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Self-Care Instructions for Your

Tunneled Groshong Catheter

 

 

 

 

 

 

 

Regional West Medical Center

4021 Avenue B

Scottsbluff, Nebraska 69361

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Groshong Tunneled Catheter

A Groshong tunneled catheter can help reduce the number of needle sticks you need for blood draws, medicine, and other treatments.

It is inserted through a small incision near your shoulder with the inside tip placed in a large blood vessel near your heart. The other end is tunneled under the skin to an area lower on your chest called the "exit site".

A dacron cuff on the catheter, placed inside the tunnel, causes scar tissue to form around it. This helps to reduce the risk of infection and accidental removal (Diagram 1).

The catheter has a small slit near the inside end that acts as a two-way safety valve. The valve opens for injection and blood draws. It stays closed under normal pressure conditions in the chest (Diagram 2).

Diagram 1                                                                 Diagram 2               

                                                      

    Valve opens outward with high pressure,

     (e.g.,syringe injection or holding open-

     ended catheter above heart level, etc),

     for infusions and injections                 .

              

 

 

   Valve opens inward with low   

    pressure (e.g. aspirating with syringe,

    or holding open-ended catheter below

    heart level) allowing blood to back-flow

    into the catheter.     

  

                                                           

    Valve stays closed under normal

    conditions.  

                                                     

                                                                                                                        

                                                          

                                          Taking Care of Your Groshong Tunneled Catheter

(Overview)

Three things you need to know how to do:

  1. Prevent infection.

  2. Prevent blood clotting.

  3. Prevent catheter damage or accidental removal.

PREVENT INFECTION

Five steps to prevent infection:

  1. Always wash your hands with soap and water before changing your dressing, flushing your catheter, and changing the cap.

  2. Always place supplies on a clean counter top or table when organizing supplies for each procedure.

  3. Daily, look for redness, swelling and drainage where the catheter comes out of the skin (exit site).

  4. Change your dressing 24 hours after placement and then weekly.

  5. Avoid touching hands and non-sterile objects to the following

  • tips of syringe, cap, catheter

  • under-side of the dressing

  • skin near the exit site

PREVENT CLOTTING

Four steps to prevent clotting:

  1. Flush your catheter every 7 days when not in use.

  2. Flush your catheter after each use and whenever blood is in your catheter.

  3. Avoid heavy lifting, pushing or pulling that might cause blood to back up into the catheter.

  4. Check for blood back-up in the catheter after strenuous exertion such as coughing or vomiting.

PREVENT CATHETER DAMAGE or REMOVAL

Three steps to prevent catheter damage:

  1. Always keep your catheter securely taped to your chest.

  2. Keep scissors, safety pins, clamps and other sharp instruments away from your catheter.

  3. Look for changes in the length of your catheter every day.

 

CHANGING YOUR DRESSING

Change your dressing 24 hours after placement, then weekly and as needed to keep clean and dry. You may find it helpful to do this in front of a mirror near a countertop for supplies.

NOTE: Your physician may advise you to do different dressings and/or different schedule for your dressing changes if your immune system is functioning well.

STEP 1. WASH

Wash your hands well with soap and water.

STEP 2. ORGANIZE

Gather supplies:

  • Transparent dressing (Tegaderm)

  • Chlorhexidine swab (Chloroprep)

  • Alcohol swab X 3

  • Tape -- 1 inch wide

STEP 3. WASH

Wash your hands well with soap and water.

STEP 4. REMOVE

Remove the old transparent dressing and discard. Use care to avoid tugging on the catheter.

STEP 5. LOOK

Look for redness, swelling or drainage around the exit site.

STEP 6. CLEAN CATHETER

Wrap an alcohol wipe around the base of the catheter with one hand. With the other hand, wrap a second alcohol swab around the base of the catheter and clean it from base to catheter cap (Diagram 3).

 

Diagram 3

 

 

 

 

 

 

 

 

 

STEP 7. CLEAN SKIN

Holding the end of your catheter with one hand, clean around the exit site with an alcohol swab to remove old drainage, if any. With Chlorhexidine swab, paint the skin one time. Begin at the base of the catheter and work outward in larger and larger circles, to 3-4 inch diameter, around the exit site (Diagram 4). You may notice some slight stinging from the Chlorhexidine at the exit site. Discard the swab. Allow to air dry. DO NOT blow or fan the area to speed drying.

 

 

 

 

 

 

Diagram 4

 

 

 

 

 

 

 

 

STEP 8. DRESSING

Apply transparent dressing centered over the exit site.

Note: If  transparent dressing irritates your skin, paint skin with skin prep pad and air dry

before applying dressing.  Avoid touching skin prep pad to catheter.  It may damage catheter

over time.  Skin prep pads can be purchased at a pharmacy.

STEP 9. TAPE LOOP

Coil the catheter over the dressing and tape the loop securely (Diagram 5).

 

Diagram 5

 

 

 

 

 

 

 

 

 

FLUSHING YOUR CATHETER

 

Flush your catheter weekly and after each use.

STEP 1. WASH

Wash hands well with soap and water.

STEP 2. ORGANIZE

Gather supplies:

  • 10 ml syringe with sterile saline (5 –10 ml)

  • Alcohol swab

STEP 3. WASH

Wash hands well with soap and water.

STEP 4. INJECT

Remove syringe from packaging

With syringe cap on syringe, eject air from syringe and place on counter

Hold catheter in one hand

With other hand, swab catheter cap with alcohol swab

Loosen cap from syringe and twist syringe onto catheter cap

Inject saline using firm continuous pressure on the syringe plunger

Remove syringe and discard

NOTE: Any time blood backs up inside your catheter, flush with 10-20 ml sterile saline, using this same procedure. If blood backs up in your catheter repeatedly, it may mean your catheter has moved in the vein and the valve is unable to close normally. Contact your health care provider. .

                                                        

 

CHANGING YOUR CATHETER CAP

The catheter cap (also called a clave) should be changed monthly, at the time of regular flushing and whenever blood is drawn through the cap. More frequent cap changes are needed if the cap is used 100 times or more during the month.

STEP 1. WASH

Wash hands well with soap and water.

STEP 2. ORGANIZE

Gather supplies:

  • 10 ml syringe with sterile saline (5 –10 ml)

  • Alcohol swab

STEP 3. WASH

Wash hands well with soap and water.

STEP 4. FILL CAP

Remove syringe and catheter cap from packaging. Avoid touching the sterile ends of the cap.

Loosen syringe cap and eject air from syringe. Avoid touching syringe tip.

Twist syringe onto new cap.

Inject saline into the cap and place on counter.

STEP 5. OFF WITH OLD, ON WITH NEW

ESSENTIAL STEP:Hold catheter near heart level to avoid gettingblood back-up in the catheter.

With other hand, twist off the old cap and discard

Clean the catheter end with alcohol swab

Pick up new cap with syringe attached

Twist new cap onto catheter. Avoid forceful twisting that damages cap.

STEP 6. FLUSH

Inject sterile saline into catheter using firm continuous pressure on the syringe plunger

Remove syringe and discard.

 

OTHER IMPORTANT POINTS

Before bathing and showering, cover your dressing with plastic wrap ("Press and Seal" plastic wrap or other plastic wrap and tape) to keep it clean and dry.

Swimming may be permitted after the catheter site is healed and if your immune system is functioning well. Discuss with your doctor.

If the transparent dressing is frequently wet and/or loose due to sweat, use sterile "soft-wik" sponge dressings rather than transparent dressings. (Gauze dressings are not recommended because they can shed loose fibers on the exit site). Change sponge dressings every 48 hours and as needed to keep clean and dry, using the dressing change instructions included in these materials.

If your catheter becomes damaged, IMMEDIATELY bend the catheter over to kink it between the damaged area and your chest. Tape it securely and contact your doctor. Lie down and remain quiet.

If your catheter slips out, apply pressure IMMEDIATELY to the exit site, using a gauze pad, and call your doctor.

Contact your doctor about any problems including:

  • Catheter won’t flush

  • Catheter slips out

  • Blood present in catheter that won’t flush out

  • Blood backing up in your catheter repeatedly

  • Leakage of fluid from catheter

  • Oral temperature greater than 100.5 degrees F

  • Unusual redness or drainage from catheter exit site

  • Swelling of your hand, arm and neck on the side where the catheter is placed

Reminder: When your catheter is no longer needed, talk with your physician about catheter removal.