Sedation

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Central Venous Catheters

Kids hate few things more than being stuck with needles — and kids with cancer usually have to go through this process many times to have blood drawn, to get chemotherapy drugs and other medications, or to receive blood transfusions or fluids.

To eliminate the need for repeated needle sticks in a vein, your doctor may recommend a central venous catheter. A central venous catheter is a surgically placed tube through which doctors can give intravenous (IV) medications and other fluids, as well as draw blood. A catheter can help take away some of the stress associated with treatment and spare kids' veins the damage that can come from frequent sticks. It also can remain in the body for as long as medically necessary.

Types of Catheters

There are a few different types of central venous catheters, but all fall under two main categories: external or subcutaneous (under the skin).

  1. External lines. With an external line, one end of a thin, flexible plastic tube is implanted into a large vein near the heart called the superior vena cava. The other end exits the skin in 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. Medications that are 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 manufacture them.
  2. Subcutaneous lines. A line that is implanted entirely under the skin is usually referred to as a port-a-cath or a medi-port. These lines are usually placed in the chest, but may sometimes be placed in the arm. One end of the thin tube is fed into a large vein while the other leads to a small rubber dome, or portal, just under the skin. When medications or other treatments are given, a special needle with attached tubing (called a Huber needle) is inserted through the skin into the port.

    Although this method of accessing the port does still require a needle, it is generally easier and less painful than a typical needle stick. A numbing cream may be used on the skin to lessen any discomfort.

Caring for Catheters

Both types of lines are implanted in an operating room while the patient is under general anesthesia, and afterward they both require some at-home care.

Broviacs and Hickman catheters require more attention than port-a-caths because the tubing remains outside of the body. To prevent infection, the dressing around the tube entry needs to be changed several times a week. If your child develops a fever (a sign of infection), notify your health care provider immediately.

A nurse will make sure you know exactly how to care for the line and what products to use before your child is sent home, so be sure to ask questions if there's anything you don't understand.

Caring for a Broviac and/or Hickman catheter

  • 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 also 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 (an anti-clotting agent) into the line.
  • 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 prior to discharge from the hospital.
  • Discuss with the doctor what types of physical activity are OK for your child. Contact sports are usually prohibited because of the potential for a blow to the chest.

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 once the incision has healed.
  • Although most physical activities are OK for kids with an internal port, check with the doctor about contact sports, as a blow to the chest could dislodge it.

Finally, be sure your child's teachers, school nurse, and physical education teacher know about the central venous line. They'll not only help ensure your child's safety at school, but also might be able to help your child deal with any related 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).

Encourage all the adults in your child's life to be sensitive to these self-esteem concerns, even though they might seem like a minor detail in the face of your child's illness.

Reviewed by: Joanne Quillen, MSN, PNP-BC
Date reviewed: May 2012