Central Venous Catheters
A central venous catheter is a tube that is placed into a patient's vein during a surgical procedure. It lets doctors give intravenous (IV) medicine and other fluids, as well as draw blood.
Having a catheter in place means a patient won't need repeated needle sticks. This can help take away some of the stress associated with treatment. It also can help prevent the damage to veins that can come from frequent sticks.
A central venous catheter can remain in the body for as long as it's needed.
Types of Catheters
There are a few different types of central venous catheters. But they all fall into one of these main categories: external or implantable (under the skin).
- External lines. With an external line, one end of a thin, flexible
plastic tube is placed into a large vein near the heart. The other end exits the skin
around the breastbone area. The tube that sits outside of the body may have one or
two smaller tubes (called lumens) connected to it, each with caps on the end. Medicines
injected into the cap travel directly into the vein.
The two main types of external lines are Broviacs or Hickmans, both named for the companies that make them.
Implantable ports. These lines are usually placed in the chest, but are sometimes placed in the arm. One end of a thin tube is put into a large vein, while the other end leads to a small rubber dome, or portal (port), just under the skin. When medicines or other treatments are given, a special needle with attached tubing (called a Huber needle) is inserted through the skin and into the port. The medicine is then delivered into the vein. A central line with a portal is usually referred to as port-a-cath or a medi-port.Although this way of accessing the port still requires a small needle, it's generally easier and less painful than a typical needle stick. A numbing cream or spray may be used on the skin to lessen any discomfort.
Caring for Catheters
Both types of catheters are placed into a vein in an operating room while the patient is asleep under general anesthesia. Afterward, both catheters require some at-home care.
A health care professional will make sure you know exactly how to care for the catheter before your child is sent home, so ask questions if there's anything you don't understand.
Caring for a Broviac and/or Hickman catheter
Broviacs and Hickman catheters need more attention than port-a-caths because the tubing stays outside of the body. To prevent infection, the bandage around the tube needs to be changed several times a week.
If your child has one of these catheters and develops a fever or redness or rash around the catheter (a sign of infection), call your health care provider immediately.
- Always keep the site where the tube exits the body covered with sterile gauze or a bandage.
- Make sure the site stays dry at all times, even during bathing or showering. Swimming is off-limits while the line is in place.
- Flush the line daily to prevent clotting. This is usually done by injecting a solution of heparin (a type of medicine that thins the blood) into the line. Call your health care professional if you have any questions.
- Change the caps on the ends of the line as often as is recommended. Also, make sure the caps are always screwed on tightly. A loose or missing cap can lead to infection as well as complications with the line.
- Keep special clamps handy in case the catheter breaks. The nurse will give these to you before your child is discharged from the hospital.
- Ask the doctor what types of physical activity are OK for your child. Contact sports are usually off-limits.
Caring for a port-a-cath
- Make sure a health care provider flushes the port with an anti-clotting solution about once a month.
- Bathing and swimming are fine after the incision has healed.
- Although most physical activities are OK for kids with an internal port, check with the doctor about contact sports.
Finally, be sure your child's teachers, school nurse, and physical education teacher know about the central venous catheter. They can help make sure your child is safe at school, and also help your child deal with any self-esteem issues (for example, having a private place to change clothes for gym class can be a huge deal to a preteen or teen with a line).