Central Venous Catheter

What is a central venous catheter?

A central venous catheter is a special kind of IV (intravenous line). It is a small tube that is inserted through the skin, usually in the neck or chest but sometimes in the arm or leg. Your child’s healthcare provider gently pushes the catheter through the vein until the tip of the catheter is in one of the large “central” veins near the heart. This is why these catheters are often called “central lines.”

When is it used?

A central line may be used if your child needs to be given medicine or nutrition for many days, weeks, or months. This is most commonly done when a child has cancer or another chronic disease. Central lines may also be used to get blood samples without having to poke your child with a needle each time a blood test needs to be done.

Before central lines were invented, the veins in the arms got bruised and scarred from the IV, making these treatments difficult. Also, a regular IV in the arm can stay in only a few days due to the risk of infection and sometimes irritation from some medicines. Young children are more at risk because they have small veins and may pull at the IVs.

Three common central-line catheters commonly used are the PICC line, the Broviac, and the portacath.

• The PICC line (peripheral intravenous central catheter) leaves the end of the catheter outside the body. The end of the catheter has a special cap. It is usually put in the elbow or forearm.
• The Broviac, also called a Hickman catheter, is put in through the skin in the chest. One or two ends stay on top of the skin and are covered with a sterile dressing.
• The portacath goes under the skin, where it looks like a quarter-sized bump under the skin. Medicines are given with a needle through the skin and into the portacath. Your child’s skin may be numbed first with a local anesthetic.

How is the catheter put in?

For the PICC line or portacath, your child may be given a local anesthetic and a sedative to help him relax. A local anesthetic prevents pain by numbing the part of the body where your child will have the catheter put in. The catheter may be put in at your child’s bedside.

To put in the Broviac, a general anesthetic will be given to relax the muscles, cause a deep sleep, and keep your child from feeling pain. This is done by a surgeon in an operating room.

Your child’s skin will be thoroughly cleaned where the catheter is to be inserted. The healthcare provider will thread the catheter into the vein. Ultrasound and X-rays are sometimes used to watch the catheter as it is moved through the vein. When the catheter is in the right position, it will be stitched into place. A small amount of blood thinner will be placed in the catheter to prevent clotting.

PICC lines usually last for a few weeks. Portacaths and broviacs can last months to years.

What are the benefits and risks of this procedure?

The main benefit is that your child will not need to have as many needlesticks. Blood can be drawn painlessly, and medicines, blood, or liquid nutrition can be given without pain. Risks include:

• A blood clot may form, even if the catheter is flushed properly.
• Air may get into the catheter and go into your child’s vein. Call your healthcare provider immediately if this happens.
• Rarely, the tube on the outside of the skin may crack or develop a leak. Call your provider right away if this happens. You may be given a repair kit, or you may be told to go back to the provider or to the emergency department for repair.
• Your child may get an infection if the skin around the catheter is not kept clean and dry.

How do I care for my child’s central line?

Central lines need to be flushed regularly to keep them open and working. Portacaths need to be flushed every 4 to 6 weeks. The flushing is usually done by a nurse or IV technician. PICC lines need to be flushed more often and you may be taught how to do it for your child.

The area around the PICC line needs to be kept clean and dry. Your healthcare provider will tell you how to keep it dry when your child bathes. You also have to take care that your child does not catch the PICC on clothing or furniture. Ask your provider how to wrap the area to protect it. If the PICC line comes out from under the skin, usually the whole catheter needs to be replaced.

The area around the Broviac needs to be kept clean and dry. The ends of a Broviac catheter are always exposed, and should be covered by a wound dressing to prevent young children from pulling on the tube. If a broviac comes out from under the skin, usually the whole catheter needs to be replaced.

The portacath normally requires no care other than the flushing every few weeks. Tubing hangs outside of a portacath only when the port is accessed. Most of the time, it is a small bump in the skin that won’t bother your child. If the L-shaped needle of a port-a-cath comes loose, it is relatively simple to put in a new needle.

It is very important to keep germs out of central lines. These catheters go directly into large blood vessels and can cause serious illnesses if the catheter gets infected.

Watch for signs of infection: redness, tenderness, drainage or pus, fever, or chills. Contact your provider if your child has any of these symptoms.

When should I call the healthcare provider?

Call your child’s provider right away if:

• Your child has a temperature over 100.4°F (38°C).
• The catheter stops working or develops a leak.
• Your child develops a red, swollen, or tender area around where the catheter was put in.