Central line troubleshooting for parents of a child with a tunneled CVAD

Central line troubleshooting for parents of a child with a tunneled CVAD


Hi I’m Karen, so my daughter’s been in
hospital for the last month and she’s been receiving her medication and nutrition through a central line. So she is coming home now and I’m here to meet the nurse specialist to find out how to troubleshoot the central line. Hello, I’m Christina McGuckin, the parenteral nutrition clinical nurse specialist and this video today is to show you how to do some troubleshooting on central
venous access devices. We have three different type of central venous access devices, we have tunneled central venous access device, we have a PICC line which often is in the arm and it can be double or single lumen and we also have port-a-cath, which is underneath the skin in the chest wall. Hello Karen, I’m Christina McGuckin, the parenteral nutrition clinical nurse specialist. And thank you for coming today, to learn about the central line troubleshooting. Now I believe your daughter Scarlett had her central line put in about four weeks ago, is that correct? Yeah, that’s right. Now Karen, what I want to do first is to talk a little bit about the operation and make you aware of some of the names of the parts of the
line and the body. We call this a central venous access device and it’s a tunneled line. It’s a tunnel line because it’s in under the skin here. When the surgeon identifies a vessel he does it through the neck. And if you can remember Scarlett will have a little neck wound on the side and that disappears after several weeks and becomes very faint. It’s important that you recognise where that is. The name of that part is the entry site, because that’s where the catheter goes down into the blood vessel and that will travel down very close to the heart. Then the line is coming out here as you see and the part where that comes out from the body we call that the exit site. The external part ideally should be on a clinifix or even a bit of tape. Like this to try and avoid it getting caught or pulled. If it was to get pulled a little bit, it would stop, this clamp here would stop it, okay? The line is in the clinifix here. What you have here is a white clamp and this clamp currently is on, to open it you have to push the back bit
and it opens. The clamp should always be somewhere on that protective sheath, okay? Okay. On the end of the line or on the hub, you have a blue bung. You place it back in and the positioning is very important, always remember to have the clamp above the clinifix. The first thing I want to talk about is probably the worst scenario that you would find. That would be you suddenly find Scarlett has got her line caught in something or she lets out a squeal and when your turn around you see the line has totally come out and it’s lying on the floor. My goodness. Okay, I want to ask you what do you think you would do apart from panic and scream yourself. What do you think you would do? Probably need to put some pressure or something? Okay, okay. And then phone you guys? Yeah, no that’s good. Okay, so you’re absolutely right about putting pressure on, but it’s not here that’s the exit site. Where does the line go into the blood vessel? Up here then? Yeah. So you want to put pressure at the entry site. You would have your hand across there. Your priority is putting that pressure on. And then you just stop where you are, and you make Scarlett sit down. You don’t lie her down, you make her sit down. If you lie her down, it can cause the bleeding much more. So shout for help from someone and that help will be asking them to call 999 and you do not remove that pressure until the ambulance arrives. Okay? And that’s quite frightening. Yeah. Yeah. Okay, so the next thing I want to talk about is infection. Infection can happen for lots of different reasons and it’s like what signs and symptoms are
you going to get, what you looking out for. So the first thing we’ll talk about
is the temperature. A normal temperature in a child would be roughly be about 36.4 to 37.4 that’s an average normal range. If the temperature is 37.5 up to 37.9
it’s like a low-grade fever it’s a warning sign potentially, but it could also be that it’s just an environmental heating and Scarlet’ is too warm. And what you would do is just remove a cardigan or a blanket and go back and check the temperature again within the hour. You can give some paracetamol at that time it won’t do any harm. If there was going to be a severe infection, it will come through the paracetamol, so you’re not going to camouflage anything. But if it’s just something brief, minor it may settle it back down and not go back up again. If you do her temperature and it’s 38, that’s a little bit more that’s not just a warning, there’s
something happening and I would say to you definitely give
paracetemol and you have to make contact with us. If you do her temperature and it’s 38.5 or higher you can’t ignore that. Yes give paracetemol, but you need to get her into a hospital straight away and you can call an ambulance, you don’t need to get yourself panicked and in a car. Absolutely you can call an ambulance 999 The other area that you would look out for infection is this tunneled area. If you see any red tracking and what I mean by tracking is could be like two lines, like a rail track and if there’s an infection brewing in here that could actually travel up into the blood vessel, under the entry site into the vessel there. And she could become really sick from that. So if you see redness up here at all in that tunneled area, flag it up, let us know. We would probably do blood samples and do some blood cultures to make sure
there’s not anything going on. You also have at the exit site, if it gets all moist, red, sore or inflamed, it could cause a problem as well. And the bacteria from there could go up, but if we care for this properly that won’t happen, okay? Okay. The other thing I want to talk to you about is the dressing itself, and troubleshooting the dressing would be making sure that the line is secured and covered. And if you find that the dressing has come loose, because these things do happen in children, especially if they have been in the shower
or getting washed, they can come loose. So if you find it’s like that, bacteria and everything can travel up in there and get up into the exit site and you really don’t want that. You would always carry some of these around with you. So what what you would do at that stage
is to take one of your, just with clean hands, you don’t need gloves on to do this, just clean hands. And it’s like opening up an elastoplast. It’s got numbers on it to tell you how to take off. So you take the back off and that bit is sticky. Then you just place that directly over where you want it to be secured. You then take the sides off just like as an elastoplast and close it down, just gently rub that in. Then you’ll see there is a wee curved part, you just get hold of that and just peel back. Just making sure the dressing remains intact and in place. That’s you got it nice and secure again. Then within about 24 hours that dressing should get changed. So that’s a temporary fix. It’s temporary fix and there are little strips here you can use these to help secure and that just keeps everything until you get the new dressing on. Okay Karen, so the next thing I want to talk about is if you were in the living room
at home and suddenly Scarlett comes in to say that there’s blood on her t-shirt. First thing you want to do is get your blue clamps, you want to know where they are so that you can get them straight away. As she is taking her t-shirt up, you’re looking at her dressing and you’re just getting the clamp and you’re going to where you need. If there’s no blood underneath, just where
the line comes out of the dressing, you put your first clamp in place. Okay. This then allows you time to actually have a look at your line, so it might be obvious and you may see where a red blob is, where it’s come out and that’s great, direct yourself straight to it. But the areas that you’re wanting to look at are the areas where there’s thick and thin material and that would be between the protective sheath and the line. As you can see on this one here, can you see where there’s the thin and thick? Yes. In the middle. If you do see a fray there, all you would do is take your second clamp and place it above it. Now it could be it’s down here, the main thing is if you can see where there’s a hole or where you think there’s a hole or a tear, you’ve identified that. What you then need to do is secure that against Scarlet’s skin with a bit of tape and then phone us or if it’s out of hours you just go straight to A&E and we would then look to see if we can repair, okay. Does that make sense? Yes. And if there was blood underneath the dressing, that’s a slightly different matter you have to remove the whole dressing okay? So you would have your clamp and you would have to place the clamp underneath here. and then phone us or if it’s out of hours just go straight to A&E. That’s everything with regards to the trouble shooting. Quite a lot of information today. But does that all make more sense? Yeah, it does, it definitely makes sense. I’ll try and remember it all. But what if I forgot something? Don’t worry, I wouldn’t have you go away home and the staff won’t have you go home without making sure you’ve understood everything. So I’ll probably come back and see you. Thank you so much for explaining all that to me. Good, you’re welcome. I’m glad I’ve helped you and I hope I’ve reassured you not scared you. Thanks for coming and joining me for the session. Thank you.


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