Central venous catheters require special care to reduce the risk of infection and other complications.
Protocols vary between hospitals. Your child’s nurse will explain the schedule and teach you how to care for the line.
Practice before you leave hospital, so you and your child can work through any anxiety and feel confident about all the procedures.
Common complications of a central line are infection (in blood or at the insertion site) and clots in the line or vein. Kinks and displacement of the line are rare.
External Line Care
Strict care is vital to minimise risk of infection or clots in the line. Showering, and bathing can be difficult as the line must be kept dry. Swimming is not allowed.
The exit site must be cleaned at least once a week and a sterile dressing applied. This dressing is secured to the skin with a very large sticky tape, and removing it may cause the child discomfort and distress.
The site should be checked daily for signs of infection (red, swollen skin or discharge). Parents are taught to flush the line with heparin to prevent clots.
Subcutaneous Port Care
As the entire catheter is under the skin, it requires no daily care. You can wash your child as normal. The port site should be checked regularly for signs of infection (red, swollen skin or discharge), especially when the port is accessed.
At least once a month, the port must be accessed and flushed with heparin to prevent clots. This is usually done by a nurse during chemotherapy or a monthly clinic visit when the child is off treatment.
Infections
Children receiving chemotherapy have a higher risk of developing infections. Frequent flushing of the external line increases opportunities for bacteria to enter the catheter, but flushing is necessary to prevent clots.
Even with diligent care, infections are common with external lines. They are much less common with subcutaneous ports.
Infection is likely if your child develops a fever over 100.4°F (38’C) or red, swollen skin at the exit/port site, or pain in that area. Blood will be drawn from the line to culture (grow in a laboratory for 24 to 48 hours) and confirm the infection.
Your child will usually be hospitalised for IV antibiotics at the first sign of infection. 10-14 days of antibiotics is usually effective. If the culture is negative, antibiotics will cease.
If the infection does not respond to treatment, the line is usually removed. A new one may be placed at the same time or later.
Clots
Streptokinase is flushed through a blocked line to dissolve the clot.
Kinks
Rarely, kinks develop where the catheter enters the neck vein. The nurse may use several non-invasive manoeuvres to resolve this.
Breaks
Very rarely, the line may break or rupture. If this happens when chemotherapy is being infused, the drugs may leak and damage surrounding tissues. The risk of a break or rupture is significantly lower with an central venous catheter than the risk of leakage from a regular IV.
