Cuffed tunnelled central venous catheter (CVC) factsheet
Introduction
A cuffed tunnelled central venous catheter (CVC) is a soft tube or catheter inserted into a large vein close to the heart. It is used to give medicine or fluids directly to your child’s bloodstream and is inserted when a child:
- needs certain medications that can only be given through a cuffed tunnelled CVC
- has small or difficult veins
- needs to have parenteral nutrition – when nutrition is given through the veins
- is having treatment that will go for longer than one month.
The cuffed tunnelled CVC is also called a Hickman, a broviac or a central line.
Before the procedure
Before the procedure, your child’s treatment team will give you information including:
- when they need to stop eating and drinking
- what time to arrive at the hospital
- what to bring with you.
They will also answer any questions about the cuffed tunnelled CVC, including:
- how it is inserted
- how to look after it
- what to do if something goes wrong at home.
During the procedure
Your child will be under a general anaesthetic for the procedure. This means they will be asleep and will not feel any pain.
Generally, the steps for inserting the cuffed tunnelled CVC are:
- the surgeon or radiologist makes two small cuts in the skin at the neck and on the chest
- the catheter is inserted into the cut in the neck, and the tip is guided into a large vein near the heart
- the other end of the catheter is passed under the skin until it comes out through the cut in the chest
- the cuts are stitched to close around the tube
- a dressing is placed over the stitches
- an X-ray is done to check that the tip of the cuffed tunnelled CVC is in the right place
- the tube is repositioned if needed.
Only a small section of the tube stays outside the body.
The tube will have one or two small openings called lumens.
Lumens are where medicine, fluid and nutrition are passed through. They can also be used to take blood.
The cuffed tunnelled CVC is held in place by using:
- a small cuff that sits around the cuffed tunnelled CVC and sticks to tissue under the skin over 5-6 weeks.
- a clear dressing on the chest where the catheter is, with the outside of the catheter looped underneath
- a securement device that supports the line and protects it from movement.
After the procedure
After the procedure, your child may have some bleeding or oozing around the cuts in the neck and chest. This will settle.
Your child may have some pain after the procedure. This can be managed with a local anaesthetic to numb the area and should get better after about a week.
Your child’s treatment team will talk to you about pain relief that can be used at home.
Let the doctor or nurse know as soon as possible if your child is still in pain after a week.
Your child must be careful not to move or pull out the cuffed, tunnelled CVC. This is most important in the first 5-6 weeks after it is inserted.
Management
Stitches and dressings
Stitches are used to hold the tube in place while the skin heals.
Dissolvable stitches will break down in the skin over time
Non-dissolvable stitches, they will be removed after 2-4 weeks.
The clear dressing on your child’s chest will need to be changed every seven days or earlier if it is:
- wet
- dirty
- not sticking to your child’s skin.
Returning to everyday activities
Your child can usually return to regular activities once the cuffed tunnelled CVC has healed, depending on their general health and treatment. Speak to your child's treatment team for information and advice about any changes to lifestyle, activity, or sports.
Your child must avoid getting their cuffed tunnelled CVC wet, but they can take showers and baths if it is covered with a taped plastic bag.
Flushing and locking
Flushing is when normal salt water, also called saline solution, is pushed into the cuffed tunnelled CVC by a syringe. This helps to stop it from becoming blocked and is done after medication has been given.
Locking is when an anti-blood clotting and antibacterial solution is left in the cuffed tunnelled CVC. This is done when the cuffed tunnelled CVC does not need to be used for up to one week and stops an infection from happening and the line from becoming blocked.
Common anti-blood clotting medications include Heparin and Citrate.
Common antibacterial solutions include Taurolidine and Taurolock.
Removing the cuffed tunnelled CVC
The cuffed tunnelled CVC is removed when:
- treatment finishes
- the line is no longer working well
- there is another problem.
A surgeon or an interventional radiologist removes the catheter while your child is under a general anaesthetic.
Common problems with the cuffed tunnelled CVC
While serious problems are rare, knowing about the risks is important.
Bleeding
There is a risk of bleeding or oozing around the cuts in the neck and chest after the cuffed tunnelled CVC is inserted. This usually stops quickly in the first day or two after the operation.
Very rarely, there can also be:
- a haemothorax – bleeding into the chest
- cardiac tamponade – bleeding around the heart.
Infection
All surgery has a risk of infection. The hospital will ensure a clean and sterile operating theatre when inserting the cuffed tunnelled CVC to prevent infection from germs entering the body through any cuts or openings.
Signs of infection include:
- redness
- pain
- heat
- swelling
- a temperature of 38 degrees or more.
If your child shows signs of infection, take them to the nearest emergency department immediately.
Infections are treated with antibiotics. If the infection is severe, your child may need their cuffed tunnelled CVC removed or replaced.
Damage to the catheter
Regularly check your child's cuffed tunnelled CVC for damage or cracks in the outer tubes and lumens. Damage can cause leaks, resulting in fluid or oozing under the dressing.
If this happens, clamp the line immediately and go to your nearest emergency department so it can be repaired or replaced.
Accidental removal and positioning
If the cuffed tunnelled CVC is moved or pulled out accidentally, you should:
- stop any medicine or fluid from running through the cuffed tunnelled CVC
- clamp the line
- apply pressure over the insertion cut in the neck and the exit cut in the chest
- call triple zero (000) for an ambulance
- call your child’s doctor while you wait for the ambulance to arrive.
You may be able to tell that the cuffed tunnelled CVC has moved if it becomes more difficult to take blood or give fluids. If this happens, tell your child’s doctor as soon as possible and follow their instructions.
Blockage
The cuffed tunnelled CVC should be flushed after every use and flushed and locked weekly if not used.
Blockage can be fixed by flushing. If this does not work, the cuffed tunnelled CVC must be replaced.
Air bubbles
Nursing staff make sure there are no air bubbles in the syringe when injecting into the cuffed tunnelled CVC. If there is a break or leak, clamp the line immediately to avoid air getting in.
Blood clots
Blood clots can form in the vein around the cuffed tunnelled CVC. These clots usually don't cause problems and can be treated with medication. However, the cuffed tunnelled CVC may need to be removed if they become too large or spread.
Serious complications
Serious complications are rare but can be life-threatening.
These can include:
- serious infection
- the cuffed tunnelled CVC damaging or puncturing the walls of the blood vessels or heart
- cardiac tamponade - fluid or blood collecting around the heart
- a haemothorax - fluid or blood collecting in the chest.
Your child may need further surgery to fix serious complications. Speak to your child’s doctor if you have any questions or concerns about complications from the cuffed tunnelled CVC.