Central line procedure: Cap change. This video will review the steps required for two people to
complete a cap change of a central vascular access device or CVAD. It is important to remember that
this procedure uses aseptic non-touch technique or ANTT. At home, this should be completed every seven
days or as needed. Central line procedures require two caregivers - a main person and a support person.
Your child's health care team may teach you how to complete central line procedures at home.
It is important to follow all procedures carefully to keep your child safe. Do not
perform these procedures unless instructed to do so by your child's health care provider.
A central vascular access device, or central line, has the following parts:
Clamps.
Lumens.
Catheter.
Access caps, which are considered key parts.
An insertion area, or exit site, which is a key site.
Dressing.
And a securement device. Caps are considered a key part of the CVAD and the insertion, or
exit site, is considered a key site.
Environment. Please see the introduction video on preparing your environment before watching this video.
First, locate an area to perform the procedure and the support person who will help you.
Find a quiet space and remove any pets or other children.
You need to limit the number of people in the room where the procedure is taking place.
Reduce air drafts by closing windows and doors and turning off fans.
Remove any clutter. Place a garbage and hand sanitizer within reach.
Find a stable, wipe-able work surface to use as your general aseptic field, such as an unused
dedicated cookie sheet. Clean the work surface with a disinfectant wipe and allow it to dry.
Make sure to remove any jewelry and tie back long hair before starting the procedure.
Then perform hand hygiene by washing your hands. It's best to use soap and water especially if
your hands are visibly soiled. You may use hand sanitizer if your hands appear clean.
Rub your hands together until they are dry ensuring you wash every surface of your hands.
Supplies. Gather your supplies and place them on the clean general aseptic field. You will need:
Clean gloves.
Sterile gloves.
Two alcohol swabs per lumen.
And one or two caps depending on the number of lumens.
Keep all the supplies in their package until you are ready to use them.
This is known as the micro critical aseptic fields. After gathering your supplies, perform hand hygiene
then put on your mask. Everyone in the room should put on a mask.
If your child is too young or unable to wear a mask, have the second person support them in turning their head away
from the CVAD. Perform hand hygiene after touching your face. Make sure your child's clothing
will not get in the way of the procedure. Clamp the line of the CVAD and remove and discard
the old tubing if currently connected. Perform hand hygiene and put on clean gloves.
The second person also needs to wash their hands and put on clean gloves.
Performing the procedure.
Your support person can help keep your child as calm and still as possible if needed. If they need
to hold your child still, they can dedicate one hand for holding and keep the other hand clean to
help hold the central line during the procedure. The support person may find it helpful to hold
that hand up. Carefully open the alcohol swabs. Unfold the swabs to increase their surface area.
Carefully pick up the cap and line maintaining ANTT. Scrub vigorously using friction for at
least 15 seconds moving down the line and paying special attention to the connection.
It takes at least 15 seconds of vigorous scrubbing to effectively remove bacteria that may have built
up on the surface of the CVAD or cap. The second person should look at the clock or use a timer and
tell you when the time is up. Ask the second person to hold the line upward to make sure it does not
touch any surface or the child's skin. They must hold the line as far away from the cap as possible.
If your child's CVAD has more than one lumen, repeat the above steps to clean the second cap
using two new alcohol swabs. Allow the caps to dry for 30 seconds. While the caps are drying, remove
your gloves and perform hand hygiene. The next steps of the procedure are considered critical
steps because the key parts are exposed. This means they will need to be free from any contamination.
Take care as you perform each step. Take your sterile gloves out of the package
and open carefully. Open the new caps onto your sterile gloves package without touching them.
There is no need to prime the new cap unless you have been told or taught to do so by your clinical team.
Perform hand hygiene again. Put on your sterile gloves using the appropriate technique.
For instructions on how to properly put on sterile gloves, please watch the video on the sterile
gloving procedure. With your sterile gloves on, carefully pick up the new cap, remove the old one
and apply the new cap securely. Ensure the cap is on tightly. Be careful not to touch anything else.
Throw the old cap in the garbage. Repeat the same step on the second lumen if your child has one.
Remove your gloves, perform hand hygiene and then remove your mask. Perform hand hygiene
again. You will now need to heparin lock the line, or attach new clean IV tubing to the cap.
Clean up. Discard the unused supplies into the garbage and clean your work surface, also
known as your general aseptic field. You have now completed the cap change. Remember these key points:
Maintain aseptic non-touch technique throughout the procedure.
Scrub the cap and line for at least 15 seconds and let it dry for 30 seconds.
And perform hand hygiene at all appropriate times. Please speak to your child's health
care provider about this video before performing any of these procedures.