5

A Tunneled Catheter
A Tunneled Catheter is a long-term CVAD with part of the catheter placed under the skin (tunneled). Sometimes these are known as Hickman or Broviac catheters, as these are some popular brands. Some Tunneled Catheters also have a cuff along the catheter that helps anchor the catheter to the tissue under the skin. It also helps serve as a barrier to infection. Catheters are tunneled for a few reasons. First, it helps anchor the catheter; it is more difficult to pull the CVAD out if there is a segment running under the skin. Second, tunneling makes the CVADs exit site separate from the vessel entrance site; this may reduce the risk of infection. Tunneled Catheters are very durable and can last for years with proper care. A Tunneled Catheter is connected directly to IV tubing for the delivery of fluids or medicine, which means no needle stick is required for the catheter to be used. These catheters are good for people who require many infusions at the same time. One disadvantage of a Tunneled Catheter is that a segment of the CVAD is outside the body. Some people dont like this because this portion of the catheter needs to be covered by a dressing and flushed to keep it working properly. Tunneled Catheters come in various types and sizes. The type of catheter you have will depend on your individual needs. For example, patients using a Tunneled Catheter for dialysis require a different type of catheter than patients receiving antibiotics, TPN (for nutrition) or chemotherapy. Tunneled Catheters are removed by your doctor or a medical professional specifically trained in the procedure. Removal is not typically done at home, but rather in a hospital or doctors office. Your doctor will most likely discuss the removal details with you prior to the procedure.

Tunneled catheters are very durable and can last for years with proper care.

Choosing and Living with a CVAD

Common Types of CVADs

Page 6

A Port
A port is a type of CVAD that is placed totally under the skin. A port is made up of two parts: the catheter and a portal body to which it is attached.The catheter sits in the vein. The body of the port is made of a plastic or metal disc with a rubbery center, or septum, that is the entry into a reservoir. The port is used by sticking a special needle (called a Huber needle) through the skin, into the rubber center, and into the reservoir. Because the port is under the skin, placing a port is a slightly longer procedure than placing other types of CVADs. Your healthcare team will explain the insertion procedure. It may be different than what we describe here. Some people like ports because the entire system is under the skin. So, when you do not need therapy, the only care it needs is to have it flushed once a month. You can swim and carry on your usual activities. There will be a small bump visible under the skin over the port. People who are active sometimes prefer ports because there are almost no activity restrictions when the port does not have a needle in it. A disadvantage of ports is that the placement and removal procedures are slightly more involved when compared to other CVADs. Also, a needle stick through the skin is needed to gain access into the port. Some people dont like the idea of another needle stick. You may ask your doctor about a prescription for numbing cream that can be used to make this needle stick more comfortable. Ports are very durable and can last for years. They are available in single and double lumen designs. They also come in different sizes, and your doctor will choose a size to fit your body and therapy needs.

A port is a type of CVAD that is implanted under the skin.

Choosing and Living with a CVAD

Some Common Problems With CVADs

Page 7

Blockages in a CVAD
A blockage, or occlusion, is a problem that can occur with CVADs. A blockage can mean that you cannot flush, infuse medicines or draw blood from the CVAD. This may mean that the medicines are not being delivered into the proper place. There are common reasons for CVADs to become blocked. Contact your doctor or nurse, who can help overcome most of these problems. Here are a few common reasons for blockages: Blood clots in the CVAD or in the blood vessel around your CVAD can cause blockage. Clots can plug up the catheter, making infusions difficult. Sometimes you can infuse your medicines, but are unable to get blood out. This may be caused by a fibrin sheath, which is tissue your body may deposit on the catheter. Both of these problems can be treated with clotbusting drugs given through the CVAD, which help dissolve the clot or sheath. Sometimes, the catheter may need replacement or other methods need to be used to restore catheter function (including angioplasty, or ballooning). Mechanical blockages, or malpositions, can occur when a catheter is in the wrong place in a blood vessel, is kinked or pinched, or has broken. This could also happen if your CVAD has accidentally come out part of the way or been pushed in too far. Sometimes the catheter can be repositioned to restore function. Residue or precipitate build-up inside the CVAD is another cause of blockage. This can occur if medications interact with one another, if they leave behind a residue, or if your CVAD is not flushed properly. Sometimes solutions can be injected into your CVAD to dissolve the residue.

A blood clot can plug up the catheter, making infusion difficult.

Choosing and Living with a CVAD

Some Common Problems With CVADs

Page 8

Infection
Infections are caused by germs getting in or around a CVAD and can become a serious problem if not treated promptly. Make sure to check daily for: Redness, swelling, warmth, tenderness or drainage where the CVAD enters or exits your body. You may have a local infection. Fever, chills, vomiting, diarrhea, fatigue, weakness and loss of appetite. These can be signs that there is an infection in your bloodstream. If any of these occur, you should contact your doctor or nurse immediately.

CVAD Tip Movement

It is possible that the tip (the deepest portion) of your CVAD can change position within your body. This can happen if you have excessive vomiting, coughing, sneezing or hiccuping, or vigorous arm movement. Notify your doctor or nurse if you have any pain or discomfort near your CVAD or in the shoulder, jaw, ear or neck, or if you have a feeling of coldness or fullness in the area. If you hear flushing or have pain when your CVAD is used, tell your nurse or doctor. Check your CVAD to make sure the section outside your body does not seem longer than usual. If it does seem longer, it may have partially come out of the vein where it is inserted. Secure the CVAD with a dressing, and call your doctor or nurse immediately for help.

Phlebitis
Inflammation of the vein, called phlebitis, can occur if the tissue or blood vessel near the CVAD gets irritated or damaged. This can be a response to a foreign body in the CVAD or to the medicine or fluids being given through the CVAD. Notify your doctor or nurse if you have redness, swelling, pain, hardness or warmth near the CVAD.

Choosing and Living with a CVAD

Some Common Problems With CVADs

Page 9

External Catheter Breakage

It is rare for your catheter to break or tear, but it can happen. Catheter breakage can be caused by using sharp objects around the catheter, too much bending or twisting of the catheter when changing caps, excessive force when flushing, or catching the external part of the catheter (e.g., on clothing) resulting in the catheter being pulled or stretched. Here are some simple steps to decrease the likelihood of catheter breakage: Never use less than a 10 cc syringe, and do not use excessive force when flushing. Avoid using sharp objects such as scissors near the catheter. Avoid twisting or kinking the catheter. Secure all external parts of the catheter so nothing is dangling free.

If your catheter does break, you may see that your dressing is wet, that fluid leaks out when you flush or that some blood is leaking out of the catheter. If the catheter is broken, immediately place a clamp above the break, close to your skin (after the catheter is placed, ask your nurse or doctor for an extra clamp to use in an emergency), and call your nurse or doctor. Some catheters can be repaired, while others may need to be removed and replaced.

Internal Catheter Breakage

Internal catheter breaks are very rare, and when they do occur, the catheter will need to be removed and replaced. If your catheter breaks on the inside, you may notice that your catheter is not working correctly. You may also notice that your heart rate is a little faster or beating irregularly, and you may feel short of breath for no obvious reason. Call your nurse or doctor immediately for instruction.

Choosing and Living with a CVAD

Conclusion / Glossary of terms

Page 10

Conclusion
CVADs provide the simplest, quickest, and most efficient way of receiving important medications and other fluids during your illness. Because problems may occur with your CVAD, it is critical for you to know the signs of a complication and alert your caregiver. This guide was developed by AVA with support from Genentech, Inc.

Glossary of Terms
Angioplasty when a doctor inflates a balloon device inside a blood vessel to flatten any plaque that blocks it and causes the blood vessel to become narrowed Catheter a flexible, usually rubber or soft plastic tube placed into the body for removing or giving fluids for diagnosis or treatment purposes Cuff outside part of the catheter that surrounds the entrance site Entrance site the place where a catheter is inserted into the body Exit site the place where a catheter comes out from the body External segment part of the catheter that is outside of the body Fibrin sheath tissue your body may deposit on the catheter Flush wash out with liquid Lumen a cavity, opening or channel inside the catheter Occlusion blockage or closing-off of a blood vessel or passageway in the body, as in a clot stopping up a blood vessel Peripheral to the outside surface, or area away from the center of an organ or of the body Therapy a procedure designed to treat disease, illness or disability Tunnel a passageway under the skin VAD - a term that describes many types of catheters that are placed in a vein or artery in your body

Choosing and Living with a CVAD