Central Venous Catheters
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Condition: Venous Access/Central Venous Catheters (Broviac, Hickman, Portacath, PICC line, Mediport)
Overview ("What is it?")
- Definition: Catheters or small tubing placed into a large vessel that goes directly to the heart that will allow fluids, medicines or nutrition to reach the bloodstream.
- Often central venous catheters are placed when longer use (weeks or months) of an intravenous catheter will be needed.
- Typically, these catheters are used for chemotherapy, intravenous nutrition, intravenous fluids, intravenous antibiotics and blood draws.
- They may sometimes be placed when a child has very small veins or in children for which it is difficult to place a peripheral intravenous (IV) catheter.
- PICC lines (Peripherally Inserted Central venous Catheters) (Figure 1)
- Non-Tunneled Catheters (“Cook”® catheters)
- Broviac®/Hickman® tunneled catheters (Figure 2)
- Portacath/Infusaport (Figure 3)
- Umbilical catheters in newborns
Figure 1. PICC Line (http://lymelens.com/wp-content/uploads/2013/06/PICC-line.jpg)
Figure 2. Broviac or Hickman catheter: The entry to the catheter is exposed on the skin.
Figure 3. Mediport/ Infusaport/Portacath: When not in use, the chamber is completely underneath the skin. When infusion or blood draw is needed, a special needle is used to go through the skin and access the port.
Diagnosis (“What tests are done before insertion of a central venous catheter?”)
- Blood tests to make sure blood is able to clot appropriately may be obtained
- Sometimes an ultrasound or Duplex study of the blood vessels may be needed to see which ones may be suitable for placement of the catheter, especially if your child has had previous central venous catheters.
Treatment (“How are the catheters inserted?”)
- Preoperative preparation: Your doctor will first decide what type of catheter is needed based on length of treatment and the indication for the central catheter
- PICC lines can often be inserted at the bedside with just a small amount of pain medication injected at the site of insertion.
- Most other central catheters will be placed in the operating room or radiology department with sedation or anesthesia. The blood vessels used for placement may be located either by percutaneous (needle directed through the skin into the vein) or cutdown (incision directly over the vein with isolation of the vein around sutures) techniques.
- Your child will have to have an empty stomach for several hours before the sedation/anesthesia.
- Postoperative care
- Most children do not experience much pain after the procedure but pain medications may be ordered as needed.
- The catheters can usually be used immediately after they are placed.
- A chest X-ray may be obtained after the procedure to confirm correct positioning of the catheter.
- You will be taught how to care for the incision and the catheter before you leave the hospital.
- The main risks of central venous catheter insertions are bleeding and infection but in an experienced surgeon’s hands, these risks are very low. Depending on how and where the catheter is placed, other risks include pneumothorax (air in the chest outside of the lung), injury to surrounding arteries and nerves and clotting of the blood vessels near and around the catheter.
- The primary benefits of the catheter are ease of administering fluids and medicines, ease of obtaining blood draws and avoids the need for frequent needle sticks to find a vein for a peripheral IV.
Home Care (“What do I need to do once my child goes home?”)
- Diet: There should be no restrictions on the diet from this procedure.
- Activity: Your child should avoid any direct contact or trauma to the site of the catheter. Once the wounds are healed, your child should be able to bathe normally although with exposed catheters (PICC lines and Broviacs) the skin exit site of the catheter will need to be covered with waterproof tape.
- Wound care: A dry, sterile dressing will need to be placed over exposed catheters, and you should be instructed in how to do this before leaving the hospital and how often to change the dressing.
- Medicines: Your child should not need any additional medicines for the catheter itself but he/she may be started on new medicines that were the indication for the catheter.
- What to call the doctor for: Call your doctor or go to the emergency room for any redness, pus drainage, fluid leakage or increased tenderness around the catheter. You should also notify your doctor immediately for any fevers.
- Follow-up care: Your child will need to follow up with their regular physician who requested the central line placement. You will need to see the surgeon again when it’s time for removal of the catheter. This can sometimes be done in the office for PICC lines and some Broviac/Hickman catheters. For catheters that have been in for several months and for portacaths, your child will need to be sedated or go to the operating room for removal.
Long-Term Outcomes (“Are there future conditions to worry about?”)
- Long-term complications of having central venous catheters include primarily infection and clotting of the catheter. These can sometimes be treated with administration of medication through the catheter but sometimes the catheter will have to be removed and replaced with a new one.
- The more catheters your child has to have, the greater the risk of chronic clotting of the blood vessels which may make it more difficult to place additional catheters in the future.
Author: Patricia Lange, MD
Editor: Marjorie J. Arca, MD