Download Hickman Catheter Care

Page 1 of 9 The Johns Hopkins Hospital Patient Information Care of Your Hickman Catheter What is a
Hickman
Catheter?
How is the
Hickman
Catheter put
in?
Will a
Hickman
Catheter limit
my activities?
Original Date 1999 Oncology Revised/ Reviewed 6/14 A Hickman is a long, purple
tube which ends in a large
vein in your chest, just above
the heart.
•
It can be used to give you
medicines, IVs or blood, and
can also be used to take
blood, so you will not have to
be stuck with needles as often.
•
It may have one, two or three lumens (branches),
depending on the type of treatment you are having.
•
It can stay in for as long as it is needed and there are
no problems.
•
The place where the catheter is put in is called the
“entrance” site. It will be in your lower neck area and
will have a stitch or skin glue. The stitch stays in for 7
days. The catheter is tunneled under the skin and
comes out in your upper chest area. This area is
called the “exit” site. It also has stitches which will be
left in for 30 days.
•
The catheter has a cuff that attaches under the skin to
help keep the catheter in place even after the stitches
are taken out. This also decreases the chance of
infection.
You may need to change some of your activities because of the
catheter.
• You may shower, but you must completely cover your
dressing and connections with plastic wrap and tape or a
dressing cover such as Aquaguard™.
• Do not let your catheter go under water, in the tub or pool.
• If your dressing gets loose or soiled, it must be
changed right away.
• Do not damage or pull on the catheter. If your catheter
dangles, secure it by taping it up or attaching it to a chain.
• Exercise, sexual activity and light housekeeping are
permitted as long as your catheter and dressing are secure.
You may not vacuum or iron, play tennis, golf, bowl or lift
•
0965 ©2009 The Johns Hopkins Hospital Page 2 of 9 The Johns Hopkins Hospital Patient Information Care of Your Hickman Catheter How will I
care for my
catheter?
Original Date 1999 Oncology Revised/ Reviewed 6/14 weights while you have the catheter. Moving the arm on the
same side of the catheter over and over again may damage
the catheter or cause it to move out of the vein
• If you have any other questions about activities you may or
may not do, talk with your doctor or nurse.
We will teach you to change your catheter cap, flush your catheter
and change the dressing and how to look for problems and who to
call if you have them. A home care company will deliver the
supplies you will need to care for your catheter. The supplies sent
may be slightly different from what is described below. A nurse
will go over this with you.
You will need to change your catheter cap every 7 days.
Changing
Your Catheter
Supplies needed:
Cap
1. New injection cap
2. Alcohol wipes
3. Masks
4. Alcohol-based hand sanitizer
Procedure:
1. Patient and caregiver put on masks.
2. Wash your hands or use hand sanitizer.
3. Be sure your catheter is clamped.
4. Open packages of alcohol wipes and new cap.
Keep them in the open packages until ready to use them.
5. Remove the old cap by turning it
counterclockwise. Do not touch the end
Of the catheter with your bare hands.
6. Scrub the top and sides of the end of the catheter with an
alcohol wipe at least 10 times like you are juicing an
orange. Do not lay the end of the catheter that you just
scrubbed on the chest.
7. Remove the cover from the new cap. Put on the new cap
by rotating it clockwise into the end of the catheter. Be
careful to touch only the outside of the cap and not the
inside part that goes into the catheter.
0965 ©2009 The Johns Hopkins Hospital Page 3 of 9 The Johns Hopkins Hospital Patient Information Care of Your Hickman Catheter Original Date 1999 Oncology Revised/ Reviewed 6/14 Flushing Your You will need to flush each lumen of your catheter once a day with
5mLs. of heparin solution if your nurse has not flushed it that day
Hickman
to keep blood from clotting in the catheter. Your homecare
Catheter
company will give you pre-filled heparin syringes for flushing your
catheter. Pre-filled syringes do not have to be refrigerated.
Supplies needed:
1. Alcohol-based hand sanitizer
2. Alcohol wipes
3. Pre-filled heparin syringes (one for each lumen)
Procedure:
1. Wash hands or use hand sanitizer.
2. Scrub the top and sides of the cap of the catheter with an
alcohol wipe at least 10 times like you are juicing an orange.
3. Do not lay the end of the catheter that you just scrubbed on
the chest.
4. Remove the cap from the heparin syringe. Check for air
bubbles. If you see air, turn the syringe with the tip facing
up and push the air out. Without touching the end of the
catheter, or the tip of the syringe, push the syringe into the
capped end of the catheter and turn it clockwise as if
screwing the syringe onto the catheter.
5. Open the clamp on the catheter. Push the heparin solution
into the catheter. If you cannot push it in, do not force it.
Call your doctor or nurse right away!
6. Take off the syringe and put it in the trash. Clamp the
catheter.
Changing the
Transparent
Dressing
You will need to change your dressing every 7 days, or any time it
becomes loose, wet or dirty. Look through the clear dressing
every day for redness, swelling or drainage such as pus or blood.
You should also touch over the dressing every day to check for
tenderness. Call your doctor or nurse if you see any of these
signs.
Supplies needed:
A dressing kit or individual supplies listed below:
1. Chloraprep™ stick or Iodine/Isopropyl Alcohol
0965 ©2009 The Johns Hopkins Hospital Page 4 of 9 The Johns Hopkins Hospital Patient Information Care of Your Hickman Catheter 2.
3.
4.
5.
6.
Original Date 1999 Oncology Revised/ Reviewed 6/14 Swabsticks
1 transparent dressing
1 package of skin prep™ or other skin protectant
2 masks
Gloves
Alcohol-based hand sanitizer
Procedure:
1. Patient and caregiver put on masks.
2. Caregiver should wash hands or use hand sanitizer.
3. Open all packages and leave the supplies in their sterile
wrappers on a clean table.
4. Remove the old dressing from the chest.
5. Wash hands again or use hand sanitizer, then put on
gloves.
6. Take the Chloraprep® stick and squeeze the wings
together until you hear it snap and the pad gets wet.
7. Using a scrubbing motion, clean in a circle, starting at the
catheter exit site and moving away from it.
Never retrace your steps!
8. Let it air dry for 1 minute. Do not wave hands or blow on
it since this may spread germs to the catheter.
9. If you are allergic or sensitive to Chloraprep®, you may
be told to use iodine/isopropyl alcohol sticks. You clean
the catheter area the same way by starting where the
catheter leaves the skin and moving out in circles. Let
the iodine air dry for 2 minutes.
10. Wipe the skin prep onto the area where the dressing
edges will go. Do not touch the catheter. Allow the skin
prep to air dry for 1 minute. Skin prep is a protective
coating to keep your skin from getting red or sore from
the stickiness of the dressing or tape.
11. Remove the backing from the transparent dressing.
12. Press the dressing over the catheter with the catheter exit
site showing through the window.
13. Remove the paper strip and smooth out the edges. There
are two extra pieces that you can peel off of the top of
0965 ©2009 The Johns Hopkins Hospital Page 5 of 9 The Johns Hopkins Hospital Patient Information Care of Your Hickman Catheter Original Date 1999 Oncology Revised/ Reviewed 6/14 the strip. Write the date and time on the tab so you know
when the dressing was last changed. Stick the tab on the
dressing. Apply the other piece under the catheter to
secure it.
14. Do not let the catheter get pulled. You may tape the
catheter up or tuck it into a bra. It is important to never
use safety pins near the catheter since they may
put a hole it.
Changing the Gauze Dressing
You may be taught to use a gauze dressing if you have an
infected catheter, drainage at the site or irritated skin. The
dressing can be changed every other day if it does not get wet,
loose or dirty. If it does, it must be changed right away. You
should look at your catheter site every time you change the
dressing. If you see redness, swelling, drainage or the site is
sore, call your doctor or nurse. Please follow the same steps for
changing the transparent dressing.
What
It is very important to watch for and report the following
problems do I problems to your doctor or nurse right away.
need to watch
for?
1. Fever greater than 100.5°
2. Shaking chills (rigors) after flushing your catheter.
3. Redness, tenderness, bleeding or drainage at your
catheter site or along the tunnel.
4. Skin rash under the dressing.
5. Pain, swelling, or numbness in your arm or neck on the
same side as the catheter.
6. Catheter cuff is seen at the exit site.
7. Difficulty flushing the catheter. If this occurs, do not
force, since this may cause the catheter to rupture.
8. Breaks, leaks or tears in your catheter. If this occurs:
clamp the catheter between the damaged area and
your body. Cover the catheter with a sterile 4x4 gauze
0965 ©2009 The Johns Hopkins Hospital Page 6 of 9 The Johns Hopkins Hospital Patient Information Care of Your Hickman Catheter Original Date 1999 Oncology Revised/ Reviewed 6/14 pad and call your doctor or nurse immediately.
9. Your catheter may be treated or may need to be
removed if complications occur.
My Doctor is_______________________________
Phone Number_____________________________
My Nurse is________________________________
Phone Number_____________________________
Other
Resources
Please watch the Hickman Catheter Video on the in-house
television. Your nurse can help you find it.
0965 ©2009 The Johns Hopkins Hospital Page 7 of 9 Hickman Care Calendar
Month:
Change dressing and cap every 7 days.
Flush Catheter every day if not used by your nurse.
0965 ©2009 The Johns Hopkins Hospital Page 8 of 9 FAQs
(frequently asked questions) about “Catheter-­‐associated Bloodstream Infections” (also known as “Central Line-­‐Associated Bloodstream Infections”) What is a catheter-­‐associated bloodstream infection? A “central line” or “central catheter” is a tube that is placed into a patient’s large vein, usually in the neck, chest, arm, or groin. The catheter is often used to draw blood, or give fluids or medications. It may be left in place for several weeks. A bloodstream infection can occur when bacteria or other germs travel down a “central line” and enter the blood. If you develop a catheter-­‐associated blood-­‐
stream infection you may become ill with fevers and chills or the skin around the catheter may become sore and red. Can a catheter-­‐related bloodstream infection be treated? A catheter-­‐associated bloodstream infection is serious, but often can be successfully treated with antibiotics. The catheter might need to be removed if you develop an infection. What are some of the things that hospitals are doing to prevent catheter-­‐associated bloodstream infections? To prevent catheter-­‐associated bloodstream infections doctors and nurses will: • Choose a vein where the catheter can be safely inserted and where the risk for infection is small. • Clean their hands with soap and water or an alcohol-­‐based hand rub before putting in the catheter. • Wear a mask, cap, sterile gown, and sterile gloves when putting in the catheter to keep it sterile. The patient will be covered with a sterile sheet. • Clean the patient’s skin with an antiseptic cleanser before putting in the catheter. • Clean their hands, wear gloves, and clean the catheter opening with an antiseptic solution before using the catheter to draw blood or give medications. Healthcare providers also clean their hands and wear gloves when changing the bandage that covers the area where the catheter enters the skin. 0965 ©2009 The Johns Hopkins Hospital Page 9 of 9 • Decide every day if the patient still needs to have the catheter. The catheter will be removed as soon as it is no longer needed. • Carefully handle medications and fluids that are given through the catheter. What can I do to help prevent a catheter-­‐associated bloodstream infection? • Ask your doctors and nurses to explain why you need the catheter and how long you will have it. • Ask your doctors and nurses if they will be using all of the prevention methods discussed above. • Make sure that all doctors and nurses caring for you clean their hands with soap and water or an alcohol-­‐based hand rub before and after caring for you. • If the bandage comes off or becomes wet or dirty, tell your nurse or doctor immediately. • Inform your nurse or doctor if the area around your catheter is sore or red. • Do not let family and friends who visit touch the catheter or the tubing. • Make sure family and friends clean their hands with soap and water or an alcohol-­‐based hand rub before and after visiting you. What do I need to do when I go home from the hospital? Some patients are sent home from the hospital with a catheter in order to continue their treatment. If you go home with a catheter, your doctors and nurses will explain everything you need to know about taking care of your catheter. • Make sure you understand how to care for the catheter before leaving the hospital. For example, ask for instructions on showering or bathing with the catheter and how to change the catheter dressing. • Make sure you know who to contact if you have questions or problems after you get home. • Make sure you wash your hands with soap and water or an alcohol-­‐based hand rub before handling your catheter. • Watch for the signs and symptoms of catheter-­‐associated bloodstream infection, such as soreness or redness at the catheter site or fever, and call your healthcare provider immediately if any occur. If you have additional questions, please ask your doctor or nurse. If you do not see your providers clean their hands, please ask them to do so. Co-­‐sponsored by: SHEA, IDSA, AHA, APIC, CDC and JCAHO 0965 ©2009 The Johns Hopkins Hospital