Introduction
A non-tunnelled central venous catheter (CVC) is a tube inserted into a large vein in the neck or groin.
Your child may have a non-tunnelled CVC inserted for treatment over a short period of up to 2 weeks or in an emergency. It gives medicine or fluids directly to your child’s bloodstream and can be used to take blood if needed. The non-tunnelled CVC is inserted when your child:
- is having major surgery
- is in an emergency medical situation
- has small or difficult veins.
The non-tunnelled CVC is also called a jugular or femoral line.
Before the procedure
A surgeon inserts the non-tunnelled CVC while your child is under a general anaesthetic. General anaesthetic means your child will be asleep and will not feel any pain during the insertion.
Before the procedure, your child’s treating 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 non-tunnelled CVC, how it is inserted, how to look after it and what to do if something goes wrong at home.
If the non-tunnelled CVC is inserted in an emergency, staff will give you information and answer any questions beforehand. This is so you can give consent to the procedure. Consent means that you understand and agree to the procedure.
During the procedure
Your child’s doctor will insert the non-tunnelled CVC in the operating theatre, intensive care unit or emergency department.
After the non-tunnelled CVC is inserted, your child will have an x-ray to ensure the catheter tip is in the correct position and safe to use.
After the procedure
Your child may have some bleeding or oozing around the cuts in the neck or groin, but this should stop soon after the non-tunnelled CVC is inserted.
The non-tunnelled CVC is held in place by using:
- a clear dressing over the insertion site – used to protect from infection and keep the area clean and dry
- a securement device that supports the line and protects it from movement.
The dressing and securement device must always stay clean, dry and in place.
Management
Flushing and locking
Flushing is when a normal salt water or saline solution is pushed into the non-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 non-tunnelled CVC. This is typically done when the non-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.
Removing the non-tunnelled CVC
The non-tunnelled CVC is removed when:
- treatment finishes
- it is no longer working well
- there is another problem.
The non-tunnelled CVC can be removed while your child is on the hospital ward without general anaesthetic.
Common problems with the non-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 non-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
Infection is always a risk when there are cuts or openings in the body, as germs can get inside. The hospital will ensure everything is clean and completely free of germs when the non-tunnelled CVC is inserted. This is called having a sterile environment.
Signs of infection include:
- redness
- pain
- heat
- swelling
- a temperature of over 38 degrees.
If your child shows signs of infection, take them to the nearest emergency department as soon as possible.
Infections are treated with antibiotics. If the infection is severe, your child will need their non-tunnelled CVC removed or replaced.
Damage to the catheter
Check the outer tubes and lumens in your child’s non-tunnelled CVC for any damage or cracks.
Damage can cause the non-tunnelled CVC to leak, and you may see 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 non-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 non-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 non-tunnelled CVC should be flushed after every use and flushed and locked weekly if not used.
A blocked, non-tunnelled CVC can sometimes be fixed by flushing. If this does not work, the non-tunnelled CVC must be replaced.
Air bubbles
Ensure no air bubbles are in the syringe when injecting into the non-tunnelled CVC. If there is a break or leak, clamp the line immediately to avoid air getting in.
Blood clots
Blood clots can develop in the vein around the non-tunnelled CVC. Blood clots should not cause any problems and can be dissolved with medication if they become too large or spread. If clots cannot be treated, the non-tunnelled CVC may need removal.
Serious complications
Serious complications are rare but can be life-threatening.
These can include:
- serious infection
- the non-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 non-tunnelled CVC.