Uncuffed tunnelled central venous catheter factsheet

Introduction

An uncuffed tunnelled central venous catheter (CVC) is a soft tube 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 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.

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 uncuffed 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 uncuffed 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 may be stitched to close around the tube
a dressing is placed over the cuts
an X-ray is done to check that the tip of the uncuffed 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 uncuffed tunnelled CVC is held in place by using:

a clear dressing on the chest where the catheter is, with the outside of the catheter 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 insertion site. 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 a few days.

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.

Management

Dressings

The clear dressing 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 uncuffed 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 uncuffed 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 uncuffed 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 are left in the uncuffed tunnelled CVC. This is done when the uncuffed 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 uncuffed tunnelled CVC

The uncuffed tunnelled CVC is removed when:

treatment finishes
the line is no longer working well
there is another problem.

A trained nurse can remove the uncuffed CVC in the hospital without a general anaesthetic.

Problems with the uncuffed 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 uncuffed 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 uncuffed 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. Your child may need their uncuffed tunnelled CVC removed or replaced if the infection is severe.

Damage to the CVC

Regularly check your child's uncuffed 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 uncuffed tunnelled CVC is moved or pulled out accidentally, you should:

stop any medicine or fluid from running through the uncuffed 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 uncuffed 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 uncuffed 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 uncuffed tunnelled CVC must be replaced.

Air bubbles

Nursing staff make sure there are no air bubbles in the syringe when injecting into the uncuffed 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 uncuffed tunnelled CVC. These clots usually don't cause problems and can be treated with medication. The uncuffed 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 uncuffed 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 uncuffed tunnelled CVC.