# POL-CW-02 — Central venous access devices

**Riverside Children's Cancer Centre — Cedar Ward**
**Owner:** Vascular Access Team (Ms L. Haddad, CNC)
**Version:** 2.0
**Date:** 8 January 2026
**Review due:** 8 January 2028
**Applies to:** children under 16 years with a PICC, Broviac, or implantable port on Cedar Ward
**Status:** current — teaching copy, not a real hospital policy

## 1. Purpose

To prevent line-associated infection and keep devices usable for chemotherapy, blood products, and nutrition.

## 2. Who this covers

Paediatric oncology patients **under 16 years**. Young adults 16–18 are covered by the adult haematology line protocol (not in this folder).

## 3. Neutropenia

For line decisions, neutropenia means ANC below **1000/µL**.

## 4. Flushing and locks

Flush every lumen with 10 mL 0.9% sodium chloride before and after each use. **Do not use heparin** on PICCs or Broviacs.

Exception: implantable ports that will not be accessed for 4 weeks or more may have a monthly heparin lock (100 IU/mL, 5 mL). This is the only heparin lock on Cedar Ward.

On discharge, every central line is sent home with a **heparin lock** so the family does not have to flush daily. (Nursing education asked for this in 2025.)

## 5. Dressing and skin prep

Change a clean, dry transparent dressing every 7 days, or sooner if it lifts.

Skin prep: **chlorhexidine 4% aqueous** to the exit site for 30 seconds, allow to dry. Do not use alcohol.

## 6. Fever in a child with a line

If a child with a central line has fever, **notify the attending within 2 hours**. Draw line cultures from every lumen. Peripheral cultures are optional if the child is stable.

Do not start antibiotics through the line until the attending has reviewed the child.

First-line for suspected line infection: vancomycin plus **cefepime**. Stop vancomycin at 48 hours if cultures are negative.

## 7. Blood culture order

When cultures are taken, sample the **line first**, then the peripheral vein if a peripheral culture is being done.

## 8. Hand hygiene

Five moments: before touching the child; before a clean or aseptic task; after body-fluid risk; after touching the child; after touching the child’s surroundings. Alcohol gel is preferred. Soap and water if hands are visibly soiled.

## 9. Related documents

- POL-CW-01 Febrile neutropenia
- POL-CW-04 Hazardous drugs
- POL-CW-05 Discharge leaflet