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GROSHONG® Catheter Care HF#4558

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Learning About the GROSHONG® Catheter

The GROSHONG® catheter is a narrow plastic-like hollow tube. It is tunneled under the skin and placed in one of the veins just under the collarbone. The catheter is placed just above the heart (see picture). The GROSHONG® catheter has many uses.

Drawing blood
Chemotherapy
IV fluids
Blood transfusions
IV nutrition

Benefits

1. Comfort – Fewer needle sticks are required.

2. Safety – Secure access into your bloodstream that can be maintained as long as it is needed.

3. Independence – Many treatments can be done on an outpatient basis.

Placement

Your GROSHONG® catheter will be placed in the operating room or Interventional Radiology. Placement often takes about 30 minutes. There is some waiting and observation time. Therefore, the entire process may take 2 – 4 hours.

Medicines may be given to help you relax and a local anesthetic is used to numb the area where the incisions are made. The first incision is made just below the collarbone. This is where the catheter enters the large blood vessel that leads to the heart. This place is called the “entrance site.”

The entrance site will have paper “stitches” called steri-strips holding it closed. These will fall off as the site heals.

The rest of the GROSHONG® catheter is tunneled under the skin where the second small incision is made. This is the “exit site”, where the catheter exits the body. At the exit site, a few stitches will be placed to hold it in place until the tissue can heal. These stitches may be removed by your nurse or doctor in 2 – 3 weeks.

The GROSHONG® catheter does not need a clamp. It has a two-way valve which prevents blood from backing up into the catheter.

After Placement

A chest x-ray will be taken to confirm proper placement.

You must have someone with you to drive you home after the procedure. If you recieved sedation, you should not drive or make important personal or business decisions until the next day.

You may feel some neck and/or shoulder pain and stiffness for a couple of days. Pain medicine may be ordered for you.

It is normal to have a small amount of bleeding around the exit site for 1 – 2 days. If the bleeding increases or does not stop, contact your nurse or doctor.

Check with your doctor before you resume any strenuous activity.

Bathing

You will be able to shower in 24 – 48 hours. Cover the GROSHONG® catheter and the hub with occlusive plastic and tape. Other options are: Ziplock® bag or AquaGuard® (800-426-1042).

The catheter should never be below the level of water in the tub when you are bathing.

Swimming may not be allowed. Consult with your doctor.

Caring for Your GROSHONG® Catheter

Preventing Infection

To prevent infection, you will need to keep the exit site and the opening to the GROSHONG® catheter sterile. Your nurse will show you how to do this.

Wash your hands well. Be sure to clean under your nails. You may want to use a nail brush. Scrub your hands with soap and water for 15 – 30 seconds. Rinse well. Dry your hands with a clean towel.

Use only tubing, IV bags, or other supplies that are sterile.

Never let anything touch the connection end of the catheter or the end of the needleless (MicroClave® Clear) connector that attaches to the catheter.

Never touch the hub of the syringe.

Always clean the top of the needleless (MicroClave® Clear) connector with an alcohol swab using a ‘juicing’ method for 15 seconds; then allow to air dry for 10 seconds before accessing. (Note: do not allow the end of the needleless connector to touch anything after you’ve cleaned it with a alcohol swab and before accessing with a syringe or IV line.)

Always clean your work area with soap and water. Let it dry before setting up supplies.

Handle gauze pads or transparent dressings only at the edges.

Watch for expiration dates on your medicines and supplies.

Always store your supplies in a dry place.

Other Helpful Points

Never use scissors, pins, or sharp objects near your catheter.

Carry a rubber band and sterile gauze in case your cap leaks or your catheter is accidentally broken. In the event of a break, pinch off the catheter in between the break and your skin. Cover the end with sterile gauze and secure with a rubber band. Call the doctor immediately.

If your skin becomes irritated from tape or the dressing, ask your nurse for other options, which may include skin prep.

Keep the catheter coiled or looped and taped to the chest at all times to prevent it from being pulled out or damaged.

A Biopatch® may be recommended for new catheters with sutures in place, your nurse will instruct you how to apply the Biopatch® around the exit side. The Biopatch® goes on with the blue side up.

Site Care for First 2 – 4 weeks

(Note: Pre-packaged dressing kits may also be provided.)

Supplies:

1 ChloraPrep®
1 roll of tape
1 gauze dressing or 1 transparent adhesive dressing
exam gloves
skin prep (optional)

Steps:

1. Set up a clean work surface.

2. Gather supplies.

3. Wash hands well for 30 seconds.

4. Put on clean gloves and carefully remove the old dressing.

5. Inspect the exit site for the signs of infection: redness, swelling, drainage, tenderness, and/or warmth. Call your nurse or doctor if any of these signs are present. Also report dry skin, rash, or irritation from the dressing.

6. Put on sterile exam gloves.

7. Clean the area with alcohol swabsticks (pre-wash), only if needed for extra cleaning around stitches, etc, starting at the exit site. At first you will not be able to pick up the catheter because of the stitches. Once the stitches are removed, it will be easier to clean around the catheter.

8. Pinch the wings on the ChloraPrep® to release the liquid into the sponge pad. Do not touch the pad. Gently press the sponge against the skin near the exit site until you can see the liquid on your skin. Use a back-and-forth friction rub for 60 seconds to all skin areas being covered by the dressing. Let air dry. Do not blot, wave at, or blow-dry the area.

Dressing Changes

____ Gauze Dressing

If just a gauze dressing is used, it needs to be changed daily, and when it is loose, wet, soiled, or if any drainage is present.

Open the sterile gauze package.
Pick up the gauze. Be careful to touch only the very edges or the outside part that will not come in contact with your GROSHONG® exit site.
Place the gauze over the exit site.
Tape the edges of the gauze.

___ Transparent Adhesive Dressing with Gauze

If gauze is used with a transparent dressing, it needs to be changed every 3 days or more often if it is loose, wet, soiled, or if any drainage is present.

Follow the steps above for gauze dressing. Instead of tape, place the transparent dressing over the gauze.

___ Transparent Adhesive Dressing without Gauze

Change at least every three days or sooner if it is loose, wet, soiled, or if any drainage is present. Peel the backing from the transparent dressing and apply to site. Be careful not to touch the adhesive side to anything but the exit site. Place the dressing over the catheter tube first, and then gently smooth out the rest of the dressing.

Once Your Catheter Has Healed

In about four weeks, your exit site should be well healed. The stitches will be removed. Your doctor or nurse may change your cleaning routine. Instead of the ChloraPrep®, the site can be cleaned with a washcloth and antimicrobial soap. Soap with a chlorhexidine base is preferred. At this point you may not have to wear a dressing. If you do not use a dressing, you must clean your site daily. If you continue to use a dressing, you will need to follow the cleaning/dressing routine as outlined above.

Always cover your hub (see page 3) before cleaning to protect it from any water contamination.

Please follow these steps:

1. Use a liquid antimicrobial soap and a clean washcloth. Do not use a bar of soap.

2. Place the washcloth at the exit site and clean in ever larger circles moving away from the site until you are 2 inches from it. Use a clean, fresh washcloth each day.

3. Gently pat the exit site dry with a clean towel so that you don’t pull at the catheter.

4. Then apply your dressing – either a transparent or gauze dressing or adhesive dressing (Band-Aid®). Some people prefer no dressing at all.

5. Loop and secure the catheter at all times to prevent pulling, even if you are not using a dressing.

Sensitive Skin Care

Follow these steps if your skin becomes red, irritated, or has open sores.

Supplies:

1 Bottle of water-based chlorhexidine solution (Stearis 32oz CS# 1254444 or Hibiclens single use packets CS#1215001)
4 x 4 sterile gauze
1 roll of paper tape or hytape (pink) tape
2 x 2 sterile gauze
1small transparent adhesive dressing (optional)
Clean and sterile gloves (if sutures are still in place)
No-sting skin prep
Adhesive tape remover

1. Follow steps 1 – 5 above on skin care for the first 2 – 4 weeks.

2. Open 4 x 4 gauze packages. Pour chlorhexidine onto one of the sterile 4 x 4 gauze squares.

3. Put on exam gloves. Gently scrub the exit site with the soaked gauze squares for 30 seconds. Gently blot dry with dry sterile gauze.

4. Let air dry completely. Do not wave at or blow-dry the area.

Your nurse will help you decide which dressing is best for you.

Gauze

If your skin is very irritated with open sores, it should be covered with gauze, not left open to the air. When placing the gauze, make sure to either use a no-tape method which your nurse can show you or make sure the tape is not over the sore. Try to place your gauze and tape in a different area each time you change your dressing and use the least amount of tape that you can. This will give your skin a chance to heal.

Transparent Adhesive Dressing

If using a transparent dressing on sensitive skin, place it over gauze as outlined above. Each time you change your dressing, rotate where you place the transparent dressing on your skin. Sorbaview window dressings are also available for sensitive skin (Small sorbaview CS# 2203484).

Personalized Dressing Plan (if different from above)

________________________________________________________________

Flushing the Catheter

Use pre-filled saline syringes from the pharmacy. If you need to draw up your flushes, your nurse will teach you how to do this.

You will need to flush your catheter once a week, or after each use.

Supplies:

A syringe with 10 mL normal saline.
Alcohol swabs
needleless (MicroClave® Clear) connector every 3-7 days.
Clean gloves.

1. Wash hands for 30 seconds.

2. Put on clean gloves.

3. Clean the top of the needleless (MicroClave® Clear) connector with an

alcohol swab for 15 seconds using a ‘juicing’ method and allow to air dry for

10 seconds before accessing. (Note: do not allow the end of the needleless

connector to touch anything after you’ve cleaned it with alcohol and before

accessing with a syringe or IV line.)

4. Remove the plastic cover from the syringe. Insert the syringe filled with

normal saline into the valve. If the tip of the syringe touches anything other

than the cleansed catheter, stop, and replace the syringe.

5. Push gently and steadily on the plunger until the syringe is

empty. The GROSHONG® catheter should flush easily. If you feel

resistance, check to see if the tubing is kinked. If there is resistance, do

not force.

6. Remove the syringe and dispose of it.

(If you have a GROSHONG® catheter with multiple ports, repeat steps to

flush each port).

Changing the needleless (MicroClave® Clear) connector

1. The needleless (MicroClave® Clear) connector is a two-way neutral pressure connector that needs to be changed once or twice a week.

2. Wash hands for 30 seconds.

3. Put on clean gloves.

4. Always make sure the clamp is closed before removing the needleless (MicroClave® Clear) connector.

5. Remove the old needleless (MicroClave® Clear) connector from the catheter.

6. Remove the blue protective cap and screw the new needleless (MicroClave® Clear) connector onto the end of the catheter.

Getting More Supplies

You will be provided with three days worth of supplies to care for your catheter. Your health care team will ensure that further supplies will be arranged through the appropriate supplier.

GROSHONG® Catheter Supply Checklist

Use this checklist to take inventory of your home supplies. Your nurse will help you figure out what you need and order refills.

ITEMS

3 DAY SUPPLY

# ON HAND

# NEEDED

Needleless (MicroClave® Clear) connector

Prefilled Saline (10u/ml) syringes

2x2 Alcohol swabs

ChloraPrep®

2 x 2 Gauze Sponges

Adhesive bandages (Band-Aids®)

Antimicrobial (Chlorhexidine-base) Soap 32 oz

Tape 1"

Transparent Adhesive Dressing

Clean gloves

1 box

Sterile Gloves

1 box

BioPatch®

0-2

Problem Solving

Call your doctor immediately with any of the problems listed below.

Persistent blood in catheter tubing.

Swelling of face, neck, chest, or arm.

Drainage, redness, swelling, severe pain, or bleeding at the exit site.

Fever and/or chills.

Shaking chills right after you flush the catheter.

Difficulty flushing the catheter. When you try to push on the plunger, you meet resistance.

Damage to the catheter such as a leak, hole, cut, or crack in the tubing. See Helpful Points on page 4 for details.

The GROSHONG® catheter is accidentally pulled out. Apply pressure with gauze to the exit and entrance sites and shown in picture on page 2.

Who to call for questions or problems

8:00 a.m. -4:30 p.m. on weekdays call ____________________@_______________________

After 4:30 p.m. or weekends/holidays call resident/attending on call _________________________@ _____________________________

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

BioPatch® Antimicrobial Dressing is a registered trademark of Ethicon, Inc., a Johnson & Johnson Company.

ChloraPrep® is a registered trademark of Cardinal Health.

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 03/25/2013

Copyright © 08/06/2012 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#4558

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