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Central Venous Catheters

During the course of treatment some medications, transfusions or fluids need to be given by vein, directly into the blood stream. While drips are often put into small veins on hands, arms or feet, it may be better in many patients to have access to a larger vein and be able to use the same line (catheter) repeatedly over many months. Such devices are called central venous catheters. A patient may require a central venous catheter for the following purposes:-

1. Long-term chemotherapy
2. Bone marrow transplant
3. Intravenous nutrition or medications

A central venous catheter is like an ordinary intravenous drip except that:

1. It is required to be inserted under strict antiseptic technique, in the operating theatre and under general anaesthesia.
2. The catheter is usually inserted into the chest wall and then tunnelled under the skin to the neck where it is inserted into one of the two large veins that empties into the heart.
3. The catheter will last a long time, for the duration of its requirement barring complications such as infection, blockage and dislodgment.

There are two main types of catheters/devices which may be placed in your child:

Central Line
A double lumen teflon cuffed catheter is inserted under a general anaesthetic and may require an anaesthetic to remove the cuffed portion of the catheter. With this cuffed catheter it can be maintained for long periods (months) and dislodgment is unlikely to occur after it has been inserted for 2 weeks or more.

Portacath
A totally implantable device (e.g. Port) which has the advantage of being totally hidden under the skin. A palpable reservoir is sited over the chest wall underneath the skin which allows needle puncture to gain access. Our experience indicates that barring from infection and blockage, the device may last a long time (years). The disadvantages are that it requires two incisions for insertion (one over the chest wall and one at the neck) and it requires an anaesthetic for removal.

Once a central venous catheter or device is judged to be needed in your child, he or she will be scheduled for an operation under general anaesthesia. In the case of a catheter, the catheter is inserted on the chest wall and tunnelled under the skin to the neck where a small incision is made so the catheter can be placed inside a vein and directed towards the heart under x-ray control. The cuff section of the catheter will be one to two inches from the exit site of the catheter and the actual exit site will be some distance from the neck wound. This technique cuts down the risk of infection and makes it a little harder to be accidentally pulled out. The neck wound will be closed with sutures which need to be removed in one week. In cases when a totally implantable device is used, a separate wound is required on the front of the chest in order to place the reservoir underneath the skin. The sutures for this wound need to stay for 10 days.

Having a central venous catheter or device means a convenient and easy access to blood sampling and setting up of an intravenous drip. In order to keep the catheter or device operational, Catheters need to be flushed weekly with heparin solution and implantable devices every 4 weeks when not in use. Any usage or flushing of the catheter or implantable device requires the strictest aseptic technique. Exposed portion of a central venous catheter requires dressing regularly.

Remember, if catheter dislodgments, infection and blockage are prevented, your child will derive the maximum benefit from having a central venous catheter or device. For children with a central venous catheter the nursing staff will provide written instructions and teach families how to care for the line at home, this includes giving you a diary to keep a record of when/who flushes or accesses the catheter or device.

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