Central Lines - Learn More
If medically necessary, a central line may be placed in you/your child with your informed consent.
A decision will be made by you/your child, and your medical team as to which type of central line will be most appropriate considering you/your child's age and treatment plan. A "HICKMAN"® catheter, "BROVIAC"® catheter, or an implanted port (Port-a-Cath) may be chosen; the differences will be explained below.
A central line is placed in a large vein and can be used to administer medication directly into the bloodstream, blood products can be transfused, and blood for labs can be withdrawn without repeatedly inserting a needle through the skin and into a vein. Central lines are for “long term” use, meaning they will be left in place for months to years.
Since you/your child will be at home with a catheter it is very important that you/your child are aware of what a catheter is, what it is used for, and how to care for it.
What is a "HICKMAN" catheter or "BROVIAC"catheter?
A "HICKMAN"® catheter or "BROVIAC"® catheter is a long, hollow tube made of soft, rubber-like material called silicone, with an opening called a lumen. This catheter is commonly referred to as a central venous catheter because it is inserted into the large vein leading directly into the heart.
Both of these catheters are made of the same material but differ in size. The "BROVIAC"® catheter has a smaller diameter and therefore lumen than the "HICKMAN"® catheter. Both the "BROVIAC"® catheter and the "HICKMAN"® catheter are available with two lumens. A two lumen catheter is like two catheters in one, outside of the body it looks like two catheters that meld into one before entering the body. There is no communication between the two lumens so different medications, fluids, blood products can be infused at the same time. You/your child's catheter name and size will be given to you for your records.
There is a Dacron cuff around the catheter, which is used to anchor the catheter under the skin so there is less danger of the catheter slipping out. The cuff also blocks bacteria so it doesn't enter the bloodstream.
What is the catheter used for?
The "HICKMAN"® catheter or "BROVIAC"® catheter is primarily used to infuse medication and fluids into a large vein without the discomfort of a needle being inserted into the vein. Again, the catheter can be used to give medications, fluids, blood products, and to take blood samples for testing.
Where does the catheter go inside the body?
Under general anesthesia, the catheter is inserted by a surgeon under the skin of you/your child's chest wall and into a large vein that leads to the heart. A small incision is made near the collarbone, which is referred to, as the “insertion site.” The insertion site is where the tip of the catheter enters the vein and then it is threaded into a large vein. A tunnel is made under the skin from the “insertion” site to another incision called the “exit” site. The catheter is pulled through the tunnel and out through the exit site incision.
You/your child may be able to feel the bulge of the Dacron cuff between the insertion and exit site. The insertion site is generally covered with special surgical tape, steri-strips, which will drop off over time. The exit site will have sutures (stitches) attached to the catheter to prevent it from slipping out while the site is healing and the cuff is adhering to the tissue. You/your child's doctor or nurses will remove the stitches; the time may vary depending on treatment plan, reaction to the sutures, age. The exit site and catheter require regular care which you/your child will be taught.
What is an implanted port?
A port, also referred to as a port-a cath, provides central venous access as does the "HICKMAN"® catheter and "BROVIAC"® catheter, but this device is totally implanted, all under the skin. Again, it allows for the infusion of fluids, medications, blood products and blood sampling.
The port is composed of a reservoir, with an injectable septum. The reservoir is attached to a silastic catheter that is threaded into a large vein leading to the heart. Port access requires that a special needle, called a huber, is inserted through the skin, through the septum into the reservoir. EMLA cream can be used which numbs the skin preventing any pain when the needle is placed.
The port is placed by a surgeon under general anesthesia. The location of the port is determined by the surgeon, patient size, age and activity level. Most ports are placed under the collarbone although they can be placed anywhere, such as under the arms on the chest wall or in the abdominal area. The catheter is tunneled and enters the vein just like the "HICKMAN"® catheter or "BROVIAC"® catheter. The port requires no special care.
Further information will be given to you to help you make the decision as to what type central line would be best for your child.
In making this decision please remember either choice of central line will be instrumental in making the months of therapy much less traumatic and less painful for you and/or your child.
The "HICKMAN" catheter and/or "BROVIAC" catheter are registered trademarks of C.R. Bard, Inc. and its related company, BCR, Inc.