Some PH therapies are delivered by continuous infusion into the body. For intravenous administration, a soft hollow tube, or central venous catheter, is placed into a large vein leading to the heart which comes out through a small opening in the chest area.
Infections, and other risks associated with CVCs, can cause serious illness and even be fatal so they require immediate attention.
- Preventing catheter-related infections
- Recognizing CVC infections
- If your catheter comes out and other emergencies
Addressing catheter-related emergencies:
Preventing catheter-related infections
Catheter site infections and blood infections (bacteremia) are among the risks associated with CVC and continuous infusion therapy. Infections can cause serious illness, worsen PH and are potentially fatal, so they require hospitalization and replacement of the CVC. Patients, caregivers and health care providers must be constantly mindful of following appropriate procedures and practices and strive to prevent CVC infections and emergencies.
One of the best ways to prevent CVC infections is through regular and thorough hand washing. Our hands come in contact with bacteria constantly throughout the day. So hands and nails must be washed thoroughly with antibacterial soap and dried with a new clean cloth or paper towel prior to CVC care, medication preparation or changing the infusion system. Wearing gloves can also be helpful but does not eliminate the necessity of excellent hand hygiene.
The catheter hub, or the end of the CVC, is a place where microorganisms can enter the catheter and cause infection in the blood. One method of protecting the end of the catheter is a closed hub system, or a needleless end-cap on the end of the CVC. With the closed hub system, the catheter hub is opened and exposed to the environment weekly only when the endcap device is changed. When using a closed hub system, it is very important to thoroughly cleanse the end-cap with alcohol and allow the alcohol to dry before connecting new tubing.
In contrast, without a closed hub system, the CVC is opened to the environment with every tubing change.
All infusion system connections may be exposed to water-borne organisms any time they get wet. Connections should always be protected from water, and it is critical that the connections are never opened if wet. While many impermeable covers for the connections have been tried, many patients find Glad Press and Seal to be the easiest, cheapest and most effective.
The catheter insertion site is a potential entry point for microorganisms. The goal is to keep the catheter site clean, dry and free of any skin reactions and infection at all times. There are many options for central line dressings and cleaning solutions for the skin. ChloraPrep is the preferred antiseptic. However, Betadine and alcohol can also be used. The use of a semi-permeable dressing such as Tagaderm (changed every seven days) or sterile gauze (changed every two days) is also recommended. Many patients face unique challenges with skin sensitivities to cleaning solutions and dressings. Since skin reactions and rashes can lead to skin and CVC-site infections, it is critical that patients report any skin reactions immediately to their PH nurses.
The medication and mixed infusion solution must remain sterile within the reservoir or cassette. Precisely follow the mixing and administration protocol taught by your PH center. If an accidental contamination occurs during the mixing of the medication, the solution should be discarded. Maintaining the integrity of the vial of medication is also essential. If accessing the vial with a needle, be sure to insert the needle with the bevel (needle opening) up at a 45% degree angle to the top of the vial to avoid coring the rubber diaphragm. For needleless access using a vial adaptor, use a vial adaptor with a flat surface that can be thoroughly disinfected with alcohol prior to access. Finally, store all open vials in a refrigerator.
Preventing catheter-related infections
Catheter site infections and blood infections (bacteremia) are among the risks associated with CVC and continuous infusion therapy. Infections can cause serious illness, worsen PH and are potentially fatal, so they require hospitalization and replacement of the CVC. Patients, caregivers and health care providers must be constantly mindful of following appropriate procedures and practices and strive to prevent CVC infections and emergencies.
One of the best ways to prevent CVC infections is through regular and thorough hand washing. Our hands come in contact with bacteria constantly throughout the day. So hands and nails must be washed thoroughly with antibacterial soap and dried with a new clean cloth or paper towel prior to CVC care, medication preparation or changing the infusion system. Wearing gloves can also be helpful but does not eliminate the necessity of excellent hand hygiene.
The catheter hub, or the end of the CVC, is a place where microorganisms can enter the catheter and cause infection in the blood. One method of protecting the end of the catheter is a closed hub system, or a needleless end-cap on the end of the CVC. With the closed hub system, the catheter hub is opened and exposed to the environment weekly only when the endcap device is changed. When using a closed hub system, it is very important to thoroughly cleanse the end-cap with alcohol and allow the alcohol to dry before connecting new tubing.
In contrast, without a closed hub system, the CVC is opened to the environment with every tubing change.
All infusion system connections may be exposed to water-borne organisms any time they get wet. Connections should always be protected from water, and it is critical that the connections are never opened if wet. While many impermeable covers for the connections have been tried, many patients find Glad Press and Seal to be the easiest, cheapest and most effective.
The catheter insertion site is a potential entry point for microorganisms. The goal is to keep the catheter site clean, dry and free of any skin reactions and infection at all times. There are many options for central line dressings and cleaning solutions for the skin. ChloraPrep is the preferred antiseptic. However, Betadine and alcohol can also be used. The use of a semi-permeable dressing such as Tagaderm (changed every seven days) or sterile gauze (changed every two days) is also recommended. Many patients face unique challenges with skin sensitivities to cleaning solutions and dressings. Since skin reactions and rashes can lead to skin and CVC-site infections, it is critical that patients report any skin reactions immediately to their PH nurses.
The medication and mixed infusion solution must remain sterile within the reservoir or cassette. Precisely follow the mixing and administration protocol taught by your PH center. If an accidental contamination occurs during the mixing of the medication, the solution should be discarded. Maintaining the integrity of the vial of medication is also essential. If accessing the vial with a needle, be sure to insert the needle with the bevel (needle opening) up at a 45% degree angle to the top of the vial to avoid coring the rubber diaphragm. For needleless access using a vial adaptor, use a vial adaptor with a flat surface that can be thoroughly disinfected with alcohol prior to access. Finally, store all open vials in a refrigerator.
Recognizing CVC infections
Learn to recognize early signs of catheter site infections or blood infections so that they can be managed and not become fatal. Notify your PH physician or nurse immediately if you experience any of the following signs of infection:
- Drainage, warmth or odor around the catheter site
- Redness or tenderness at the catheter site and/or extending under the skin along the CVC track
- Fever of 100.5 F (38 C) or greater or chills
- Unexplained malaise or flu-like symptoms. While CVC infections are generally rare, even one infection can have serious consequences
In case of emergencies
PHA’s Empowered Patient Toolkit includes a notice for emergency medical personnel that might respond to your 911 call. You can post this on your refrigerator and keep it handy.
Toolkit
If your catheter comes out and other emergencies
It’s an emergency if your catheter falls out, is pulled out, begins leaking or becomes cracked. Here’s what to do:
If the catheter comes out
If the catheter falls out or is pulled out, call 911 immediately. Continuously delivered medication only stays in your body for a short time after delivery is stopped. Any disruption creates the risk of increased symptoms and even death. Tell 911 you have a life-threatening emergency and ask them to dispatch an ambulance immediately. While waiting for help to arrive, minimize physical activity and put oxygen on if you have it at home. Cover the area where the catheter came out (with your hand) and apply pressure if bleeding. When help arrives, advise emergency personnel of your condition. Emergency personnel must start an IV in your arm to ensure that you continue to receive your life-sustaining medication.
If the catheter is leaking or cracked
If the catheter is leaking or cracked, call 911 immediately. Your medicine may be leaking out, and a doctor must repair or replace the catheter as soon as possible. Tell 911 you have a life-threatening emergency and ask them to dispatch an ambulance immediately.
If blood is backing up the catheter or leaking out, use the clamp to close off the catheter to stop blood from backing up. Try to wrap the crack or hole tightly with tape, but if it is still leaking you must clamp off the line. When help arrives, advise emergency personnel of your condition and that they must start an IV in your arm to ensure that you continue to receive your life-sustaining medication.
If the catheter is loose
If you notice a fuzzy raised area where your catheter comes out of the skin, call your PH doctor immediately. The catheter has a small “cuff” under the skin that is designed to hold the catheter in place. Over time, this cuff sits under the skin and forms a bond between the skin and muscle. Sometimes the catheter can come loose, and you will see this cuff start to appear outside the skin. The catheter cannot safely be “pushed” back in. A doctor must repair or replace it.
If this happens to you, secure the catheter with dressing, using extra tape, and make several “safety loops” to prevent the catheter from accidentally pulling out. Call your PH doctor or clinic and ask how you should proceed.
