Emergency Central Venous Access Device (CVAD) procedures by The Hospital for Sick Children.
Overview. This video will show family members, teachers, daycare providers, and other caregivers
how to manage the emergency procedures for a central line, also known as central venous
access device or CVAD. Review this video with the child's primary caregiver in case you will
need to perform any of these procedures. A central venous access device or CVAD,
is an IV line that is inserted into a large vein. It is used in children who need IV therapy such as
medications, chemotherapy, nutrition or fluids for a long period of time. CVADs can include central
lines also known as a CVL or CVC, peripherally inserted central catheters or picks and ports
A CVAD is made up of the following parts, a catheter, a clamp to close access, an access cap,
an insertion area or exit site, and the dressing to cover and protect the tube and exit site.
This video will cover what you need to do in the following situations: one, the central line
breaks, is cut or cracks. Two, the cap falls off the central line. Three, the central line is pulled out.
Four, the dressing is loose or lifting, and five, the dressing falls off the central line.
Emergency kit. For these emergency procedures, you will need a CVAD emergency kit. Always keep this kit with
the child. The CVAD emergency kit should include the following: padded clamps, tape, sterile gauze,
a new sterile dressing, a new sterile cap, and alcohol swabs. Before you start any procedure,
if possible, please wash your hands using soap and water or hand sanitizer.
If a pair of clean unused gloves is available, they may also be used.
Remember to stay calm. Have the child lay down and explain to them what is happening.
What to do if the line breaks, is cut, or cracks. If the line breaks,
is cut or cracks, the child may be bleeding. Stay calm and proceed with the procedure.
From the emergency kit take out the padded clamps and clamp the child's central line between their
body and the breakage. If you do not have one of these clamps, fold the line and tape it to mimic
clamping. Clean the broken area with an alcohol swab.
Wrap the end of the line and the clamp, or the open area, with gauze.
Tape the gauze roll to the child.
If you are not the child's guardian, contact them immediately. If the child is actively
bleeding, or you are unable to reach their guardian, call 9-1-1 and tell the operator you
have a medical emergency and the child has a broken central line and needs EMS support.
Inform the EMS operator if the child is bleeding. If you are the child's guardian, and there is
no active bleeding, contact a member of your child's healthcare team for further instructions.
What to do if the cap falls off. First, make sure that the clamp on the CVAD is closed.
Then take the alcohol swab and scrub the end of the line where the cap would sit for 15 seconds.
Allow it to dry for 15 seconds.
Open the new cap package.
Remove the blue protective top. Make sure that you do not touch the end of the cap.
Screw the cap back onto the line. If you are trained to do so, change the cap using aseptic
non-touch technique, or ANTT as soon as possible. If you have not been trained, contact the child's
guardian, who has had CVAD training, so that the cap change can happen as soon as possible.
What to do if the central line is pulled out.
Take the gauze out of the emergency kit and use it to apply pressure to the line exit site.
Use your other hand to apply pressure to the side of the neck directly above the line exit site.
If the child has a peripherally inserted central catheter, or PICC line,
the exit site will be on the arm. Apply pressure for a minimum of 10 minutes to stop the bleeding.
After 10 minutes, check if the bleeding has stopped. If it is unclear if the bleeding has
stopped, continue holding pressure. If you are not the child's guardian, contact them immediately.
Continue to apply pressure if the bleeding has not stopped. If a second person is available,
ask them to call the child's guardian so you can continue applying pressure.
If you are the child's guardian and the bleeding has stopped with pressure,
clean the exit site with the usual cleaning solution and apply a bandage over the area.
Contact a member of your child's healthcare team for further instructions. If possible,
bring the broken catheter to the hospital with you. If the bleeding does not stop or if you are
not the child's guardian, call 9-1-1 and tell the operator you have a medical emergency and
need EMS support for a child with a central line that has been pulled out that is actively bleeding.
What to do if the dressing comes loose.
If the edges of the dressing are lifting, reinforce the edges of the dressing with tape.
If you are trained to do so, change the dressing using aseptic non-touch technique
or ANTT. If you have not been trained, contact the child's guardian who has had CVAD training
so that the dressing change can happen as soon as possible. What to do if the dressing falls off.
If the dressing has fallen off, you will need to place a new dressing over the site. If the old dressing
is still partially attached, carefully remove it. Open the new dressing and place it over the site.
Make sure that the site is visible under the clear part of the dressing.
Remove the upper part of the dressing.
And secure the line.
If you are trained to do so, change the dressing using aseptic non-touch technique. If you have
not been trained, contact the child's guardian who has had CVAD training so
that the dressing change can happen as soon as possible. Remember, once you finish any of these
procedures, appropriately discard the supplies and wash your hands as soon as possible.
Tell the child's primary caregiver that the emergency kit has been used and will need to be replaced.
Finally, if you are not sure what to do, contact the child's guardian, their healthcare team, or call 9-1-1,
depending on the situation. The most important thing for you to remember is to stay calm.
Thank you. We are here to help. If you have questions or need further
tips please contact the child's primary caregiver.