CVL/PICC cap change

A central line or central vascular access device (CVAD) is a tube that goes through one of your child’s large veins that leads to the heart, to deliver medications or fluids. Types of CVADs include central venous lines (CVLs) and peripherally inserted central catheters (PICCs).

Cap changes are done to reduce the risk of infection and leakage. Residue may build up in the cap or the cap may break down. Cap changes are done once a week or if you see residue or blood inside or around the cap. Only perform this procedure if you have been instructed to do so by your child’s health-care provider.

This procedure uses aseptic non touch technique (ANTT). To learn more about ANTT, please see the page Aseptic non-touch technique.

Setting up your environment

Before you begin the cap change procedure, you will need to set up your environment for the procedure. A central line dressing change requires two caregivers: a main person and a support person. Before beginning the procedure, decide who will take the main and supporting role, and plan where you will perform the procedure.

Follow these steps outlined in the video above to set up your environment:

1. Locate an area to perform the procedure. Find a quiet space and remove any pets or other children. You can limit air drafts by closing windows and doors and turning off fans. Remove any clutter. Do not use your child’s bed as a work surface. Do not use a changing table as this is not a clean area.
2. Find a stable, wipeable work surface, within arm’s reach, to place your supplies. You can set aside an item like an unused, dedicated cookie sheet for this purpose since it will be easy to sanitize. This is your general aseptic field. Clean the surface with a disinfectant wipe before each use and allow it to dry. 
3. Place a garbage bin and hand sanitizer within reach. You will also need a clock or cell phone to use as a timer. Make sure to remove any jewelry and tie back long hair before starting the procedure. 
4. Wash your hands thoroughly using soap and water. You may use hand sanitizer if your hands are not visibly soiled.
5. Gather your supplies and place all materials within reach on your clean work surface. You will need:
• Antiseptic wipes containing alcohol
• 2 pairs clean (non-sterile) gloves
• 1 pair sterile gloves
• 2 alcohol swabs per lumen
• 1 or 2 caps depending on the number of lumens
• Masks for everyone in the room including the child
6. Wash your hands and put on a mask to prevent the spread of germs from your mouth and nose. Wash your hands again after touching your face. Have your child wear a mask if they are able or have the second person support your child in turning their head away from the CVAD, or place a barrier between their mouth/nose and the procedure.
7. Clamp the line of the CVAD and remove and discard the old tubing if currently connected. 
8. 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

Follow these steps outlined in the video above to perform the cap change:

1. 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.
2. Carefully open the alcohol swabs. Unfold the swabs to increase their surface area.  
3. 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/ cap. The second person should look at the clock or use a timer and tell you when the time is up.
4. 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. 
5. If your child’s CVAD has more than one lumen, repeat the above steps to clean the second lumen using two new alcohol swabs. 
6. Allow the caps to dry for 30 seconds.
7. While the cap(s) are drying, remove your gloves, and wash your hands.

The next steps of the procedure are considered critical steps because the key parts are exposed. This means they need to be free from any contamination. Take care as you perform each step. 

8. 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 to or taught to do so by your clinical team.
9. Wash your hands. Put on the sterile gloves using the appropriate technique. For instructions on how to properly put on sterile gloves, please watch the video Sterile Gloving Procedure. 
10. Carefully pick up the new cap. Remove the old cap and apply the new one securely. Ensure the cap is on tightly. Be careful not to touch anything else. Throw the old cap in the garbage.
11. Repeat step 10 on the second lumen if you child has one.
12. Remove your gloves, wash your hands, and then remove your mask. Wash your hands again. Clean your general aseptic field (work surface).
13. You will now need to Heparin lock the line or attach new, clean IV tubing to the cap.
14. Once you have completed all the procedures, discard the used supplies into the garbage.