A central venous access catheter or (CVAC) is recommended for patients who regularly undergo dialysis or chemotherapy treatments, or for patients who frequently receive antibiotic or antifungal infusions or nutritional supplements.

A CVAC is a small, hollow tube that is placed by an OIA interventional radiologist into a large central vein under your shoulder bone. Guided by specialized x-ray imaging, the catheter is then threaded through a small tunnel created for it under the skin and anchored in place. With a CVAC, patients are spared the irritation and discomfort of repeated needle injections.

More than 3.4 million CVACs were placed in 2005 and the number is increasing each year. There are several types of CVACs, including tunneled catheters (referred to as Hickman or Broviac catheters), peripherally inserted central catheters (often called PICC lines or long lines), dialysis catheters and implantable ports. Your doctor will explain which one you will have inserted prior to your procedure.

Venous Access Catheter Guidelines

When Your Procedure Is Scheduled

• Our scheduler will give you a date and time for your procedure at Overlake Hospital Medical Center. You will need to arrive at the hospital two hours before the procedure to allow the admitting and nursing staffs to get you ready. 
  
• Please let the scheduler know if you take Coumadin, Plavix, Insulin or Metformin. You will need to receive specialized instructions.
  
• If you have any questions regarding your procedure, you may call us at 425-688-5507.
  
• The admitting department will attempt to call you the night before your procedure to confirm your arrival time.
  
• Please plan to leave any jewelry or valuables at home.
  
• Make sure to arrange for someone to drive you home after the procedure.

Preparation

• Please take your normal heart and blood pressure medications with a sip of water. If you are a diabetic and take insulin, ask your doctor about modifying your insulin dose for the day of your procedure.
  
• You need to be at the hospital’s admitting area two hours before you procedure’s scheduled start time. This is located at the large desk at the hospital’s main entrance (across from Stanza’s Café).
  
• You will be taken down to your room where you will meet your nurse. You will be asked to change into a patient gown. An IV will be started and blood drawn for lab tests. The nurse will ask you for your medical history. If possible, bring a list of all the medications you take and when you take them.
  
• The nurse will also ask you about allergies. If you are allergic to radiology/contrast dye please let them know.
  
• If there is a possibility that you’re pregnant, please let the nurse know. You will be asked to sign a form if you are a female of childbearing age (12-57).
  
• The nurse or tech will clean and shave, as necessary, an area around the catheter’s point of entry.
  
• Before the procedure, the interventional nurse will meet with you and your family to review the procedure and answer any questions you might have.

What to Expect During the Procedure

• The procedure takes 30-45 minutes. You will meet the OIA interventional radiologist who will go over the consent form and answer any questions you might still have.
  
• You may receive sedation medication during the procedure to help you relax.
  
• The area where the catheter is to be inserted will cleansed and draped and you will receive a local anesthetic that will numb the area where the radiologist will be placing the central line. You may feel a small sting when this occurs.
  
• A needle is inserted into the skin, creating a small tunnel. The CVAC is then placed in the tunnel with the tip coming to rest in a large vein.
  
• You may feel some pressure and slight discomfort during the procedure, but it is not very painful.
  
• As the radiologist places the central line through the sheath, he or she may ask you to hum. This helps prevent changes in pressure that may allow air to enter the sheath.
  
• During the procedure the nurse will be monitoring your heart, blood pressure and the oxygen level in your blood.
  
• Once the procedure is over you will be transferred back to your room.

What to Expect After the Procedure

• Most patients will be discharged about 2-4 hours after their procedure.
  
• You will be given written instructions and a phone number to call if you have any questions or concerns. 
  
• Most doctors recommend that showering be avoided until the incision heals.
  
• You will be sore for one to two weeks after your CVAC is first inserted. This will limit your activity. After that, you should continue to avoid any activity that causes a pulling sensation or pain around the CVAC. To avoid unnecessary problems, the catheter that is outside your body should be secured with tape.
  
• It is important to keep your CVAC very clean. A dressing is usually recommended.
  
• Sometimes, despite your best efforts, your CVAC can become blocked. To reduce the risk, flush your CVAC with sterile saline once a day. Flushing the CVAC with saline keeps the inside as clean as possible.
  
• A sign that your CVAC is blocked is a leakage of fluid near its opening or feeling resistance when you flush it. If you feel resistance when flushing, do not continue and call your doctor immediately.
• If you think your CVAC is blocked or an infection does not clear up with extra care, call the OIA interventional radiologist who placed your CVAC and/or your primary care doctor immediately. The doctor will arrange for proper treatment of your problem. In some cases, you will need to have your CVAC changed, and you may need antibiotic medicine. You may even need to be admitted to the hospital.
  
• To avoid infections, follow these instructions unless your doctor specifies otherwise:
  
  • Keep the skin around your CVAC dry. After the incision heals you can take showers, but cover the area with plastic wrap. Tape the edges of the plastic wrap to your skin so that water cannot get in. If the area does get wet, dry the skin completely after your shower.
    
  • Keep the skin around your CVAC clean. Clean the area every day or every other day with a cotton swab that has been moistened with hydrogen peroxide. Always wash your hands before you clean your CVAC site.
    
  • Keep the skin around your CVAC covered. After cleaning the skin around the CVAC site, cover the area with a clean bandage or dressing. Change the dressing if it gets wet.
    
  • Call your doctor immediately if:
    
    • Your CVAC becomes dislodged or broken.
      
    • You have stitches and they become loose.
      
    • Your CVAC begins to leak.
      
    • There is blood in or around your CVAC.
      
    • Flushing or injecting medication causes pain.
      
• One of the interventional nurses will do a follow-up call the next day after your discharge. Write down any questions you might have for them.
  
• To speak to an interventional nurse, please call 425-688-5005. It is best to call between 8AM and 4PM Monday thru Friday. You can leave a message on the voicemail, and a nurse will return your call as soon as possible.
  
• If you are on Coumadin and have been told not to take it before your procedure, you need to check with your physician, and/or the Anti-Coagulation Clinic for instructions.
  
• If you an insulin-dependent diabetic, restart your regular dosing when you get home.
  
• You may resume taking all of your normal medications once you are home.