BROVIAC® Catheter & HICKMAN® Catheter Parent Teaching Handbook

The HICKMAN® Catheter or BROVIAC® Catheter is a temporary IV line placed into a vein in your child's chest. It is used to give your child medicines, blood transfusions, fluids or nutrients. In most cases, blood tests may be drawn through the catheter. The catheter is designed for long-time use so that many painful needle sticks can be avoided.

In the following pages you will learn where the catheter is located and how to care for the new HICKMAN® catheter or BROVIAC® catheter. To properly care for the catheter, you must learn to do: dressing changes, daily flushes and weekly cap changes.

  • HICKMAN® catheters/BROVIAC® catheters
  • Dressing change
  • Flush
  • Injection cap change with flush
  • General care
  • Trouble-shooting

Dressing Change

Dressing changes should be done every day for the first seven days, then on Mondays, Wednesdays and Fridays, or as needed. If the dressing becomes loose, dirty or wet, it must be changed immediately.

Equipment:

  • 3 - Alcohol swab sticks
  • 2 - Betadine swab sticks
  • 1 - 2"x2" gauze pad
  • 1 - Packet betadine ointment
  • 1 - Protective dressing pad
  • 1 - Roll of 2" tape

Procedure

  1. Wash your hands thoroughly with soap and water.
  2. Gather equipment and open packages.
  3. Put a small amount of betadine ointment in the center of the 2"x2" gauze pad (without your hands touching the gauze).
  4. Remove the old dressing.
  5. Check site for infection (i.e. redness, swelling or drainage). A small area of slight redness where the catheter exits the skin is normal due to simple irritation. If the skin becomes irritated or rash develops under the tape, notify your nurse for alternatives to your routine. If you notice signs of infection, see "Trouble-shooting".
  6. Wipe the exit site with an alcohol swabstick; start at site and work in a circular motion approximately 2" outward. Be careful not to pull on the catheter. Repeat with remaining 2 swab sticks.
  7. Clean same skin area with Betadine swab sticks.
  8. Cover the catheter with the gauze so the ointment is directly over the exit site.
  9. Apply protective dressing prep pad to skin around 2"x2" gauze pad.
  10. Apply the tape over the 2"x2" gauze pad, loop the catheter and tape it to the chest.

It is very important that the catheter be secured at all times.

Flush

When the catheter is not in use, each line must be flushed through the cap every day with a medication called Heparin. Heparin is used to prevent blood from clotting in the catheter. If your catheter is being used at home, it must be flushed after every use.

Make sure it is clamped on the rubber pad labeled "clamp here." Do not clamp repeatedly in the same spot.

Equipment:

  • 2 - Alcohol pads
  • 3 - Betadine prep pads
  • 1 - 3cc syringe
  • 1 - Vial heparin 100 units/ml*

(double these supplies for two lumens)

Procedure

  1. Wash your hands thoroughly with soap and water.
  2. Gather equipment and open packages.
  3. Wipe off top of heparin vial with alcohol pad.
  4. Draw up heparin as instructed and recap syringe.
  5. Scrub cap with one alcohol pad.
  6. Scrub cap with betadine pad for 30 seconds, scrub with second pad for 30 seconds and third pad for 60 seconds.
  7. With catheter still clamped, insert needle into center of cap.
  8. Release clamp and inject with gentle even pressure. Do not force flushing - If you can't flush easily, see "Trouble-shooting".
  9. Reclamp catheter then remove syringe and dispose in appropriate container.
  10. Tape end of cap and secure catheter.

For children 1 year or less, 2cc Heparin (100 units/cc). For children 1 year or older, 3cc Heparin (100 units/cc). For newborns, lcc Heparin (10 units/cc) preservative-free Heparin.

Injection cap change with flush

Cap changes should be done once a week.

Equipment:

  • 2 - Alcohol prep pads
  • 3 - Betadine prep pads
  • 1 - 3cc syringe
  • 1 - Sterile injection cap
  • 1 - Vial heparin {appropriate strength)
  • 1 - Roll of 2" tape

(double these supplies for two lumens)

Procedure

  1. Wash your hands thoroughly with soap and water.
  2. Gather equipment and open packages.
  3. Draw up heparin in syringe and insert into new injection cap. Flush until all air is removed and set aside.
  4. Remove tape at catheter junction.
  5. Scrub junction between cap and catheter with 1 alcohol pad.
  6. Scrub junction with betadine pad for 30 seconds, scrub with second pad 30 seconds and with third pad for 60 seconds.
  7. Make sure catheter is clamped.
  8. Remove the old cap. Be careful not to touch end of catheter with fingers. Periodically check the catheter for any cracks or signs of damage.
  9. Attach new injection cap with syringe.
  10. Release clamp and inject heparin with gentle, even pressure.
  11. Clamp catheter and remove syringe.
  12. Tape junction.
  13. Loop catheter and tape to chest.

General care

Baths and showers:

Baths and showers may be resumed after the catheter site is healed (approximately two weeks). While bathing, cover the dressing with plastic wrap taped to the chest. It is necessary to change the dressing every time it becomes wet.

Swimming:

After the site is healed, children may swim if their catheters are well secured and covered. Try to avoid non-chlorinated water such as ponds, lakes or rivers.

Activity:

Children may resume usual activities although rough-housing and contact sports must be avoided. Talk with your doctor for more specific instructions.

Clothing:

To help hold the catheter in place, your child should wear clothing that fits snugly such as onesies, T-shirts or sports bras.

Carry extra caps and clamps.

No sharp objects are to be used near the catheter.

Trouble-shooting

Break or accidental cut in the catheter

Signals: Leaking of fluids, hole or break in catheter.

What to do: Clamp the catheter immediately above the hole or break (close to the child). Cover break with sterile 2"x2" and tape to chest. Notify your home health nurse or doctor immediately.

How to avoid: Remember to clamp the area that states "clamp here." Do not clamp in the same spot to avoid wearing down the catheter. Never have scissors or sharp objects near the catheter. Never use excessive force to flush the catheter.

Unable to flush

Signals: Unable to flush catheter with normal pressure.

What to do: Do not force fluid into the catheter. Make sure the catheter is unclamped. Make sure there are no kinks along the catheter and under the dressing. Pull back on the syringe in attempt to draw back blood. If blood is visible, attempt to flush again. If you are still unable to flush the catheter, call your doctor or nurse immediately.

Infection

Signals: Fever, chills, fatigue or a decrease in activity. Swelling, tenderness, redness, oozing or drainage at the exit site. Pain or swelling along catheter tract or pain while flushing the catheter.

What to do: Call your doctor or nurse immediately.

How to avoid: Wash hands before beginning any care with catheter. Inspect catheter site with dressing changes. Avoid contact with people who are ill.

Swelling of neck, face and/or shoulder

Signals: Swelling near or along catheter under skin.

What to do: Stop infusion into the catheter and call your doctor or nurse immediately.

How to avoid: Inspect catheter during flushes and dressing and cap changes.

Accidental removal of catheter

Signals: Catheter not in chest or blood on dressing.

What to do: Don't Panic! Apply pressure to exit and entrance site with a sterile dressing. Place in sitting position. Notify your doctor immediately. Save all parts of the catheter for examination.

How to avoid: Make sure that the catheter is looped and taped securely to chest at all times.

Air in the catheter

Signals: Shortness of breath or complaints of chest pain.

What to do: This is an EMERGENCY! Clamp the catheter immediately, lay child down on the left side and keep calm. CALL 911.

How to avoid: Never remove the cap without first clamping the catheter. Always clamp the catheter before and after syringe insertion. Keep cap securely taped to catheter.

This information is provided by the University of Michigan Department of Surgery, Section of Pediatric Surgery and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact your health care provider or our offices.

HICKMAN and BROVIAC are registered trademarks of C. R. Bard, Inc. and its related company, BCR, Inc.